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Wu M, Yu J, Zhong A, Tang Y, Li M, Liu C, Sun D. Muscle ultrasound to identify prednisone-induced muscle damage in adults with nephrotic syndrome. Steroids 2024; 207:109434. [PMID: 38710261 DOI: 10.1016/j.steroids.2024.109434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
Steroid myopathy is a non-inflammatory toxic myopathy that primarily affects the proximal muscles of the lower limbs. Due to its non-specific symptoms, it is often overshadowed by patients' underlying conditions. Prolonged or high-dosage use of glucocorticoids leads to a gradual decline in muscle mass. There are no tools available to identify the course of steroid myopathy before the patient displays substantial clinical symptoms. In this study, we investigated individuals with nephrotic syndrome receiving prednisone who underwent muscle ultrasound to obtain cross-sectional and longitudinal pictures of three major proximal muscles in the lower limbs: the vastus lateralis, tibialis anterior, and medial gastrocnemius muscles. Our findings revealed that grip strength was impaired in the prednisolone group, creatine kinase levels were reduced within the normal range; echo intensity of the vastus lateralis and medial gastrocnemius muscles was enhanced, the pennation angle was reduced, and the tibialis anterior muscle exhibited increased echo intensity and decreased thickness. The total dose of prednisone and the total duration of treatment impacted the degree of muscle damage. Our findings indicate that muscle ultrasound effectively monitors muscle structure changes in steroid myopathy. Combining clinical symptoms, serum creatine kinase levels, and grip strength improves the accuracy of muscle injury evaluation.
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Affiliation(s)
- Mengmeng Wu
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Jinnuo Yu
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Ao Zhong
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Yifan Tang
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Manzhi Li
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Caixia Liu
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Dong Sun
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Clinical Research Center For Kidney Disease, Xuzhou Medical University, Xuzhou 221002, China.
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2
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He A, Koszegi B, Uzun S, Bilgic A, Bozca BC, Yang B, Daneshpazhooh M, Boziou M, Patsatsi A, Kakuta R, Takahashi H, Nery D, Mundin C, Ramirez-Quizon M, Culton D, McAlpine S, Johal J, Shulruf B, Stone JH, Murrell DF. Autoimmune blistering diseases treated with glucocorticoids: An international study of steroid-induced myopathy. J Eur Acad Dermatol Venereol 2024. [PMID: 38818849 DOI: 10.1111/jdv.20149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/17/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Patients with autoimmune blistering diseases (AIBDs) are often exposed to chronic glucocorticoid (GC) treatment with many side effects. Glucocorticoid-induced myopathy (GIM) is a well-established side effect, which particularly affects the proximal muscles. The Glucocorticoid Toxicity Index (GTI) is a validated global assessment tool which quantifies GC toxicity over time. OBJECTIVES This study marks the first study which analyses GIM in patients with AIBDs. The objectives of this study were to utilize the GTI to investigate the nature and prevalence of GIM in AIBD patients and explore potential risk factors. METHODS This international cohort study was conducted in blistering disease clinics across Australia, China, Greece, Iran, Japan, the Philippines, Turkey and the United States of America between February 2019 and July 2023. The GTI tool was completed by a medical practitioner at each patient visit. Data related to glucocorticoid toxicity were entered into the Steritas GTI 2.0 to generate an aggregate improvement and cumulative worsening score at each visit. RESULTS The study included 139 patients. There were 132 episodes of myopathy, and 47.5% of patients developed muscle weakness at some point during the study period. Cumulative GC dose correlated positively with myopathy risk, while average dose and treatment duration were not significant. Older age, male gender and obesity more than doubled the likelihood of developing GIM. CONCLUSIONS GIM is a common side effect experienced by AIBD patients on GC treatment. Muscle weakness is less likely to occur if cumulative GC dose is less than 0.75 mg/kg/day. Studies of exercise programs to mitigate myopathy and newer alternative treatments to reduce cumulative GC dose should be considered.
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Affiliation(s)
- A He
- Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
| | - B Koszegi
- Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
| | - S Uzun
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - A Bilgic
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - B C Bozca
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - B Yang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - M Daneshpazhooh
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Boziou
- Second Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Patsatsi
- Second Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - R Kakuta
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - H Takahashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - D Nery
- Department of Dermatology, Rizal Medical Center, Pasig, Philippines
| | - C Mundin
- Department of Dermatology, Rizal Medical Center, Pasig, Philippines
| | - M Ramirez-Quizon
- Department of Dermatology, Rizal Medical Center, Pasig, Philippines
| | - D Culton
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - S McAlpine
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - J Johal
- Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
| | - B Shulruf
- Faculty of Medicine, UNSW, Sydney, Australia
| | - J H Stone
- Division of Rheumatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - D F Murrell
- Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
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Wu M, Liu C, Sun D. Glucocorticoid-Induced Myopathy: Typology, Pathogenesis, Diagnosis, and Treatment. Horm Metab Res 2024; 56:341-349. [PMID: 38224966 DOI: 10.1055/a-2246-2900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Glucocorticoid-induced myopathy is a non-inflammatory toxic myopathy typified by proximal muscle weakness, muscle atrophy, fatigue, and easy fatigability. These vague symptoms coupled with underlying disorders may mask the signs of glucocorticoid-induced myopathy, leading to an underestimation of the disease's impact. This review briefly summarizes the classification, pathogenesis, and treatment options for glucocorticoid-induced muscle wasting. Additionally, we discuss current diagnostic measures in clinical research and routine care used for diagnosing and monitoring glucocorticoid-induced myopathy, which includes gait speed tests, muscle strength tests, hematologic tests, bioelectrical impedance analysis (BIA), dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), electromyography, quantitative muscle ultrasound, histological examination, and genetic analysis. Continuous monitoring of patients receiving glucocorticoid therapy plays an important role in enabling early detection of glucocorticoid-induced myopathy, allowing physicians to modify treatment plans before significant clinical weakness arises.
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Affiliation(s)
- Mengmeng Wu
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Caixia Liu
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Dong Sun
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
- Department of Internal Medicine and Diagnostics, Xuzhou Medical University, Xuzhou, China
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Meza-Valderrama D, Sánchez-Rodríguez D, Messaggi-Sartor M, Muñoz-Redondo E, Morgado-Pérez A, Tejero-Sánchez M, De Jaime-Gil E, Leiva-Banuelos N, Marco E. Supplementation with β-hydroxy-β-methylbutyrate after resistance training in post-acute care patients with sarcopenia: A randomized, double-blind placebo-controlled trial. Arch Gerontol Geriatr 2024; 119:105323. [PMID: 38171034 DOI: 10.1016/j.archger.2023.105323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES This study aimed to evaluate the efficacy of adding β-hydroxy-β- methylbutyrate (HMB) supplementation to a 12-week exercise-based rehabilitation program in older adults with sarcopenia after discharge from a post-acute geriatric rehabilitation unit. STUDY DESIGN A randomized, double-blind, placebo-controlled trial with two parallel groups. The intervention group received 3 g/day of Ca-HMB and participated in a 12- week resistance training program (3 sessions/week). The control group received a placebo and followed the same training program. MAIN OUTCOME MEASURES The primary outcomes were the improvements of handgrip strength and physical performance assessed through the Short Physical Performance Battery (SPPB) and 4-meter gait speed; and handgrip strength. All variables were assessed at baseline, post-intervention, and 1-year follow-up. RESULTS After completing the 12-week exercise program, the intervention group showed significant improvements in SPPB-Balance (1.3, 95 %CI 0.3 to 2.4) and total SPPB score (2.2, 95 %CI 0.4 to 4.0). Intra-group analysis demonstrated gains in the SPPB-Chair Stand (0.7 points, 95 %CI 0.0 to 1.4) and total SPPB score (2.1 points, 95 %CI 0.3 to 3.9) in the intervention group. Improvements in handgrip strength were observed in women (3.7 kg, 95 %CI: 0.2 to 7.3) at the end of the intervention, and persisted at the 1-year follow-up. CONCLUSIONS Our findings suggest that the supplementation of 3 g/day of Ca-HMB with resistance exercise may significantly enhance muscle strength and physical performance among older women with sarcopenia after recent hospitalization. Given this study's limitations, the intervention's effectiveness cannot be drawn, and further studies are needed.
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Affiliation(s)
- Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation, Vía Centenario, 0819 Panamá City, Panamá; Sistema Nacional de Investigación- Secretaria Nacional de Ciencia e Investigación, Clayton Ciudad del Saber Edificio 205, 0819 Panamá City, Panamá.
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A.Van Gehuchten 4, 1020 Brussels, Belgium; WHO Collaborating Center for Public Health aspects of musculoskeletal health and ageing. Division of Public Health, Epidemiology and Health Economics, University of Liège, Pl. du Vingt Août 7, 4000, Liège, Belgium
| | - Monique Messaggi-Sartor
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Elena Muñoz-Redondo
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Andrea Morgado-Pérez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Marta Tejero-Sánchez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Elisabet De Jaime-Gil
- Geriatrics Department, Hospital del Mar - Centre Fòrum, Carrer de Llull 410, 08019, Barcelona, Catalonia, Spain
| | - Nuria Leiva-Banuelos
- Geriatrics Department, Hospital del Mar - Centre Fòrum, Carrer de Llull 410, 08019, Barcelona, Catalonia, Spain
| | - Ester Marco
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain; Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain
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5
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V Bonm A, Taylor LP. Management of Neurologic Complications in Patients with Brain and Spine Tumors. Semin Neurol 2024; 44:53-63. [PMID: 38176424 DOI: 10.1055/s-0043-1777422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Patients with brain and spine tumors represent a distinct population with unique needs. We provide a practical review of neurologic care in this group with an emphasis on familiarizing the general neurologist to the nuances of neuro-oncologic supportive care. We review the management of cerebral edema, steroid dosing, and pertinent side effects. We discuss seizure management, including choice of anticonvulsants, putative antitumor effects, and important seizure mimics like drop attacks. We review the presentation and symptomatology of stroke-like migraine attack after radiation therapy (SMART syndrome). We describe the signs and symptoms that should prompt concern for metastatic spinal cord compression, as well as both acute and definitive treatment options. Finally, we discuss the underappreciated incidence of venous thromboembolic events, particularly in patients with gliomas, and review the data on management.
