Predicting postoperative hypocortisolism in patients with non-aldosterone-producing adrenocortical adenoma: a retrospective single-centre study.

BACKGROUND: Limited information exists on postoperative hypocortisolism and hypothalamus-pituitary-adrenal axis recovery in patients with adrenal incidentaloma following unilateral adrenalectomy. We evaluated frequency of postoperative hypocortisolism and predictors for recovery in non-aldosterone-producing adrenocortical adenoma patients after unilateral adrenalectomy. METHODS: A retrospective analysis of 32 adrenal incidentaloma patients originally included in the ITACA trial (NCT04127552) with confirmed non-aldosterone-producing adrenocortical adenoma undergoing unilateral adrenalectomy from September 2019 to April 2023 was conducted. Preoperative assessments included adrenal MRI, anthropometrics, evaluation of comorbidities, adrenal function assessed via ACTH, urinary free cortisol, and 1 mg dexamethasone suppression test. ACTH and serum cortisol or Short Synacthen test were performed within 6 days, 6 weeks, 6 months, and a year after surgery. RESULTS: Six days postoperative, 18.8% of patients had normal adrenal function. Among those with postoperative hypocortisolism, 53.8% recovered by 6 weeks. Patients with earlier adrenal recovery (6 weeks) had lower preoperative 1 mg dexamethasone suppression test (median 1 mg dexamethasone suppression test 76.2 [61.8-111.0] nmol/L vs 260.0 [113.0-288.5] nmol/L, p < 0.001). Univariate analysis showed preoperative 1 mg dexamethasone suppression test negatively related with baseline ACTH levels (r = - 0.376; p = 0.041) and negatively associated with the 6-week baseline (r = - 0.395, p = 0.034) and 30-min cortisol levels during Short Synacthen test (r = - 0.534, p = 0.023). Logistic regression analysis demonstrated preoperative 1 mg dexamethasone suppression test as the only biochemical predictor for 6-week adrenal recovery: ROC curve identified a 1 mg dexamethasone suppression test threshold of 131 nmol/L predicting 6-week recovery with 89.5% sensitivity and 72.7% specificity (AUC 0.87; 95% CI 66.9-98.7, p < 0.001). Other preoperative assessments (tumor size, ACTH levels and anthropometrics) were not associated with postoperative hypothalamus-pituitary-adrenal axis function, but the presence of diabetes was associated with a lower probability of recovery (OR = 24.55, p = 0.036). ACTH levels increased postoperatively in all patients but did not predict hypothalamus-pituitary-adrenal axis recovery. CONCLUSIONS: The preoperative 1 mg dexamethasone suppression test cortisol value and presence of diabetes are the only relevant predictor of hypothalamus-pituitary-adrenal axis recovery in patients with non-aldosterone- producing adrenocortical adenoma undergoing surgery, regardless other clinical and biochemical variables. Notably, pre- and postoperative ACTH levels did not predict hypothalamus-pituitary-adrenal axis recovery. These findings point towards the potential for saving resources by optimizing their allocation during follow-up assessments for patients with non-aldosterone-producing adrenocortical adenoma undergoing unilateral adrenalectomy.

Low prolactin level identifies hypoactive sexual desire disorder women with a reduced inhibition profile.

PURPOSE: Data on the role of prolactin (PRL) in the physiologic range in the female sexual response are scanty. We aimed at investigating the association between PRL and sexual function as assessed by the Female Sexual Function Index (FSFI). We explored the presence of a cut-off level of PRL able to identify Hypoactive Sexual Desire Disorder (HSDD). METHODS: 277 pre- and post-menopausal women consulting for Female Sexual Dysfunction (FSD) and sexually active were enrolled in an observational, retrospective study. 42 women were used as no-FSD controls. A clinical, biochemical and psychosexual evaluation was performed. The main outcome measures were: FSFI, Female Sexual Distress Scale-Revised, Middlesex Hospital Questionnaire and Sexual excitation/sexual inhibition scale (SIS/SES). RESULTS: Normo-PRL FSD women (n = 264) showed lower FSFI Desire score than controls (n = 42), and higher than hyper-PRL FSD women (n = 13). These differences emerged both in pre-menopausal and post-menopausal subjects. In the normo-PRL FSD group, those with PRL in the higher quintile reported higher FSFI Desire scores than those with PRL in the lowest quintile. Women with HSDD presented a lower PRL level than those without (p = 0.032). A ROC curve analysis for PRL showed an accuracy of 0.610 ± 0.044 (p = 0.014) in predicting HSDD. With a threshold of < 9.83 µg/L, sensitivity and specificity for HSDD were 63% and 56%, respectively. Subjects with PRL < 9.83 µg/L also reported lower sexual inhibition (p = 0.006) and lower cortisol levels (p = 0.003) than those with PRL > = 9.83 µg/L. CONCLUSIONS: Hyper-PRL is associated with low desire; however, among normo-PRL FSD women, those with the lowest levels demonstrated a poorer desire than those with the highest levels. PRL < 9.83 µg/L predicted HSDD and a lower sexual inhibitory trait.

Changes in left ventricular repolarization after short-term testosterone replacement therapy in hypogonadal males.

