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1.
Front Endocrinol (Lausanne) ; 13: 925378, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35813618

RESUMEN

Objective: primary empty sella (PES) represents a frequent finding, but data on hormonal alterations are heterogeneous, and its natural history is still unclear. Our aim was to evaluate the pituitary function of patients with PES over a long follow-up. Design: multicenter retrospective cohort study enrolling patients referred between 1984-2020 to five Pituitary Units, with neuroradiological confirmed PES and a complete hormonal assessment. Methods: we analyzed hormonal (including basal and dynamic evaluations), clinical and neuroradiological data collected at diagnosis and at the last visit (at least 6 months of follow-up). Results: we recruited 402 patients (females=63%, mean age=51.5 ± 16 years) with PES (partial, total, undefined in 66%, 13% and 21%, respectively). Hypopituitarism was present in 40.5% (hypogonadism=20.4%, hypoadrenalism=14.7%, growth hormone deficiency=14.7%, hypothyroidism=10.2%, diabetes insipidus=1.5%; multiple deficiencies=11.4%) and hypeprolactinemia in 6.5%. Interestingly, hormonal alterations were diagnosed in 29% of incidental PES. Hypopituitarism was associated with male sex (p=0.02), suspected endocrinopathy (p<0.001), traumatic brain injury (p=0.003) and not with age, BMI, number of pregnancies and neuroradiological grade. A longitudinal assessment was possible in 166/402 (median follow-up=58 months). In 5/166 (3%), new deficiencies occurred, whereas 14/166 (8.4%) showed a hormonal recovery. A progression from partial to total PES, which was found in 6/98 patients assessed with a second imaging, was the only parameter significantly related to the hormonal deterioration (p=0.006). Conclusions: this is the largest cohort of patients with PES reported. Hypopituitarism is frequent (40%) but hormonal deterioration seems uncommon (3%). Patients need to be carefully evaluated at diagnosis, even if PES is incidentally discovered.


Asunto(s)
Síndrome de Silla Turca Vacía , Hipopituitarismo , Adulto , Anciano , Estudios de Cohortes , Síndrome de Silla Turca Vacía/complicaciones , Síndrome de Silla Turca Vacía/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Hipopituitarismo/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
2.
J Clin Endocrinol Metab ; 105(2)2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31532828

RESUMEN

CONTEXT: Mortality and infection-related hospital admissions are increased in patients with primary adrenal insufficiency (PAI). However, the risk of primary care-managed infections in patients with PAI is unknown. OBJECTIVE: To estimate infection risk in PAI due to Addison's disease (AD) and congenital adrenal hyperplasia (CAH) in a primary care setting. DESIGN: Retrospective cohort study using UK data collected from 1995 to 2018. MAIN OUTCOME MEASURES: Incidence of lower respiratory tract infections (LRTIs), urinary tract infections (UTIs), gastrointestinal infections (GIIs), and prescription counts of antimicrobials in adult PAI patients compared to unexposed controls. RESULTS: A diagnosis of PAI was established in 1580 AD patients (mean age 51.7 years) and 602 CAH patients (mean age 35.4 years). All AD patients and 42% of CAH patients were prescribed glucocorticoids, most frequently hydrocortisone in AD (82%) and prednisolone in CAH (50%). AD and CAH patients exposed to glucocorticoids, but not CAH patients without glucocorticoid treatment, had a significantly increased risk of LRTIs (adjusted incidence rate ratio AD 2.11 [95% confidence interval (CI) 1.64-2.69], CAH 3.23 [95% CI 1.21-8.61]), UTIs (AD 1.51 [95% CI 1.29-1.77], CAH 2.20 [95% CI 1.43-3.34]), and GIIs (AD 3.80 [95% CI 2.99-4.84], CAH 1.93 [95% CI 1.06-3.52]). This was mirrored by increased prescription of antibiotics (AD 1.73 [95% CI 1.69-1.77], CAH 1.77 [95% CI 1.66-1.89]) and antifungals (AD 1.89 [95% CI 1.74-2.05], CAH 1.91 [95% CI 1.50-2.43]). CONCLUSIONS: There is an increased risk of infections and antimicrobial use in PAI in the primary care setting at least partially linked to glucocorticoid treatment. Future studies will need to address whether more physiological glucocorticoid replacement modes could reduce this risk.