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Affiliation(s)
- Alipi V Bonm
- Department of Neurology, Swedish Neuroscience Institute, Seattle, Washington
| | - Lynne P Taylor
- Department of Neurology, University of Washington, Seattle, Washington
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6
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Benz E, Lahousse L, Arinze JT, Wijnant S, de Ridder M, Rivadeneira F, Brusselle G, Stricker BH. Oral corticosteroid use and sarcopenia-related traits in older people with chronic airway disease: a population-based study. ERJ Open Res 2023; 9:00492-2023. [PMID: 37753286 PMCID: PMC10518877 DOI: 10.1183/23120541.00492-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 09/28/2023] Open
Abstract
Background Sarcopenia is characterised by two major phenotypic components: low handgrip strength (HGS) and appendicular skeletal muscle index (ASMI). Oral corticosteroid (OCS) use is an important medication for acute respiratory exacerbations in patients with COPD and asthma. However, the association of OCS and sarcopenia components in older people is largely unexplored. The aim of this study was to examine the association between OCS use and HGS or ASMI in the general population and explore interactions with chronic airway diseases. Methods From the population-based Rotterdam Study, 5054 participants (age 69.0±8.8 years; 56% females) were included in the cross-sectional analysis and 1324 in the longitudinal analysis. Associations between OCS and muscle strength and mass were analysed using linear regression models adjusted for age, sex, fat %, height, kidney function, smoking and comorbidities. Results At baseline, ever-OCS users had lower handgrip strength (β= -0.48, 95% CI -0.84- -0.12) than never-OCS users, with cumulative frequency (≥10 OCS prescriptions)-dependent effects (β= -1.25, 95% CI -2.16- -0.33). COPD ever-OCS users, but not asthma, had lower handgrip strength (β= -0.98, 95% CI -1.91- -0.06) and lower lean mass (β= -0.14, 95% CI -0.27- -0.01) than never-OCS users. After 5.6 years of follow-up in those free of sarcopenia traits at baseline, COPD ever-OCS users developed lower handgrip strength (β= -1.64, 95% CI -2.87- -0.40) with frequency (β= -3.64, 95% CI -6.57- -0.72) and duration (β= -1.51, 95% CI -2.87- -0.15) association compared to never-OCS users. Conclusions OCS use is associated with a decline in handgrip strength in people with COPD in a cumulative frequency and duration-dependent manner. Routine muscle examination may be necessary for patients with COPD.
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Affiliation(s)
- Elizabeth Benz
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Johnmary T. Arinze
- Department of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sara Wijnant
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Maria de Ridder
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Guy Brusselle
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Bruno H. Stricker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Evcik D. Musculoskeletal involvement: COVID-19 and post COVID 19. Turk J Phys Med Rehabil 2023; 69:1-7. [PMID: 37201006 PMCID: PMC10186015 DOI: 10.5606/tftrd.2023.12521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 05/20/2023] Open
Abstract
The worldwide pandemic of coronavirus disease 2019 (COVID-19) was known to predominantly affect the lungs, but it was realized that COVID-19 had a large variety of clinical involvement. Cardiovascular, gastrointestinal, neurological, and musculoskeletal systems are involved by direct or indirect mechanisms with various manifestations. The musculoskeletal involvement can manifest during COVID-19 infection, due to medications used for the treatment of COVID-19, and in the post/long COVID-19 syndrome. The major symptoms are fatigue, myalgia/arthralgia, back pain, low back pain, and chest pain. During the last two years, musculoskeletal involvement increased, but no clear consensus was obtained about the pathogenesis. However, there is valuable data that supports the hypothesis of angiotensinconverting enzyme 2, inflammation, hypoxia, and muscle catabolism. Additionally, medications that were used for treatment also have musculoskeletal adverse effects, such as corticosteroid-induced myopathy and osteoporosis. Therefore, while deciding the drugs, priorities and benefits should be taken into consideration. Symptoms that begin three months from the onset of the COVID-19 infection, continue for at least two months, and cannot be explained by another diagnosis is accepted as post/long COVID-19 syndrome. Prior symptoms may persist and fluctuate, or new symptoms may manifest. In addition, there must be at least one symptom of infection. Most common musculoskeletal symptoms are myalgia, arthralgia, fatigue, back pain, muscle weakness, sarcopenia, impaired exercise capacity, and physical performance. In addition, the female sex, obesity, elderly patients, hospitalization, prolonged immobility, having mechanical ventilation, not having vaccination, and comorbid disorders can be accepted as clinical predictors for post/long COVID-19 syndrome. Musculoskeletal pain is also a major problem and tends to be in chronic form. There is no consensus on the mechanism, but inflammation and angiotensin-converting enzyme 2 seem to play an important role. Localized and generalized pain may occur after COVID-19, and general pain is at least as common as localized pain. An accurate diagnosis allows physicians to initiate pain management and proper rehabilitation programs.
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Affiliation(s)
- Deniz Evcik
- Department of Physical Medicine and Rehabilitation, Ankara Private Güven Hospital, Ankara, Türkiye
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8
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Irisin and Bone in Sickness and in Health: A Narrative Review of the Literature. J Clin Med 2022; 11:jcm11226863. [PMID: 36431340 PMCID: PMC9699623 DOI: 10.3390/jcm11226863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
Abstract
Irisin is a hormone-like myokine produced by the skeletal muscle in response to exercise. Upon its release into the circulation, it is involved in the browning process and thermogenesis, but recent evidence indicates that this myokine could also regulate the functions of osteoblasts, osteoclasts, and osteocytes. Most human studies have reported that serum irisin levels decrease with age and in conditions involving bone diseases, including both primary and secondary osteoporosis. However, it should be emphasized that recent findings have called into question the importance of circulating irisin, as well as the validity and reproducibility of current methods of irisin measurement. In this review, we summarize data pertaining to the role of irisin in the bone homeostasis of healthy children and adults, as well as in the context of primary and secondary osteoporosis. Additional research is required to address methodological issues, and functional studies are required to clarify whether muscle and bone damage per se affect circulating levels of irisin or whether the modulation of this myokine is caused by the inherent mechanisms of underlying diseases, such as genetic or inflammatory causes. These investigations would shed further light on the effects of irisin on bone homeostasis and bone disease.
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9
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Role of Glucocorticoid Signaling and HDAC4 Activation in Diaphragm and Gastrocnemius Proteolytic Activity in Septic Rats. Int J Mol Sci 2022; 23:ijms23073641. [PMID: 35408999 PMCID: PMC8998191 DOI: 10.3390/ijms23073641] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
Sepsis increases glucocorticoid and decreases IGF-1, leading to skeletal muscle wasting and cachexia. Muscle atrophy mainly takes place in locomotor muscles rather than in respiratory ones. Our study aimed to elucidate the mechanism responsible for this difference in muscle proteolysis, focusing on local inflammation and IGF-1 as well as on their glucocorticoid response and HDAC4-myogenin activation. Sepsis was induced in adult male rats by lipopolysaccharide (LPS) injection (10 mg/kg), and 24 h afterwards, rats were euthanized. LPS increased TNFα and IL-10 expression in both muscles studied, the diaphragm and gastrocnemius, whereas IL-6 and SOCS3 mRNA increased only in diaphragm. In comparison with gastrocnemius, diaphragm showed a lower increase in proteolytic marker expression (atrogin-1 and LC3b) and in LC3b protein lipidation after LPS administration. LPS increased the expression of glucocorticoid induced factors, KLF15 and REDD1, and decreased that of IGF-1 in gastrocnemius but not in the diaphragm. In addition, an increase in HDAC4 and myogenin expression was induced by LPS in gastrocnemius, but not in the diaphragm. In conclusion, the lower activation of both glucocorticoid signaling and HDAC4-myogenin pathways by sepsis can be one of the causes of lower sepsis-induced proteolysis in the diaphragm compared to gastrocnemius.
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10
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Irisin and Secondary Osteoporosis in Humans. Int J Mol Sci 2022; 23:ijms23020690. [PMID: 35054874 PMCID: PMC8775753 DOI: 10.3390/ijms23020690] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
Irisin is a peptide secreted by skeletal muscle following exercise that plays an important role in bone metabolism. Numerous experiments in vitro and in mouse models have shown that the administration of recombinant irisin promotes osteogenesis, protects osteocytes from dexamethasone-induced apoptosis, prevents disuse-induced loss of bone and muscle mass, and accelerates fracture healing. Although some aspects still need to be elucidated, such as the dose- and frequency-dependent effects of irisin in cell cultures and mouse models, ample clinical evidence is emerging to support its physiological relevance on bone in humans. A reduction in serum irisin levels, associated with an increased risk of osteoporosis and bone fractures, was observed in postmenopausal women and in both men and women during aging, Recently, cohort studies of subjects with secondary osteoporosis showed that these patients have lower circulating levels of irisin, suggesting that this myokine could be a novel marker to monitor bone quality in this disease. Although there are still few studies, this review discusses the emerging data that are highlighting the involvement of irisin in some diseases that cause secondary osteoporosis.
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11
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Yoshida K, Matsuoka T, Kobatake Y, Takashima S, Nishii N. Quantitative assessment of muscle mass and gene expression analysis in dogs with glucocorticoid-induced muscle atrophy. J Vet Med Sci 2022; 84:275-281. [PMID: 34980764 PMCID: PMC8920714 DOI: 10.1292/jvms.21-0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to quantitatively evaluate muscle mass and gene expression in
dogs with glucocorticoid-induced muscle atrophy. Five healthy beagles received oral
prednisolone for 4 weeks (1 mg/kg/day), and muscle mass was then evaluated via computed
tomography. Histological and gene expression analyses were performed using biopsy samples
from the biceps femoris before and after prednisolone administration. The cross-sectional
area of the third lumbar paraspinal and mid-femoral muscles significantly decreased after
glucocorticoid administration (from 27.5 ± 1.9 to 22.6 ± 2.0 cm2 and from 55.1
± 4.7 to 50.7 ± 4.1 cm2, respectively; P<0.01). The fast-
and slow-twitch muscle fibers were both atrophied (from 2,779 ± 369 to 1,581 ± 207
μm2 and from 2,871 ± 211 to 1,971 ± 169 μm2, respectively;
P<0.05). The expression of the growth factor receptor-bound protein
10 (GRB10) significantly increased after prednisolone administration
(P<0.05). Because GRB10 suppresses insulin
signaling and the subsequent mammalian target of rapamycin complex 1 activity, increased
expression of GRB10 may have resulted in a decrease in protein anabolism.