BACKGROUND AND AIM: Evidences suggest that androgen deficiency is associated with sudden cardiac death (SCD). Our purpose was to analyse some electrocardiographic (ECG) markers of repolarization phase in hypogonadal patients either at baseline or after testosterone replacement therapy (TRT). PATIENTS AND METHODS: Baseline and after 6 months of testosterone replacement therapy, 14 hypogonadal patients and 10 age-matched controls underwent a short-term ECG recordings at rest and immediately after a maximal exercise test. The following ECG parameters have been collected: QTe (the interval between the q wave the end of T wave), QTp (the interval between the q wave and the peak of T wave), and Te (the interval between the peak and the end of T wave). RESULTS: At baseline, in the hypogonadal patients, corrected QTe and QTp values were longer at rest than in the controls at rest (p < 0.05), whereas, during the recovery phase, only the QTp remained significantly longer (p < 0.05). After TRT, hypogonadal patients showed an improvement only in Te (p < 0.05). Conversely, any difference between hypogonadal patients and control subjects was found with respect to the markers of temporal dispersion of repolarization phases, except for a worse QTp → Te coherence (p = 0.001) obtained during the recovery phase. CONCLUSIONS: In conclusion, at rest, hypogonadal patients suffer from a stable increase in the myocardial repolarization phase without an increase in its temporal dispersion and, hence, the SCD risk seems to be low.

[Percutaneous biliary drainage in obstructions due to malignant pathology]. / Drenaggio biliare percutaneo nelle ostruzioni da patologia maligna.

Experience with percutaneous transhepatic biliary drainage (PBD) in 68 cases of malignant biliary obstructions, is described. 78 procedures (11 external drains, 36 internal-external drains, 17 soft endoprosthesis and 14 self-expandable metallic stents), were performed between December 1989 and December 1991. No significant differences in terms of results were found between internal endoprosthesis and metallic stents. The mortality rate of the procedure was 1.47% (1 case). Complications for the internal prostheses were: obstructions 8 (25.8%), dislodgement 2 (6.5%), cholangitis 1 (3.2%) and metastases along the catheter tract 1 (3.2%). Considering this, the Authors prefer the endoprosthesis instead of external or internal-external drainages.

[Assessment with magnetic resonance imaging of response to radiotherapy for tongue and mouth floor tumors]. / Valutazione mediante Risonanza Magnetica della risposta al trattamento radiante dei tumori della lingua e del pavimento orale.

To investigate the role of Magnetic Resonance Imaging (MRI) in assessing the effects of radiation therapy and in differentiating postirradiation scar tissue from residual tumor, we examined 22 patients with primary squamous cell carcinoma of the tongue and floor of the mouth treated with definitive radiation therapy; all patients were examined before and after treatment. Pretreatment MRI showed mass effect and obliteration of the fascial planes, with hyperintense signal on T2 and T1 post-Gd-DTPA injection sequences in all patients. Follow-up exams were performed 4 months after radiation therapy completion to wait for postirradiation phlogistic changes to become less apparent. The role of posttreatment exams was determined on the basis of clinical and bioptic follow-up. Radiation therapy yielded complete remission in 16/22 patients and partial remission in 6/22. MR follow-up showed, in complete remission patients, persistently obliterated fascial planes in 12/16 patients (75%) and a residual mass, hypointense on T2-weighted sequences and without enhancement in 9/16 patients (56%). In all partial remission patients, MRI showed some residual tissue hyperintense on T2-weighted sequences, with persistent enhancement. Persistent alterations in primary tumor sites, such as residual tissue and fascial plane obliteration, are frequent findings after irradiation. Hyperintense signal and enhancement can persist for months after radiation therapy as signs of postirradiation changes. To conclude, MRI performed 4 months after radiation therapy appears as a reliable tool to refer a residual mass to scar tissue when MR signal is hypointense on T2-weighted and enhanced sequences and to residual tumor when MR signal is hyperintense on T2-weighted and post-Gd-DTPA sequences.

[Comparison of computerized tomography and magnetic resonance in staging of T and N parameters in head and neck neoplasms]. / Stadiazione dei parametri "T" e "N" dei tumori della testa e del collo con tomografia computerizzata e risonanza magnetica a confronto.

January 1990, through January 1994, eighty untreated patients with head and neck cancer were consecutively submitted to CT and MRI of the head and neck before surgery. CT and MR findings were then compared to operative histologic findings. Forty-eight of 52 T4 cases at CT were confirmed at surgery (89%), 7 of 13 T3 cases at CT were also confirmed (54%), as well as 8 of 15 T2 cases (53%). CT understaged 13 cases (6 T3 and 7 T2), which surgery staged as T4, CT overstaged 4 cases as T4, which were 2 pT2 and 2 pT3 at histology. All the 54 cases MRI staged as T4 were confirmed at surgery (100%), 3 of 12 MRI staged as T3 were pT4 at surgery (25%) and, finally, 4 of 14 cases MRI staged as T2 were pT4 at histology (28%). Only one case staged as pT4 at surgery and CT had been staged as T3 by MRI because the latter method had failed to depict hyoid involvement. On the other hand, in 6 cases MRI correctly modified CT staging. Overall CT accuracy was 79% and MR accuracy 91%. CT sensitivity was 70% versus 75% with MRI, specificity was 80% versus 78%, respectively, and overall accuracy 75% versus 76%. Only in two patients MRI correctly modified CT staging (N1 at surgery). Our results confirm various advantages of MRI over CT in the assessment of tumor mass ("T" parameter), mainly in T2 and T3 cases, because MRI yields higher soft tissue contrast resolution and has multiplanar capabilities. CT was superior to MRI only in the assessment of bone involvement. This study also confirmed similar CT and MR capabilities in detecting lymph node tumor spread. Finally, MRI did not allow earlier detection of micrometastases than CT.