Asunto(s)
Enfermedad de Addison/microbiología , Hiperplasia Suprarrenal Congénita/microbiología , Infecciones/epidemiología , Enfermedad de Addison/tratamiento farmacológico , Hiperplasia Suprarrenal Congénita/tratamiento farmacológico , Adulto , Susceptibilidad a Enfermedades , Femenino , Glucocorticoides/efectos adversos , Humanos , Incidencia , Infecciones/etiología , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Reino Unido/epidemiología
3.
Neuroendocrinology ; 110(7-8): 595-603, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31525736

RESUMEN

INTRODUCTION: Available data on pituitary incidentalomas mostly derive from small-scale studies, with heterogeneous inclusion criteria and limited follow-up. No paper has focused specifically on clinically nonfunctioning pituitary in-cidentalomas (CNFPIs). OBJECTIVE: To describe the charac-teristics and the natural history of patients diagnosed with CNFPIs. METHODS: Retrospective multicenter cohort study evaluating hormonal, imaging, and visual field characteristics at diagnosis and during follow-up of CNFPIs investigated in 2 Pituitary Centers. RESULTS: Three hundred and seventy-one patients were included (50.9% microadenomas, 35.6% males). Men were older and more likely to have a macroadenoma (p < 0.01). Totally, 23.7% of patients presented secondary hormonal deficits (SHDs), related to tumor size (higher in macroadenomas; p < 0.001) and age (higher in older patients; p < 0.001). Hypogonadism was the most frequent SHD (15.6%). Two hundred and ninety-six patients had follow-up data, 29.1% required surgery after first evaluation, and 97 had at least 3 years of follow-up. In total, 15.3% adenomas grew (more macroadenomas), but only in microadenomas patients with longer follow-up showed a higher growth trend. Totally, 5.2% of patients developed new SHDs (micro- vs. macroadenomas p = 1.000), and in 60% of them this was not associated with an increase in tumor size. Thirteen additional patients required surgery during follow-up (1 microadenoma at diagnosis). CONCLUSIONS: Macroadenomas and age are risk factors for SHD in CNFPIs, which occur at diagnosis in a quarter of patients. During follow-up, macroadenomas tend to grow more often, but microadenomas display higher growth trend as follow-up increases. Deterioration of pituitary function is not always related to adenoma growth.


Asunto(s)
Adenoma/epidemiología , Adenoma/patología , Neoplasias Hipofisarias/epidemiología , Neoplasias Hipofisarias/patología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Humanos , Hallazgos Incidentales , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnóstico , Estudios Retrospectivos
4.
J Endocrinol Invest ; 41(8): 1017, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29611050

RESUMEN

Unfortunately, the fourth author's middle name was missed out in the original publication of this article. The complete correct name should read as follows.

5.
Eur J Endocrinol ; 177(1): 73-83, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28468767

RESUMEN

BACKGROUND: The independent role of mild autonomous cortisol secretion (ACS) in influencing the cardiovascular event (CVE) occurrence is a topic of interest. We investigated the role of mild ACS in the CVE occurrence in patients with adrenal incidentaloma (AI) by standard statistics and artificial neural networks (ANNs). METHODS: We analyzed a retrospective record of 518 AI patients. Data regarding cortisol levels after 1 mg dexamethasone suppression (1 mg DST) and the presence of obesity (OB), hypertension (AH), type-2 diabetes (T2DM), dyslipidemia (DL), familial CVE history, smoking habit and CVE were collected. RESULTS: The receiver-operating characteristic curve analysis suggested that 1 mg DST, at a cut-off of 1.8 µg/dL, had the best accuracy for detecting patients with increased CVE risk. In patients with 1 mg-DST ≥1.8 µg/dL (DST+, n = 223), age and prevalence of AH, T2DM, DL and CVE (66 years, 74.5, 25.9, 41.4 and 26.8% respectively) were higher than that of patients with 1 mg-DST ≤1.8 µg/dL (61.9 years, 60.7, 18.5, 32.9 and 10%, respectively, P < 0.05 for all). The CVE were associated with DST+ (OR: 2.46, 95% CI: 1.5-4.1, P = 0.01), regardless of T2DM, AH, DL, smoking habit, gender, observation period and age. The presence of at least two among AH, T2DM, DL and OB plus DST+ had 61.1% sensitivity in detecting patients with CVE. By using the variables selected by ANNs (familial CVE history, age, T2DM, AH, DL and DST+) 78.7% sensitivity was reached. CONCLUSIONS: Cortisol after 1 mg-DST is independently associated with the CVE occurrence. The ANNs might help for assessing the CVE risk in AI patients.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Hidrocortisona/metabolismo , Redes Neurales de la Computación , Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/epidemiología , Neoplasias de las Glándulas Suprarrenales/fisiopatología , Adulto , Factores de Edad , Anciano , Enfermedades Cardiovasculares/epidemiología , Dexametasona/farmacología , Diabetes Mellitus Tipo 2/complicaciones , Dislipidemias/complicaciones , Femenino , Humanos , Hidrocortisona/sangre , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Prevalencia , Estudios Retrospectivos , Fumar
6.
J Endocrinol Invest ; 37(8): 709-714, 2014 08.
Artículo en Inglés | MEDLINE | ID: mdl-24844565