Taken together, 1 mg/kg/day oral prednisolone for 4 weeks induced significant muscle
atrophy in dogs, and GRB10 might participate in the pathology of
glucocorticoid-induced muscle atrophy in canines.
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Affiliation(s)
- Kei Yoshida
- Joint Department of Veterinary Medicine, The United Graduate School of Veterinary Science, Gifu University
| | - Toshio Matsuoka
- Joint Department of Veterinary Medicine, Faculty of Applied Biological Science, Gifu University.,Blanco Animal Hospital
| | - Yui Kobatake
- Joint Department of Veterinary Medicine, Faculty of Applied Biological Science, Gifu University
| | - Satoshi Takashima
- Joint Department of Veterinary Medicine, Faculty of Applied Biological Science, Gifu University
| | - Naohito Nishii
- Joint Department of Veterinary Medicine, The United Graduate School of Veterinary Science, Gifu University.,Joint Department of Veterinary Medicine, Faculty of Applied Biological Science, Gifu University
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12
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FUKUSHIMA T, TANAKA T, FUKUSHIMA S, WATANABE M, AOKI J, ITO A, INAMOTO Y, KIM SW, KAWAI A, FUKUDA T. Improvement in the Physical Function and Quality of Life through Exercise and Physical Activity Intervention Using a Smartphone after Allogeneic Hematopoietic Cell Transplantation: A Case Report. Phys Ther Res 2022; 25:162-167. [PMID: 36819913 PMCID: PMC9910345 DOI: 10.1298/ptr.e10196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Physical activity (PA) interventions positively affect the physical function (PF) in patients with advanced cancer. However, patients must remain motivated during the intervention. We report a case wherein a smartphone application for PA intervention was useful in motivating the patient to improve adherence. METHODS A 40-year-old woman underwent an allogeneic hematopoietic cell transplantation (allo-HCT) for an advanced extranodal natural killer/T-cell lymphoma. On day 6, she developed the posterior reversible encephalopathy syndrome. She was managed in the intensive care unit for 3 days, and her PF declined markedly. We initiated a smartphone-based PA intervention from day 35. She was instructed to maintain a PA diary for self-monitoring of the daily steps and to set a new step-count goal every week. RESULTS The PA and PF improved within a short period thereafter. However, she developed severe acute graft-versus-host disease and was administered with high-dose systemic corticosteroids from day 49. The PA, PF, and quality of life (QOL) decreased again. The intervention was continued for 5 months with a high adherence. The PA, PF, and QOL improved gradually. She resumed independent activities of daily living and was discharged on day 202. CONCLUSION Smartphone-based PA intervention may be effective against post-allo-HCT physical dysfunction.
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Affiliation(s)
- Takuya FUKUSHIMA
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Japan
| | - Takashi TANAKA
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Japan
| | - Suguru FUKUSHIMA
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Japan
| | - Mizuki WATANABE
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Japan
| | - Jun AOKI
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Japan
| | - Ayumu ITO
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Japan
| | - Yoshihiro INAMOTO
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Japan
| | - Sung-Won KIM
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Japan
| | - Akira KAWAI
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Japan
| | - Takahiro FUKUDA
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Japan
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13
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Tsamis KI, Boutsoras C, Kaltsonoudis E, Pelechas E, Nikas IP, Simos YV, Voulgari PV, Sarmas I. Clinical features and diagnostic tools in idiopathic inflammatory myopathies. Crit Rev Clin Lab Sci 2021; 59:219-240. [PMID: 34767470 DOI: 10.1080/10408363.2021.2000584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Idiopathic inflammatory myopathies (IIMs) are rare autoimmune disorders affecting primarily muscles, but other organs can be involved. This review describes the clinical features, diagnosis and treatment for IIMs, namely polymyositis (PM), dermatomyositis (DM), sporadic inclusion body myositis (sIBM), immune-mediated necrotizing myopathy (IMNM), and myositis associated with antisynthetase syndrome (ASS). The diagnostic approach has been updated recently based on the discovery of circulating autoantibodies, which has enhanced the management of patients. Currently, validated classification criteria for IIMs allow clinical studies with well-defined sets of patients but diagnostic criteria to guide the care of individual patients in routine clinical practice are still missing. This review analyzes the clinical manifestations and laboratory findings of IIMs, discusses the efficiency of modern and standard methods employed in their workup, and delineates optimal practice for clinical care. Α multidisciplinary diagnostic approach that combines clinical, neurologic and rheumatologic examination, evaluation of electrophysiologic and morphologic muscle characteristics, and assessment of autoantibody immunoassays has been determined to be the preferred approach for effective management of patients with suspected IIMs.
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Affiliation(s)
- Konstantinos I Tsamis
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece.,School of Medicine, European University Cyprus, Nicosia, Cyprus.,Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | | | | | - Ilias P Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Yannis V Simos
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Sarmas
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
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14
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Gonzalez Rodriguez E, Marques-Vidal P, Aubry-Rozier B, Papadakis G, Preisig M, Kuehner C, Vollenweider P, Waeber G, Hans D, Lamy O. Diurnal Salivary Cortisol in Sarcopenic Postmenopausal Women: The OsteoLaus Cohort. Calcif Tissue Int 2021; 109:499-509. [PMID: 34003339 PMCID: PMC8484096 DOI: 10.1007/s00223-021-00863-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/30/2021] [Indexed: 01/06/2023]
Abstract
Sarcopenia, similar to hypercortisolism, is characterized by loss of muscle mass and strength. Cortisol circadian rhythm changes with aging (blunted late-day nadir values) were suggested to contribute to this decline. We aimed to explore the relationship between diurnal salivary cortisol values and sarcopenia diagnosis and its components in postmenopausal women. This is a cross-sectional study within the OsteoLaus population-based cohort in Lausanne (Switzerland). Participants had a body composition assessment by dual X-ray absorptiometry (DXA), a grip strength (GS) measure, and salivary cortisol measures (at awakening, 30 min thereafter, 11 AM (sc-11AM) and 8 PM (sc-8PM)). Associations between salivary cortisol and sarcopenia diagnosed by six different criteria (based on appendicular lean mass (ALM) assessed by DXA, and muscle strength by GS), and its components, were analyzed. 471 women aged > 50 years (63.0 ± 7.5) were included. Various definitions identified different participants as sarcopenic, who consistently presented higher salivary cortisol at 11 AM and/or 8 PM. There were no associations between salivary cortisol levels and ALM measures, either absolute or after correction to height squared (ALM index) or body mass index. GS was inversely correlated to sc-11AM (r = - 0.153, p < 0.001) and sc-8PM (r = - 0.118, p = 0.002). Each 10 nmol/l increase of sc-11AM, respectively sc-8PM, was associated with a GS decrease of 1.758 (SE 0.472) kg, respectively 2.929 (SE 1.115) kg. In postmenopausal women, sarcopenia is associated with higher salivary cortisol levels at 11 AM and 8 PM. An increase of daily free cortisol levels in the physiological range could participate to sarcopenia development by decreasing muscle function in postmenopausal women.
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Affiliation(s)
- Elena Gonzalez Rodriguez
- Interdisciplinary Center for Bone Diseases, Service of Rhumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- Interdisciplinary Center of Bone Diseases, Service of Rheumatology, CHUV, Lausanne University Hospital, Rue Pierre-Decker 4, 1011, Lausanne, Switzerland.
| | - Pedro Marques-Vidal
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bérengère Aubry-Rozier
- Service of Genetic Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgios Papadakis
- Service of Endocrinology, Diabetology and Metabolism, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Epidemiology and Psychopathology Research Unit, Department of Psychiatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christine Kuehner
- Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Peter Vollenweider
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gerard Waeber
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Didier Hans
- Interdisciplinary Center for Bone Diseases, Service of Rhumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Lamy
- Interdisciplinary Center for Bone Diseases, Service of Rhumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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15
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Clavario P, De Marzo V, Lotti R, Barbara C, Porcile A, Russo C, Beccaria F, Bonavia M, Bottaro LC, Caltabellotta M, Chioni F, Santangelo M, Hautala AJ, Griffo R, Parati G, Corrà U, Porto I. Cardiopulmonary exercise testing in COVID-19 patients at 3 months follow-up. Int J Cardiol 2021; 340:113-118. [PMID: 34311011 PMCID: PMC8302817 DOI: 10.1016/j.ijcard.2021.07.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/29/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022]
Abstract
Background Long-term effects of Coronavirus Disease of 2019 (COVID-19) are of utmost relevance. We aimed to determine: 1) the functional capacity of COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2) the characteristics associated with cardiopulmonary exercise testing (CPET) performance; 3) the safety and tolerability of CPET. Methods We prospectively enrolled consecutive patients with laboratory-confirmed COVID-19 from Azienda Sanitaria Locale 3, Genoa. Three months after hospital discharge a complete clinical evaluation, trans-thoracic echocardiography, CPET, pulmonary function tests, and dominant leg extension (DLE) maximal strength measurement were performed. Results From the 225 patients discharged alive from March to November 2020, we excluded 12 incomplete/missing cases and 13 unable to perform CPET, leading to a final cohort of 200. Median percent-predicted peak oxygen uptake (%pVO2) was 88% (78.3–103.1). Ninety-nine (49.5%) patients had %pVO2 below, whereas 101 (50.5%) above the 85% predicted value. Among the 99 patients with reduced %pVO2, 61 (61%) had a normal anaerobic threshold: of these, 9(14.8%) had respiratory, 21(34.4%) cardiac, and 31(50.8%) non-cardiopulmonary reasons for exercise limitation. Inerestingly, 80% of patients experienced at least one disabling symtpom, not related to %pVO2 or functional capacity. Multivariate linear regression showed percent-predicted forced expiratory volume in one-second(β = 5.29,p = 0.023), percent-predicted diffusing capacity of lungs for carbon monoxide(β = 6.31,p = 0.001), and DLE maximal strength(β = 14.09,p = 0.008) to be independently associated with pVO2. No adverse event was reported during or after CPET, and no involved health professional developed COVID-19. Conclusions At three months after discharge, about 1/3rd of COVID-19 survivors show functional limitations, mainly explained by muscular impairment, calling for future research to identify patients at higher risk of long-term effects that may benefit from careful surveillance and targeted rehabilitation.
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Affiliation(s)
- Piero Clavario
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Vincenzo De Marzo
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Roberta Lotti
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Cristina Barbara
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Annalisa Porcile
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Carmelo Russo
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Federica Beccaria
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Marco Bonavia
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Luigi Carlo Bottaro
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Marta Caltabellotta
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Flavia Chioni
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Monica Santangelo
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Arto J Hautala
- Faculty of Sports and Health Sciences, University of Jyväskylä, Finland
| | - Raffaele Griffo
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ugo Corrà
- IRCCS, Istituti Clinici Scientifici Maugeri, Care and Research Institute, Department of Cardiac Rehabilitation, Veruno-Novara, Italy
| | - Italo Porto
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy.
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16
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Fuji S, Byrne M, Nagler A, Mohty M, Savani BN. How we can mitigate the side effects associated with systemic glucocorticoid after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2021; 56:1248-1256. [PMID: 33514922 DOI: 10.1038/s41409-020-01205-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/30/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for patients with a hematologic disease. Although the clinical outcomes after allo-HCT have significantly improved during the last few decades, graft-versus-host disease (GVHD) is still a major cause of post-HCT morbidity and mortality. Systemic glucocorticoids (GC) remain an integral part of treatment in patients with GVHD including both acute and chronic GVHD. Although it is well-known that usage of systemic GC is associated with various side effects, the short- and long-term effects of GCs in the HCT setting are not well-characterized due to limited published data. In order to clarify this issue, we summarize the information on side effects associated with GCs, focusing specifically on the sequelae of these agents in the early post-HCT period. In instances where limited data are available, we included data from other fields such as autoimmune diseases, given the potential parallels between autoimmune conditions and GVHD.
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Affiliation(s)
- Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan.
| | - Michael Byrne
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, TN, USA
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohamad Mohty
- Service d'Hématologie Clinique, Hopital Saint-Antoine, Sorbonne University, INSERM UMRs 938, Paris, France
| | - Bipin N Savani
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, TN, USA
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17
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Wu K, Michalski A, Cortes D, Rozenberg D, Mathur S. Glucocorticoid-induced myopathy in people with asthma: a systematic review. J Asthma 2021; 59:1396-1409. [PMID: 33951991 DOI: 10.1080/02770903.2021.1926488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To review the current literature on the evidence and the underlying characteristics of glucocorticoids (type, dosage, and duration) associated with myopathy in asthma. DATA SOURCES Four electronic databases were searched to October 19, 2020. STUDY SELECTION Inclusion criteria: adults or adolescents with asthma, taking systemic glucocorticoids, and measures of muscle impairments. RESULTS Nine studies met the eligibility criteria. The methodologic quality of most studies was fair or good. Two studies reported significantly lower inspiratory muscle function in outpatients taking daily oral glucocorticoids (≥10 mg), but one study reported no such difference. No differences was found in limb muscle strength in one study. Only 11-36% patients with acute exacerbation taking glucocorticoids intravenously suffered from limb muscle weakness during/after critical care admissions. Two studies reported significant associations between dosage of oral glucocorticoid use and inspiratory and limb muscle function, whereas seven studies did not find any significant correlations among the characteristics of systemic glucocorticoids and myopathy. Two studies comparing people with non-glucocorticoid dependent asthma taking inhaled glucocorticoid and healthy people did not find any significant differences in their inspiratory muscle strength and endurance. CONCLUSIONS There were limited studies and inconsistent results on glucocorticoid-induced myopathy in people with asthma, and its association with the characteristics of glucocorticoids use. We recommended future studies should use a commonly accepted operational definition of myopathy, utilize a cohort study design, measure the cumulative dosage of glucocorticoids, and integrate possible confounding factors in the analysis.
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Affiliation(s)
- Kenneth Wu
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anna Michalski
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Heart, Lung, and Vascular Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Daniel Cortes
- Department of Pharmacy, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sunita Mathur
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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18
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Vogel F, Braun LT, Rubinstein G, Zopp S, Künzel H, Strasding F, Albani A, Riester A, Schmidmaier R, Bidlingmaier M, Quinkler M, Deutschbein T, Beuschlein F, Reincke M. Persisting Muscle Dysfunction in Cushing's Syndrome Despite Biochemical Remission. J Clin Endocrinol Metab 2020; 105:dgaa625. [PMID: 32882010 PMCID: PMC7538105 DOI: 10.1210/clinem/dgaa625] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/31/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT Glucocorticoid-induced myopathy is a characteristic symptom of endogenous Cushing's syndrome (CS). Its long-term outcome is largely unknown. OBJECTIVE To evaluate long-term muscle function following the remission of endogenous CS. STUDY DESIGN Observational longitudinal cohort study. SETTING Tertiary care hospitals and a specialized outpatient clinic. PATIENTS As part of the prospective multicenter German Cushing's Registry, we assessed muscle strength in patients with overt endogenous CS. We studied the patients at the time of diagnosis (n = 88), after 6 months (n = 69), and thereafter annually, following surgical remission over a period of up to 4 years (1 year: n = 55; 2 years: n = 34; 3 years: n = 29; 4 years: n = 22). Muscle function was evaluated by hand grip strength and by chair rising test. RESULTS Grip strength was decreased to 83% of normal controls (100%) at the time of diagnosis. It further decreased to 71% after 6 months in remission (P ≤ 0.001) and showed no improvement during further follow-up compared with baseline. Chair rising test performance improved initially (8 seconds at baseline vs 7 seconds after 6 months, P = 0.004) but remained at this reduced level thereafter (7 seconds after 3 years vs 5 seconds in controls, P = 0.038). In multivariate analysis, we identified, as predictors for long-term muscle dysfunction, age, waist-to-hip ratio, and hemoglobin A1c at baseline. Furthermore, muscle strength during follow-up was strongly correlated with quality of life. CONCLUSION This study shows that CS-associated myopathy does not spontaneously resolve during remission. This calls for action to identify effective interventions to improve muscle dysfunction in this setting.
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Affiliation(s)
- Frederick Vogel
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | - Leah T Braun
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | - German Rubinstein
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | - Stephanie Zopp
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | - Heike Künzel
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | - Finn Strasding
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | - Adriana Albani
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | - Anna Riester
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | - Ralf Schmidmaier
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | - Martin Bidlingmaier
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
| | | | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Beuschlein
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Martin Reincke
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig Maximilians University Munich, München, Germany
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19
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Barbot M, Zilio M, Scaroni C. Cushing's syndrome: Overview of clinical presentation, diagnostic tools and complications. Best Pract Res Clin Endocrinol Metab 2020; 34:101380. [PMID: 32165101 DOI: 10.1016/j.beem.2020.101380] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cushing's syndrome (CS) is a severe condition that results from chronic exposure to elevated circulating cortisol levels; it is a rare but potentially life-threating condition, especially when not timely diagnosed and treated. Even though the diagnosis can be straightforward in florid cases due to their typical phenotype, milder forms can be missed. Despite the availability of different screening tests, the diagnosis remains challenging as none of the available tools proved to be fully accurate. Due to the ubiquitous effect of cortisol, it is easy understandable that its excess leads to a variety of systemic complications including hypertension, metabolic syndrome, bone damages and neurocognitive impairment. This article discusses clinical presentation of CS with an eye on the most frequent cortisol-related comorbidities and discuss the main pitfalls of first- and second-line tests in endogenous hypercortisolism diagnostic workup.
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Affiliation(s)
- Mattia Barbot
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy.
| | - Marialuisa Zilio
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy
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20
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Guarnotta V, Prinzi A, Pitrone M, Pizzolanti G, Giordano C. Circulating Irisin Levels as a Marker of Osteosarcopenic-Obesity in Cushing's Disease. Diabetes Metab Syndr Obes 2020; 13:1565-1574. [PMID: 32494173 PMCID: PMC7227819 DOI: 10.2147/dmso.s249090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/26/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate circulating irisin levels in patients with active and controlled Cushing's disease (CD). DESIGN Forty-four patients with CD evaluated during the active phase and after 12 months of biochemical remission and 40 controls were recruited. METHODS Phenotypic, anthropometric, hormonal and metabolic parameters, including insulin sensitivity estimation by homeostatic model of insulin resistance, Matsuda index and oral disposition index and circulating irisin levels were evaluated. RESULTS Patients with active CD showed lower irisin levels compared to controls (p<0.001) and controlled CD (p<0.001). The independent variables significantly associated with irisin were waist circumference (WC) (p=0.025), body fat percentage (BF%) (p=0.009), PTH (p=0.007) and chair rising test (CRT) (p<0.001) in active CD and WC (p=0.013), BF% (p=0.014), PTH (p=0.038), CRT (p=0.029) and urinary-free cortisol (p<0.001) in controlled CD. CONCLUSION Circulating irisin levels tend to be lower in patients with active CD compared to those with controlled CD and controls. They are strongly associated with osteosarcopenia and central obesity in CD and therefore may be a possible marker of diagnosis.