RESUMEN

PURPOSE: The aim of this study was to evaluate the efficacy of post-operative radioiodine ablation with 1,850 MBq after recombinant human thyrotropin (rhTSH) administration in patients with differentiated thyroid carcinoma (DTC). We also aimed to assess the prognostic role of several patient features on the outcome of ablation. METHODS: We retrospectively analyzed data from a total of 125 patients with DTC who underwent post-operative radioiodine ablation with 1,850 MBq of ¹³¹I after preparation with rhTSH. One injection of 0.9 mg rhTSH was administered on each of two consecutive days; ¹³¹I therapy was delivered 24 h after the last injection, followed by a post-therapy whole-body scan. Successful ablation was assessed 6-12 months later and defined as an rhTSH-stimulated serum thyroglobulin (Tg) level ≤1.0 ng/ml and a normal neck ultrasound. RESULTS: Patients were stratified according to the American Thyroid Association (ATA) Management Guidelines for Differentiated Thyroid Cancer. Successful ablation was achieved in 82.4 % of patients, with an ablation rate of 95.1 % in low-risk patients and 76.2 % in intermediate-risk patients. Analyzing the correlation between ablation outcome and patient characteristics, we found a statistically significant association between failure to ablate and class of risk based on ATA guidelines (p = 0.025) and a stimulated Tg value at ablation of above 5 ng/ml (p < 0.001). CONCLUSION: The use of 1,850 MBq post-operative radioiodine thyroid remnant ablation in association with rhTSH is effective for low- and intermediate-risk patients. Moreover, in our study, we found a statistical correlation between failure to ablate and class of risk based on ATA guidelines for DTC and a stimulated Tg value at ablation.


Asunto(s)
Carcinoma Papilar/radioterapia , Quimioradioterapia Adyuvante , Radioisótopos de Yodo/uso terapéutico , Radiofármacos/uso terapéutico , Glándula Tiroides/efectos de la radiación , Neoplasias de la Tiroides/radioterapia , Tirotropina/uso terapéutico , Adenocarcinoma Folicular/tratamiento farmacológico , Adenocarcinoma Folicular/patología , Adenocarcinoma Folicular/radioterapia , Adenocarcinoma Folicular/cirugía , Adulto , Carcinoma/tratamiento farmacológico , Carcinoma/patología , Carcinoma/radioterapia , Carcinoma/cirugía , Carcinoma Papilar/tratamiento farmacológico , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Carcinoma Papilar Folicular/tratamiento farmacológico , Carcinoma Papilar Folicular/patología , Carcinoma Papilar Folicular/radioterapia , Carcinoma Papilar Folicular/cirugía , Terapia Combinada , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Neoplasia Residual/epidemiología , Neoplasia Residual/prevención & control , Proteínas Recombinantes/uso terapéutico , Estudios Retrospectivos , Riesgo , Cáncer Papilar Tiroideo , Glándula Tiroides/efectos de los fármacos , Glándula Tiroides/patología , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/tratamiento farmacológico , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tirotropina/genética , Imagen de Cuerpo Entero
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