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Affiliation(s)
- Valentina Guarnotta
- Dipartimento di Promozione Della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Palermo, Italy
| | - Antonio Prinzi
- Dipartimento di Promozione Della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Palermo, Italy
| | - Maria Pitrone
- Dipartimento di Promozione Della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Palermo, Italy
| | - Giuseppe Pizzolanti
- Dipartimento di Promozione Della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Palermo, Italy
| | - Carla Giordano
- Dipartimento di Promozione Della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Palermo, Italy
- Correspondence: Carla Giordano; Giuseppe Pizzolanti Piazza Delle Cliniche 2, Palermo90127, ItalyTel +39 0916552110; +39 0916552138Fax +39 0916552123 Email ;
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Müller LM, Kienitz T, Deutschbein T, Riester A, Hahner S, Burger-Stritt S, Berr CM, Oßwald A, Braun L, Rubinstein G, Reincke M, Quinkler M. Glucocorticoid Receptor Polymorphisms Influence Muscle Strength in Cushing's Syndrome. J Clin Endocrinol Metab 2020; 105:5587858. [PMID: 31613324 DOI: 10.1210/clinem/dgz052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT An important clinical feature of Cushing's syndrome (CS) is proximal muscle myopathy caused by glucocorticoid induced protein metabolism. However, interindividual differences cannot be explained solely by the pure extent of hypercortisolemia. OBJECTIVE To evaluate the effects of glucocorticoid receptor (GR) polymorphisms (BclI, N363S, ER22/23EK and A3669G), which influence peripheral glucocorticoid sensitivity on muscular function in endogenous CS. METHODS 205 patients with proven endogenous CS (128 central, 77 adrenal) from 3 centers of the German Cushing's Registry and 125 subjects, in whom CS was ruled out, were included. All subjects were assessed for grip strength (via hand grip dynamometer) and performed a chair-rising test (CRT). DNA samples were obtained from peripheral blood leukocytes for GR genotyping. RESULTS In patients with active CS, normalized handgrip strength of the dominant and nondominant hand was higher in A3669G minor allele than in wildtype carriers (P = .006 and P = .021, respectively). CS patients in remission and ruled-out CS showed no differences in handgrip strength regarding A3669G minor allele and wildtype carriers. Male CS patients harboring the ER22/23EK wildtype presented lower hand grip strength than minor allele carriers (P = .049 dominant hand; P = .027 nondominant hand). The other polymorphisms did not influence handgrip strength. CRT showed no differences regarding GR polymorphisms carrier status. CONCLUSION Handgrip strength seems to be more susceptible to hypercortisolism in A3669G wildtype than in A3669G minor allele carriers. This might partially explain the inter-individual differences of glucocorticoid-induced myopathy in patients with endogenous CS. ER22/23EK polymorphism seems to exert sex-specific differences.
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Affiliation(s)
- Lisa Marie Müller
- Endocrinology in Charlottenburg, Berlin, Germany
- Clinical Endocrinology CCM, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tina Kienitz
- Endocrinology in Charlottenburg, Berlin, Germany
- Clinical Endocrinology CCM, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | - Anna Riester
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Stefanie Hahner
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | - Stephanie Burger-Stritt
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | - Christina M Berr
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Andrea Oßwald
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Leah Braun
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - German Rubinstein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
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Effect of the severity of acute graft-versus-host disease on physical function after allogeneic hematopoietic stem cell transplantation. Support Care Cancer 2019; 28:3189-3196. [PMID: 31712955 DOI: 10.1007/s00520-019-05124-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively investigate the effect of the severity of acute graft-versus-host disease (GVHD) on physical function after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS 76 patients were included as subjects of this study. Severity of acute GVHD was classified according to the method defined by Grucksberg. To evaluate physical function, the knee extensor strength and six-minute walk distance (6MWD) were performed. RESULTS Among these patients, 54% developed acute GVHD; of these, 32%, 54%, and 15% of patients had grade I, grade II, and grades III-IV GVHD, respectively. In the grade I-II groups, mild acute GVHD following allo-HSCT resulted in a gradual decline in physical function, which improved at discharge. However, in cases of severe acute GVHD, physical function deteriorated, implementation of rehabilitation became difficult, and the decline in physical function persisted even at discharge. CONCLUSION These results indicate that severe acute GVHD negatively affects physical function leading to longer hospital days because of inadequate rehabilitation interventions.
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23
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Minetto MA, Caresio C, Salvi M, D'Angelo V, Gorji NE, Molinari F, Arnaldi G, Kesari S, Arvat E. Ultrasound-based detection of glucocorticoid-induced impairments of muscle mass and structure in Cushing's disease. J Endocrinol Invest 2019; 42:757-768. [PMID: 30443856 DOI: 10.1007/s40618-018-0979-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the glucocorticoid-induced impairments of muscle mass and structure in patients presenting different stages of steroid myopathy progression. METHODS Thirty-three patients (28 women) affected by active (N = 20) and remitted (N = 13) Cushing's disease were recruited and the following variables were assessed: walking speed, handgrip strength, total body and appendicular muscle mass by bioelectrical impedance analysis (BIA), thickness and echo intensity of lower limb muscles by ultrasonography. RESULTS The two groups of patients showed comparable values of both handgrip strength [median (interquartile range) values: active disease: 27.4 (7.5) kg vs. remitted disease: 26.4 (9.4) kg; P = 0.58] and walking speed [active disease: 1.0 (0.2) m/s vs. remitted disease: 1.1 (0.3) m/s; P = 0.43]. Also, the thickness of the four muscles and all BIA-derived sarcopenic indices were comparable (P > 0.05 for all comparisons) between the two groups. On the contrary, the echo intensity of vastus lateralis, tibialis anterior (lower portion), and medial gastrocnemius was significantly (P < 0.05 for all comparisons) higher in patients with active disease compared to patients with remitted disease. Finally, significant negative correlations were found in the whole group of patients between muscle echo intensity and muscle function assessments. CONCLUSIONS We provided preliminary evidence that the ultrasound-derived measurements of muscle thickness and echo intensity can be useful to detect and track the changes of muscle mass and structure in patients with steroid myopathy and we suggest that the combined assessment of muscle mass, strength, and performance should be systematically applied in the routine examination of steroid myopathy patients.
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Affiliation(s)
- M A Minetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - C Caresio
- Biolab, Department of Electronics and Telecommunications, Polytechnic University of Turin, Turin, Italy
| | - M Salvi
- Biolab, Department of Electronics and Telecommunications, Polytechnic University of Turin, Turin, Italy
| | - V D'Angelo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - N E Gorji
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - F Molinari
- Biolab, Department of Electronics and Telecommunications, Polytechnic University of Turin, Turin, Italy
| | - G Arnaldi
- Clinic of Endocrinology and Metabolic Diseases, Ospedali Riuniti di Ancona University Hospital, Ancona, Italy
| | - S Kesari
- Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, CA, USA
| | - E Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
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24
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Borba VZC, Costa TL, Moreira CA, Boguszewski CL. MECHANISMS OF ENDOCRINE DISEASE: Sarcopenia in endocrine and non-endocrine disorders. Eur J Endocrinol 2019; 180:R185-R199. [PMID: 30913536 DOI: 10.1530/eje-18-0937] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/26/2019] [Indexed: 12/11/2022]
Abstract
Objective This paper reviews the main mechanisms, diagnostic criteria, treatment options and available data on sarcopenia in endocrine and non-endocrine disorders. The literature notes the presence of sarcopenia as a comorbid condition or a complication of another clinical situation and not a disease that only affects elderly patients. Method We performed a literature review, focusing on the following: mechanisms related to sarcopenia in elderly patients, and sarcopenia as it presents in the context of chronic and endocrine diseases; diagnostic tools and methods; aspects of sarcopenia and treatment options specific to chronic diseases and endocrine disorders respectively. Results Sarcopenia in chronic and endocrine disorders shares many mechanisms with sarcopenia affecting elderly patients, but certain diseases can have a predominant aspect that leads to sarcopenia. The prevalence of sarcopenia varies, depending on different diagnostic criteria, from around 12 to 60% in chronic illnesses and 15 to 90% in endocrine disorders. The interplay between sarcopenia, chronic diseases and elderly patients requires further study, to clarify the impact of each, in terms of prognosis and mortality. Conclusion Awareness of the presentation of sarcopenia in the context of other diseases and ages (and not just the elderly) is fundamental to ensure that preventive measures can be deployed.
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Affiliation(s)
| | - Tatiana Lemos Costa
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
| | - Carolina Aguiar Moreira
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
- Pro-Renal Brasil, Lab PRO, Bone Histomorphometry Section, Curitiba, Brazil
| | - Cesar Luiz Boguszewski
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
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Kwak MK, Lee SE, Cho YY, Suh S, Kim BJ, Song KH, Koh JM, Kim JH, Lee SH. The Differential Effect of Excess Aldosterone on Skeletal Muscle Mass by Sex. Front Endocrinol (Lausanne) 2019; 10:195. [PMID: 30984113 PMCID: PMC6450066 DOI: 10.3389/fendo.2019.00195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/07/2019] [Indexed: 01/04/2023] Open
Abstract
The effects of excess aldosterone on skeletal muscle in individuals with primary aldosteronism (PA) are unknown. To examine the effects of aldosterone on skeletal muscle mass in patients with PA, by sex, 309 consecutive patients were enrolled. Skeletal muscle and fat mass of 62 patients with PA were compared with those of 247 controls with non-functioning adrenal incidentaloma (NFAI). Body composition parameters were measured using bioelectrical impedance analysis, and plasma aldosterone concentration (PAC) was measured using radioimmunoassay. The PAC in all women, but not in men, showed an inverse association with both appendicular skeletal muscle mass (ASM) (β = -0.197, P = 0.016) and height-adjusted ASM (HA-ASM) (β = -0.207, P = 0.009). HA-ASM in women (but not in men) with PA was 5.0% lower than that in women with NFAI (P = 0.036). Furthermore, women with PA had a lower HA-ASM than 1:1 age- and sex-matched controls with NFAI by 5.7% (P = 0.049) and tended to have a lower HA-ASM than 1:3 age-, sex-, and menopausal status-matched controls without adrenal incidentaloma (AI) by 7.3% (P = 0.053). The odds ratio (OR), per quartile increase in PAC, of low HA-ASM in women was 1.18 [95% confidence interval (CI), 1.01-1.39; P = 0.035]. The odds of HA-ASM in subjects with PA were 10.63-fold (95% CI: 0.83-135.50) higher, with marginal significance (P = 0.069) than in those with NFAI. Skeletal muscle mass in women with PA was lower than that in women with NFAI; suggesting that excess aldosterone has adverse effects on skeletal muscle metabolism.
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Affiliation(s)
- Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Dontan Sacred Heart Hospital, Hwaseong-Si, South Korea
| | - Seung-Eun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, South Korea
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Jae Hyeon Kim
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Seung Hun Lee
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Improda N, Barbieri F, Ciccarelli GP, Capalbo D, Salerno M. Cardiovascular Health in Children and Adolescents With Congenital Adrenal Hyperplasia Due to 21-Hydroxilase Deficiency. Front Endocrinol (Lausanne) 2019; 10:212. [PMID: 31031703 PMCID: PMC6470198 DOI: 10.3389/fendo.2019.00212] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/18/2019] [Indexed: 12/18/2022] Open
Abstract
Increasing evidence indicates that adults with Congenital Adrenal Hyperplasia (CAH) may have a cluster of cardiovascular (CV) risk factors. In addition, ongoing research has highlighted that children and adolescents with CAH are also prone to developing unfavorable metabolic changes, such as obesity, hypertension, insulin resistance, and increased intima-media thickness, which places them at a higher risk of developing CV disease in adulthood. Moreover, CAH adolescents may exhibit subclinical left ventricular diastolic dysfunction and impaired exercise performance, with possible negative consequences on their quality of life. The therapeutic management of patients with CAH remains a challenge and current treatment regimens do not always allow optimal biochemical control. Indeed, overexposure to glucocorticoids and mineralocorticoids, as well as to androgen excess, may contribute to the development of unfavorable metabolic and CV abnormalities. Long-term prospective studies on large cohorts of patients will help to clarify the pathophysiology of metabolic alterations associated with CAH. Meanwhile, further efforts should be made to optimize treatment and identify new therapeutic approaches to prevent metabolic derangement and improve long-term health outcomes of CAH patients.
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Affiliation(s)
- Nicola Improda
- Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Flavia Barbieri
- Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Gian Paolo Ciccarelli
- Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Donatella Capalbo
- Department of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Mariacarolina Salerno
- Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
- *Correspondence: Mariacarolina Salerno
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Minetto MA, Caresio C, D'Angelo V, Lanfranco F, Ghizzoni L, Roatta S, Arvat E, Kesari S. Diagnostic evaluation in steroid-induced myopathy: case report suggesting clinical utility of quantitative muscle ultrasonography. Endocr Res 2018; 43:235-245. [PMID: 29648902 DOI: 10.1080/07435800.2018.1461904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We present a patient with adrenal Cushing's syndrome causing steroid myopathy. The purpose of the case report is to illustrate the clinical usefulness of quantitative muscle ultrasonography for the assessment of glucocorticoid-induced changes in muscle mass (MM) and structure. METHODS Assessments of physical performance, muscle strength, MM (i.e., total body skeletal MM, appendicular skeletal MM, and thickness of lower limb muscles), and muscle structure (i.e., echo intensity of lower limb muscles) were performed in the patient both in the active phase of the disease (preoperatively) and 6 months after surgical intervention (postoperatively). RESULTS Muscle strength, physical performance, and MM were low both preoperatively and postoperatively. We also found preoperatively an increased echo intensity that normalized postoperatively. CONCLUSIONS Clinical implications of these findings are double-fold. First, although the muscle structure can recover quickly in steroid myopathy patients, the recovery of MM may take months to years. Second, we show that muscle echo intensity can be useful to track the progression of steroid myopathy overtime and may help to indicate early response to therapeutic interventions. Further prospective studies are needed to confirm the value of muscle echo intensity in patients with endogenous or exogenous Cushing's syndrome presenting with steroid myopathy.
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Affiliation(s)
- Marco Alessandro Minetto
- a Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences , University of Turin , Turin , Italy
- b Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences , University of Turin , Turin , Italy
| | - Cristina Caresio
- c Biolab, Department of Electronics and Telecommunications , Politecnico di Torino , Turin , Italy
| | - Valentina D'Angelo
- d Oncological Endocrinology Unit, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Fabio Lanfranco
- a Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Lucia Ghizzoni
- a Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Silvestro Roatta
- e Department of Neuroscience , University of Turin , Turin , Italy
| | - Emanuela Arvat
- d Oncological Endocrinology Unit, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Santosh Kesari
- f Department of Translational Neurosciences and Neurotherapeutics , John Wayne Cancer Institute and Pacific Neuroscience Institute , Santa Monica , CA , USA
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Wan Muhammad Hatta SF, Kandaswamy L, Gherman-Ciolac C, Mann J, Buch HN. An unusual case of shortness of breath. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180074. [PMID: 30087779 PMCID: PMC6063989 DOI: 10.1530/edm-18-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 11/08/2022] Open
Abstract
Myopathy is a well-known complication of hypercortisolism and commonly involves proximal lower-limb girdle. We report a rare case of Cushing’s syndrome in a 60-year-old female presenting with significant respiratory muscle weakness and respiratory failure. She had history of rheumatoid arthritis, primary biliary cirrhosis and primary hypothyroidism and presented with weight gain and increasing shortness of breath. Investigations confirmed a restrictive defect with impaired gas transfer but with no significant parenchymatous pulmonary disease. Respiratory muscle test confirmed weakness of respiratory muscles and diaphragm. Biochemical and radiological investigations confirmed hypercortisolaemia secondary to a left adrenal tumour. Following adrenalectomy her respiratory symptoms improved along with an objective improvement in the respiratory muscle strength, diaphragmatic movement and pulmonary function test.
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Affiliation(s)
- S F Wan Muhammad Hatta
- 1New Cross Hospital, Wolverhampton, UK
- 2Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia
| | | | | | - J Mann
- 1New Cross Hospital, Wolverhampton, UK
| | - H N Buch
- 1New Cross Hospital, Wolverhampton, UK
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29
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Kim JH, Kwak MK, Ahn SH, Kim H, Cho YY, Suh S, Kim BJ, Song KH, Lee SH, Koh JM. Alteration in skeletal muscle mass in women with subclinical hypercortisolism. Endocrine 2018; 61:134-143. [PMID: 29717464 DOI: 10.1007/s12020-018-1598-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/09/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Despite the well-known deleterious effects of cortisol on skeletal muscle, whether subtle cortisol excess in subclinical hypercortisolism (SH) affects skeletal muscle mass is unknown. Our objective was to understand the effects of the cortisol level on skeletal muscle mass in patients with SH. METHODS We compared skeletal muscle mass and fat mass (FM) between 21 patients with SH (12 women and 9 men) and 224 controls (67 women and 157 men) with nonfunctioning adrenal incidentaloma (NFAI). Medical records were reviewed, and we measured body composition parameters using bioelectrical impedance analysis and serum cortisol levels after the overnight 1-mg dexamethasone suppression test (DST). RESULTS After adjusting for confounding factors, 1-mg DST levels were inversely correlated with appendicular skeletal muscle mass (ASM) (γ = -0.245, P = 0.040), lower limb ASM (γ = -0.244, P = 0.040), and appendicular skeletal muscle index (ASMI; height-adjusted ASM) (γ = -0.229, P = 0.048) in all women, but not men. ASM and ASMI were significantly lower by 6.2% (P = 0.033) and 5.9% (P = 0.046), respectively, in women with SH compared with those with NFAI, but not men. Conversely, FM and percent fat mass were similar between the two groups. Compared with women with NFAI, among those with SH, lower limb, but not upper limb, ASM was lower by 6.8% (P = 0.020). CONCLUSIONS This study showed that women with SH had lower skeletal muscle mass, especially of the lower limb, and suggested that subtle cortisol excess also has adverse effects on skeletal muscle metabolism.
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Affiliation(s)
- Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Seong Hee Ahn
- Department of Endocrinology, Inha University School of Medicine, Incheon, 22332, Korea
| | - Hyeonmok Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea.
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
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Archer‐Lahlou E, Lan C, Jagoe RT. Physiological culture conditions alter myotube morphology and responses to atrophy treatments: implications for in vitro research on muscle wasting. Physiol Rep 2018; 6:e13726. [PMID: 29932505 PMCID: PMC6014447 DOI: 10.14814/phy2.13726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 01/05/2023] Open
Abstract
Standard in vitro myotube culture conditions are nonphysiological and there is increasing evidence that this may distort adaptations to both catabolic and anabolic stimuli and hamper preclinical research into mechanisms and treatments for muscle atrophy in cancer and other chronic diseases. We tested a new model of myotube culture which mimics more accurately the basal conditions for muscle tissue in patients with chronic disease, such as cancer. Myotubes derived from C2C12 myoblasts, cultured under the modified conditions were thinner, more numerous, with more uniform morphology and an increased proportion of mature myotubes. Furthermore, modified conditions led to increased expression of mir-210-3p, genes related to slow-twitch, oxidative phenotype and resistance to commonly used experimental atrophy-inducing treatments. However, treatment with a combination of drugs used in anti-cancer treatment (doxorubicin and dexamethasone) under the modified culture conditions did lead to myotube atrophy which was only partially prevented by co-administration of curcumin. The results underline the importance and potential advantages of using physiological conditions for in vivo experiments investigating mechanisms of muscle atrophy and especially for preclinical screening of therapies for cancer-related muscle wasting.
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Affiliation(s)
- Elodie Archer‐Lahlou
- Lady Davis Institute for Medical ResearchSegal Cancer CentreJewish General HospitalMcGill UniversityMontrealQuebecCanada
| | - Cathy Lan
- Lady Davis Institute for Medical ResearchSegal Cancer CentreJewish General HospitalMcGill UniversityMontrealQuebecCanada
| | - R. Thomas Jagoe
- Lady Davis Institute for Medical ResearchSegal Cancer CentreJewish General HospitalMcGill UniversityMontrealQuebecCanada
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31
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Minetto MA, D'Angelo V, Arvat E, Kesari S. Diagnostic work-up in steroid myopathy. Endocrine 2018; 60:219-223. [PMID: 29143179 DOI: 10.1007/s12020-017-1472-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Steroid myopathy is a well-known sign of endogenous Cushing's syndrome as well as a side effect of glucocorticoid administration. The clinical finding of muscle weakness and the clinical inspection of the muscle size are the most commonly used diagnostic tools, sometimes in combination with needle electromyography, but there are no means to detect the myopathy before the appearance of clinical or electrodiagnostic signs. Until now, no guidelines have been produced for a disease-specific evaluation of muscle impairment in patients with Cushing's syndrome. REVIEW We reviewed the measurement properties and limitations of the following tools that are currently adopted in clinical research and routine care for diagnosis and monitoring of steroid myopathy: muscle strength assessment; needle biopsy; intramuscular and surface electromyography; laboratory assays; muscle mass assessments (through bioelectrical impedance analysis, dual-energy X-ray absorptiometry, and computed tomography). CONCLUSIONS We suggest that the management of steroid myopathy patients in clinical research and practice would benefit from a multidisciplinary approach based on the combined assessment of muscle mass, strength, and performance. However, further studies are required to establish an operational definition of steroid myopathy and to identify population-specific criteria for diagnosis of the myopathic process.
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Affiliation(s)
- Marco Alessandro Minetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy.
| | - Valentina D'Angelo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Santosh Kesari
- Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, CA, USA
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Wiskemann J, Herzog B, Kuehl R, Schmidt ME, Steindorf K, Schwerdtfeger R, Dreger P, Bohus M. Impact of HSCT Conditioning and Glucocorticoid Dose on Exercise Adherence and Response. Med Sci Sports Exerc 2018; 49:2143-2150. [PMID: 28657933 DOI: 10.1249/mss.0000000000001357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Evidence from randomized controlled trials (RCT) that exercise interventions have beneficial effects in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) is growing. However, intensive chemotherapy conditioning and glucocorticoid (GC) treatment is always part of an allo-HSCT and possibly affect exercise adherence and training response. Therefore, we aimed to examine whether various conditioning protocols or different doses of GC treatment affect exercise adherence and/or training response during the inpatient period. METHODS We analyzed inpatient data from intervention groups of two large RCT in allo-HSCT patients (n = 113). The intervention incorporated partly supervised endurance and resistance exercise three to five times per week. According to the potentially interfering factors, the patients were divided into groups depending on intensity of conditioning (myeloablative conditioning (MAC), reduced-intensity conditioning (RIC), and nonmyeloablative conditioning (NMC)) and cumulative dose of GC treatment (GC low ≤9 mg·kg prednisone or GC high >9 mg·kg prednisone) and were compared. RESULTS Median exercise adherence (target value, five sessions weekly) during the inpatient period was 64% in MAC, 54% in RIC, and 63% in NMC. The proportion of prematurely terminated training sessions ranged from 11% to 15%. Tiredness was the most frequent cause of exercise termination in all groups. Exercise adherence, duration (min·wk) and type of training was significantly associated with GC dose. With regard to training response, results suggest that GC-low patients tend to respond better in knee extensor muscle strength. CONCLUSIONS Exercise adherence during inpatient period is significantly affected by dose of GC treatment but not by condition regimen. However, given the reasonable adherence rates also in the GC-high group, data support the feasibility and importance of exercising for all allo-HSCT patients during the inpatient period.
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Affiliation(s)
- Joachim Wiskemann
- 1Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, GERMANY; 2Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, GERMANY; 3Bone Marrow Transplant Unit, German Clinic for Diagnostics, Wiesbaden, GERMANY; 4Department of Medicine V, Heidelberg University Hospital, Heidelberg, GERMANY; 5Central Institute of Mental Health, Mannheim, GERMANY; and 6Faculty of Health, University of Antwerp, BELGIUM
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Factors influencing spinal sagittal balance, bone mineral density, and Oswestry Disability Index outcome measures in patients with rheumatoid arthritis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:406-415. [PMID: 29185111 DOI: 10.1007/s00586-017-5401-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/24/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To identify the factors influencing spinal sagittal alignment, bone mineral density (BMD), and Oswestry Disability Index (ODI) outcome measures in patients with rheumatoid arthritis (RA). METHODS We enrolled 272 RA patients to identify the factors influencing sagittal vertical axis (SVA). Out of this, 220 had evaluation of bone mineral density (BMD) and vertebral deformity (VD) on the sagittal plane; 183 completed the ODI questionnaire. We collected data regarding RA-associated clinical parameters and standing lateral X-ray images via an ODI questionnaire from April to December 2012 at a single center. Patients with a history of spinal surgery or any missing clinical data were excluded. Clinical parameters included age, sex, body mass index, RA disease duration, disease activity score 28 erythrocyte sedimentation rate (DAS28-ESR), serum anti-cyclic citrullinated peptide antibody, serum rheumatoid factor, serum matrix metalloproteinase-3, BMD and treatment type at survey, such as methotrexate (MTX), biological disease-modifying anti-rheumatic drugs, and glucocorticoids. We measured radiological parameters including pelvic incidence (PI), lumbar lordosis (LL), and SVA. We statistically identified the factors influencing SVA, BMD, VD, and ODI using multivariate regression analysis. RESULTS Multivariate regression analysis showed that larger SVA correlated with older age, higher DAS28-ESR, MTX nonuse, and glucocorticoid use. Lower BMD was associated with female, older age, higher DAS28-ESR, and MTX nonuse. VD was associated with older age, longer disease duration, lower BMD, and glucocorticoid use. Worse ODI correlated with older age, larger PI-LL mismatch or larger SVA, higher DAS28-ESR, and glucocorticoid use. CONCLUSIONS In managing low back pain and spinal sagittal alignment in RA patients, RA-related clinical factors and the treatment type should be taken into consideration.
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Abstract
RATIONALE We report a case of acute steroid myopathy in a patient with eczema receiving one dose of intra-muscular injection of Compound betamethasone. PATIENT CONCERNS Acute steroid myopathy (ASM) is usually caused by exogenous corticosteroids, and typically, occurs with therapy using intravenous corticosteroids at high doses. DIAGNOSES The patient was considered as a diagnosis of acute steroid myopathy. INTERVENTIONS The patient was treated with non-steroid anti-inflammatory drug and other symptomatic therapy. OUTCOMES ASM was gradually improved after 2 weeks symptomatic treatment and completely recovered after one-month treatment. LESSONS The diagnosis of steroid myopathy is a clinical diagnosis based on characteristic symptoms. Higher dose of steroids, especially fluorinated steroids, for longer periods of time increases the risk of steroid-induced myopathy.
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Berr CM, Stieg MR, Deutschbein T, Quinkler M, Schmidmaier R, Osswald A, Reisch N, Ritzel K, Dimopoulou C, Fazel J, Hahner S, Stalla GK, Beuschlein F, Reincke M. Persistence of myopathy in Cushing's syndrome: evaluation of the German Cushing's Registry. Eur J Endocrinol 2017; 176:737-746. [PMID: 28325824 DOI: 10.1530/eje-16-0689] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cushing's syndrome (CS) is characterized by an excessive secretion of glucocorticoids that results in a characteristic clinical phenotype. One feature of clinical hypercortisolism is breakdown of protein metabolism translating into clinical consequences including glucocorticoid-induced myopathy. While surgery is effective in control of cortisol excess, the effect of biochemical remission on muscular function is yet unclear. METHODS In a cross-sectional study we analyzed 47 patients with CS during the florid phase (ActiveCS). 149 additional patients were studied 2-53 years (mean: 13 years) after surgery in biochemical long-term remission (RemissionCS). Also, 93 rule-out CS patients were used as controls (CON). All subjects were assessed for grip strength using a hand grip dynamometer and underwent the chair rising test (CRT). RESULTS Hand grip strength (85% vs 97% of norm, P = 0.002) and the CRT performance (9.5 s vs 7.1 s, P = 0.001) were significantly lower in ActiveCS compared to the CON group. Six months after treatment grip strength further decreased in CS (P = 0.002) and CRT performance remained impaired. The RemissionCS group (mean follow-up 13 years) had reduced hand grip strength (92% compared to normal reference values for dominant hand, P < 0.001). The chair rising test performance was at 9.0 s and not significantly different from the ActiveCS group (P = 0.45). CONCLUSION CS affects muscle strength in the acute phase, but functional impairment remains detectable also during long-term follow-up despite biochemical remission.
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Affiliation(s)
- Christina M Berr
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mareike R Stieg
- RG NeuroendocrinologyMax Planck Institute of Psychiatry, Munich, Germany
| | - Timo Deutschbein
- Department of Internal Medicine IDivision of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | | | - Ralf Schmidmaier
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Osswald
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katrin Ritzel
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Julia Fazel
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stefanie Hahner
- Department of Internal Medicine IDivision of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Günter K Stalla
- RG NeuroendocrinologyMax Planck Institute of Psychiatry, Munich, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany
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Fraticelli P, Cardinali M, Biondi L, Benfaremo D, Mattioli M, Mazzucchelli R, Montironi R, Gabrielli A. A painful diagnosis. Intern Emerg Med 2017; 12:341-347. [PMID: 28238180 DOI: 10.1007/s11739-017-1638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Paolo Fraticelli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy.
| | - Marco Cardinali
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Lorenzo Biondi
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Devis Benfaremo
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Massimo Mattioli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
| | - Roberta Mazzucchelli
- Anatomia Patologica, Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - Rodolfo Montironi
- Anatomia Patologica, Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - Armando Gabrielli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, AN, Italy
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Prevention and management of glucocorticoid-induced side effects: A comprehensive review. J Am Acad Dermatol 2017; 76:201-207. [DOI: 10.1016/j.jaad.2016.02.1241] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 12/15/2022]
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Pivonello R, Isidori AM, De Martino MC, Newell-Price J, Biller BMK, Colao A. Complications of Cushing's syndrome: state of the art. Lancet Diabetes Endocrinol 2016; 4:611-29. [PMID: 27177728 DOI: 10.1016/s2213-8587(16)00086-3] [Citation(s) in RCA: 309] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/06/2015] [Accepted: 03/01/2016] [Indexed: 01/13/2023]
Abstract
Cushing's syndrome is a serious endocrine disease caused by chronic, autonomous, and excessive secretion of cortisol. The syndrome is associated with increased mortality and impaired quality of life because of the occurrence of comorbidities. These clinical complications include metabolic syndrome, consisting of systemic arterial hypertension, visceral obesity, impairment of glucose metabolism, and dyslipidaemia; musculoskeletal disorders, such as myopathy, osteoporosis, and skeletal fractures; neuropsychiatric disorders, such as impairment of cognitive function, depression, or mania; impairment of reproductive and sexual function; and dermatological manifestations, mainly represented by acne, hirsutism, and alopecia. Hypertension in patients with Cushing's syndrome has a multifactorial pathogenesis and contributes to the increased risk for myocardial infarction, cardiac failure, or stroke, which are the most common causes of death; risks of these outcomes are exacerbated by a prothrombotic diathesis and hypokalaemia. Neuropsychiatric disorders can be responsible for suicide. Immune disorders are common; immunosuppression during active disease causes susceptibility to infections, possibly complicated by sepsis, an important cause of death, whereas immune rebound after disease remission can exacerbate underlying autoimmune diseases. Prompt treatment of cortisol excess and specific treatments of comorbidities are crucial to prevent serious clinical complications and reduce the mortality associated with Cushing's syndrome.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Cristina De Martino
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - John Newell-Price
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK; The Endocrine Unit, The Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Beverly M K Biller
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
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Grisold W, Grisold A, Löscher WN. Neuromuscular complications in cancer. J Neurol Sci 2016; 367:184-202. [PMID: 27423586 DOI: 10.1016/j.jns.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/08/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
Cancer is becoming a treatable and even often curable disease. The neuromuscular system can be affected by direct tumor invasion or metastasis, neuroendocrine, metabolic, dysimmune/inflammatory, infections and toxic as well as paraneoplastic conditions. Due to the nature of cancer treatment, which frequently is based on a DNA damaging mechanism, treatment related toxic side effects are frequent and the correct identification of the causative mechanism is necessary to initiate the proper treatment. The peripheral nervous system is conventionally divided into nerve roots, the proximal nerves and plexus, the peripheral nerves (mono- and polyneuropathies), the site of neuromuscular transmission and muscle. This review is based on the anatomic distribution of the peripheral nervous system, divided into cranial nerves (CN), motor neuron (MND), nerve roots, plexus, peripheral nerve, the neuromuscular junction and muscle. The various etiologies of neuromuscular complications - neoplastic, surgical and mechanic, toxic, metabolic, endocrine, and paraneoplastic/immune - are discussed separately for each part of the peripheral nervous system.
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Affiliation(s)
- W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.
| | - A Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - W N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Minetto MA, Qaisar R, Agoni V, Motta G, Longa E, Miotti D, Pellegrino MA, Bottinelli R. Quantitative and qualitative adaptations of muscle fibers to glucocorticoids. Muscle Nerve 2015; 52:631-9. [PMID: 25594832 DOI: 10.1002/mus.24572] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 12/29/2014] [Accepted: 01/07/2015] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The aim of this study was to understand the effects of short-term glucocorticoid administration in healthy subjects. METHODS Five healthy men received dexamethasone (8 mg/day) for 7 days. Vastus lateralis muscle biopsy and knee extension torque measurement were performed before and after administration. A large number of individual muscle fibers were dissected from the biopsy samples (pre-administration: n = 165, post-administration: n = 177). RESULTS Maximal knee extension torque increased after administration (∼ 13%), whereas both type 1 and type 2A fibers had decreased cross-sectional area (type 1: ∼ 11%, type 2A: ∼ 17%), myosin loss (type 1: ∼ 18%, type 2A: ∼ 32%), and loss of specific force (type 1: ∼ 24%, type 2A: ∼ 33%), which were preferential for fast fibers. CONCLUSION Short-term dexamethasone administration in healthy subjects elicits quantitative and qualitative adaptations of muscle fibers that precede (and may predict) the clinical appearance of myopathy in glucocorticoid-treated subjects.
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Affiliation(s)
- Marco Alessandro Minetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Rizwan Qaisar
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Valentina Agoni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanna Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Emanuela Longa
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Danilo Miotti
- Fondazione Salvatore Maugeri, Scientific Institute of Pavia, Pavia, Italy
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Minetto MA, Ghigo E. Sarcopenia in Endocrine Disorders - The Iceberg or Its Tip? EUROPEAN ENDOCRINOLOGY 2015; 11:41-42. [PMID: 29632567 PMCID: PMC5819062 DOI: 10.17925/ee.2015.11.01.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/10/2015] [Indexed: 11/24/2022]
Abstract
Endocrine myopathies represent disorders of the musculoskeletal system that significantly impair the state of health. Sarcopenia is their pathophysiological common denominator. Recent reports have shown that endocrine disorders, even when subclinical, may also be associated with tendinopathies. It may thus be suggested that both hormones and hormonal disorders have complex actions on the musculoskeletal system and that musculoskeletal endocrinology represents a fascinating research area still awaiting exploration.
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Affiliation(s)
| | - Ezio Ghigo
- Professor of Endocrinology; Director of the School of Medicine, University of Turin, Turin, Italy
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Marra AM, Improda N, Capalbo D, Salzano A, Arcopinto M, De Paulis A, Alessio M, Lenzi A, Isidori AM, Cittadini A, Salerno M. Cardiovascular abnormalities and impaired exercise performance in adolescents with congenital adrenal hyperplasia. J Clin Endocrinol Metab 2015; 100:644-52. [PMID: 25405496 DOI: 10.1210/jc.2014-1805] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT PATIENTS with classic congenital adrenal hyperplasia (CAH) are treated with lifelong glucocorticoids (GCs). Cardiovascular and metabolic effects of such therapy in adolescents have never been quantified. OBJECTIVE Our objective was to investigate left ventricular (LV) morphology, function, and exercise performance in adolescents with CAH. DESIGN AND SETTING We conducted a cross-sectional and controlled study conducted at a tertiary referral center. PATIENTS Twenty patients with classic CAH (10 females) aged 13.6 ± 2.5 years and 20 healthy controls comparable for sex and pubertal status were enrolled in the study and compared with a group of 18 patients without CAH receiving a similar dose of GCs for juvenile idiopathic arthritis. MAIN OUTCOMES MEASURES Echocardiographic assessment and symptom-limited exercise testing were performed. Anthropometric, hormonal and biochemical parameters were also measured. RESULTS Compared with healthy controls, patients with CAH exhibited an increased body mass index (P < .001), waist-to-height ratio (P < .001), and percent body fat (P < .001) as well as higher insulin concentrations and homeostasis model assessment of insulin resistance index even after adjustment for body mass index (P = .03 and P = .05, respectively). Moreover, CAH patients exhibited an impaired exercise capacity as shown by reduced peak workload (99 ± 27 vs 126 ± 27 W, P < .01) and higher systolic blood pressure response at peak (156 ± 18 vs 132 ± 11 mm Hg, P < .01; Δ = 45 ± 24 vs 22 ± 10 mm Hg, P = .05) with respect to healthy controls. CAH males displayed mild LV diastolic dysfunction as documented by significant prolongation of both isovolumic relaxation time (118 ± 18 vs 98 ± 11 milliseconds, P < .05) and mitral deceleration time (138 ± 25 vs 111 ± 15 milliseconds, P < .01). No significant differences in cardiovascular function were found between CAH and juvenile idiopathic arthritis patients. CONCLUSION Adolescents with CAH exhibit impaired exercise performance and enhanced systolic blood pressure response during exercise. In our population, such abnormalities appear related to GC therapy rather than CAH per se. CAH males, but not females, present mild LV diastolic dysfunction that correlates with testosterone concentrations suggesting a sex hormone-related difference.
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Affiliation(s)
- Alberto M Marra
- Internal Medicine (A.M.M., A.S., A.D.P., A.C.) and Pediatric (N.I., D.C., M.Al., M.S.) Sections, Department of Translational Medical Sciences, "Federico II" University School of Medicine, 80131 Naples, Italy; Department of Cardiac Surgery (M.Ar.), Instituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; and Department of Experimental Medicine (A.L., A.M.I.), "Sapienza" University, 00186 Rome, Italy
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Effect of exercise therapy on muscle mass and physical functioning in patients undergoing allogeneic hematopoietic stem cell transplantation. Support Care Cancer 2014; 23:985-92. [DOI: 10.1007/s00520-014-2425-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
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Izumi Y, Miyashita T, Kitajima T, Yoshimura S, Takeoka A, Eguchi K, Motomura M, Kawakami A, Migita K. Two cases of refractory polymyositis accompanied with steroid myopathy. Mod Rheumatol 2014; 25:143-9. [DOI: 10.3109/14397595.2013.874750] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yasumori Izumi
- Department of General Internal Medicine and Rheumatology, NHO National Nagasaki Medical Center, Omura, Japan
| | - Taiichiro Miyashita
- Department of General Internal Medicine and Rheumatology, NHO National Nagasaki Medical Center, Omura, Japan
| | - Tsubasa Kitajima
- Department of General Internal Medicine and Rheumatology, NHO National Nagasaki Medical Center, Omura, Japan
| | - Shunsuke Yoshimura
- Department of General Internal Medicine and Rheumatology, NHO National Nagasaki Medical Center, Omura, Japan
| | - Atsushi Takeoka
- Department of General Internal Medicine and Rheumatology, NHO National Nagasaki Medical Center, Omura, Japan
| | - Katsumi Eguchi
- Department of Rheumatology, Sasebo City General Hospital, Sasebo, Japan
| | - Masakatsu Motomura
- Department of Neurology and Rheumatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Neurology and Rheumatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kiyoshi Migita
- Department of General Internal Medicine and Rheumatology, NHO National Nagasaki Medical Center, Omura, Japan
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Two cases of refractory polymyositis accompanied with steroid myopathy. Mod Rheumatol 2013. [DOI: 10.1007/s10165-013-0858-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morishita S, Kaida K, Yamauchi S, Sota K, Ishii S, Ikegame K, Kodama N, Ogawa H, Domen K. Relationship between corticosteroid dose and declines in physical function among allogeneic hematopoietic stem cell transplantation patients. Support Care Cancer 2013; 21:2161-9. [DOI: 10.1007/s00520-013-1778-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
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Arnaldi G, Mancini T, Tirabassi G, Trementino L, Boscaro M. Advances in the epidemiology, pathogenesis, and management of Cushing's syndrome complications. J Endocrinol Invest 2012; 35:434-48. [PMID: 22652826 DOI: 10.1007/bf03345431] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cushing's syndrome (CS) is a clinical condition resulting from chronic exposure to glucocorticoid excess. As a consequence, hypercortisolism contributes significantly to the early development of systemic disorders by direct and/or indirect effects. Complications such as obesity, hypertension, diabetes, dyslipidemia, and hypercoagulability cause premature atherosclerosis and increase cardiovascular mortality. Impairment of the skeletal system is a relevant cause of morbidity and disability in these patients especially due to the high prevalence of vertebral fractures. In addition, muscle weakness, emotional lability, depression, and impairment of quality of life are very common. Clinical management of these patients is complex and should be particularly careful in identifying global cardiovascular risks and aim at controlling all complications. Although the primary goal in the prevention and treatment of complications is the correction of hypercortisolism, treatment does not completely eliminate these comorbidities. Given that cardiovascular risk and fracture risk can persist after cure, early detection of each morbidity could prevent the development of irreversible damage. In this review we present the various complications of CS and their pathogenetic mechanisms. We also suggest the clinical management of these patients based on our extensive clinical experience and on the available literature.
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Affiliation(s)
- G Arnaldi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy.
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