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De Sousa SMC, McCormack A, Orsmond A, Shen A, Yates CJ, Clifton-Bligh R, Santoreneos S, King J, Feng J, Toubia J, Torpy DJ, Scott HS. Increased prevalence of germline pathogenic CHEK2 variants in individuals with pituitary adenomas. J Clin Endocrinol Metab 2024:dgae268. [PMID: 38651569 DOI: 10.1210/clinem/dgae268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
CONTEXT CHEK2 is a cell cycle checkpoint regulator gene with a long-established role as a clinically relevant, moderate risk breast cancer predisposition gene, with greater risk ascribed to truncating variants than missense variants. METHODS We assessed 165 individuals with pituitary adenomas for CHEK2 variants. The study consisted of a primary cohort of 29 individuals who underwent germline and tumour whole exome sequencing, and a second, independent cohort of 136 individuals who had a targeted next-generation sequencing panel performed on both germline and tumour DNA (n=52) or germline DNA alone (n=84). RESULTS We identified rare, coding, non-synonymous germline CHEK2 variants amongst 3/29 (10.3%) patients in our primary cohort and 5/165 (3.0%) patients overall, with affected patients having a range of hormone secretion types (prolactinoma, thyrotrophinoma, somatotrophinoma and non-functioning pituitary adenoma). No somatic variants were identified. Two variants were definitive null variants (c.1100delC, c.444+1G>A), classified as pathogenic. Two variants were missense variants (p.Asn186His, p.Thr476Met), classified as likely pathogenic. Even when considering the null variants only, the rate of CHEK2 variants was higher in our cohort compared to national control data (1.8% vs. 0.5%, P=0.049). CONCLUSIONS This is the first study to suggest a role for the breast cancer predisposition gene, CHEK2, in pituitary tumorigenesis, with pathogenic/likely pathogenic variants found in 3% of patients with pituitary adenomas. As pituitary adenomas are relatively common and typically lack classical autosomal dominant family histories, risk alleles - such as these variants found in CHEK2 - might be a significant contributor to pituitary adenoma risk in the general population.
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Affiliation(s)
- Sunita M C De Sousa
- Endocrine & Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australian Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Andreas Orsmond
- Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Angeline Shen
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J Yates
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Roderick Clifton-Bligh
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
- Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Stephen Santoreneos
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James King
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Jinghua Feng
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, an SA Pathology and University of South Australia alliance, Adelaide, South Australia, Australia
- ACRF Cancer Genomics Facility, Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia
| | - John Toubia
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, an SA Pathology and University of South Australia alliance, Adelaide, South Australia, Australia
- ACRF Cancer Genomics Facility, Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia
| | - David J Torpy
- Endocrine & Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Hamish S Scott
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, an SA Pathology and University of South Australia alliance, Adelaide, South Australia, Australia
- ACRF Cancer Genomics Facility, Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia
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Petersenn S, Fleseriu M, Casanueva FF, Giustina A, Biermasz N, Biller BMK, Bronstein M, Chanson P, Fukuoka H, Gadelha M, Greenman Y, Gurnell M, Ho KKY, Honegger J, Ioachimescu AG, Kaiser UB, Karavitaki N, Katznelson L, Lodish M, Maiter D, Marcus HJ, McCormack A, Molitch M, Muir CA, Neggers S, Pereira AM, Pivonello R, Post K, Raverot G, Salvatori R, Samson SL, Shimon I, Spencer-Segal J, Vila G, Wass J, Melmed S. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. Nat Rev Endocrinol 2023; 19:722-740. [PMID: 37670148 DOI: 10.1038/s41574-023-00886-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/07/2023]
Abstract
This Consensus Statement from an international, multidisciplinary workshop sponsored by the Pituitary Society offers evidence-based graded consensus recommendations and key summary points for clinical practice on the diagnosis and management of prolactinomas. Epidemiology and pathogenesis, clinical presentation of disordered pituitary hormone secretion, assessment of hyperprolactinaemia and biochemical evaluation, optimal use of imaging strategies and disease-related complications are addressed. In-depth discussions present the latest evidence on treatment of prolactinoma, including efficacy, adverse effects and options for withdrawal of dopamine agonist therapy, as well as indications for surgery, preoperative medical therapy and radiation therapy. Management of prolactinoma in special situations is discussed, including cystic lesions, mixed growth hormone-secreting and prolactin-secreting adenomas and giant and aggressive prolactinomas. Furthermore, considerations for pregnancy and fertility are outlined, as well as management of prolactinomas in children and adolescents, patients with an underlying psychiatric disorder, postmenopausal women, transgender individuals and patients with chronic kidney disease. The workshop concluded that, although treatment resistance is rare, there is a need for additional therapeutic options to address clinical challenges in treating these patients and a need to facilitate international registries to enable risk stratification and optimization of therapeutic strategies.
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Affiliation(s)
- Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg, Germany.
- University of Duisburg-Essen, Essen, Germany.
| | | | | | - Andrea Giustina
- San Raffaele Vita-Salute University, Milan, Italy
- IRCCS Hospital San Raffaele, Milan, Italy
| | | | | | | | - Philippe Chanson
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Monica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yona Greenman
- Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Mark Gurnell
- University of Cambridge, Cambridge, UK
- Addenbrooke's Hospital, Cambridge, UK
| | - Ken K Y Ho
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | | | | | - Ursula B Kaiser
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Maya Lodish
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ann McCormack
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Mark Molitch
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Alberto M Pereira
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | | | - Kalmon Post
- Mount Sinai Health System, New York, NY, USA
| | - Gerald Raverot
- Department of Endocrinology, Reference Centre for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est" Hospices Civils de Lyon, Bron, France
| | | | | | - Ilan Shimon
- Tel Aviv University, Tel Aviv, Israel
- Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | | | - Greisa Vila
- Medical University of Vienna, Vienna, Austria
| | - John Wass
- University of Oxford, Oxford, UK
- Churchill Hospital, Oxford, UK
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Petersenn S, Fleseriu M, Casanueva FF, Giustina A, Biermasz N, Biller BMK, Bronstein M, Chanson P, Fukuoka H, Gadelha M, Greenman Y, Gurnell M, Ho KKY, Honegger J, Ioachimescu AG, Kaiser UB, Karavitaki N, Katznelson L, Lodish M, Maiter D, Marcus HJ, McCormack A, Molitch M, Muir CA, Neggers S, Pereira AM, Pivonello R, Post K, Raverot G, Salvatori R, Samson SL, Shimon I, Spencer-Segal J, Vila G, Wass J, Melmed S. Author Correction: Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. Nat Rev Endocrinol 2023:10.1038/s41574-023-00916-2. [PMID: 37848631 DOI: 10.1038/s41574-023-00916-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg, Germany.
- University of Duisburg-Essen, Essen, Germany.
| | | | | | - Andrea Giustina
- San Raffaele Vita-Salute University, Milan, Italy
- IRCCS Hospital San Raffaele, Milan, Italy
| | | | | | | | - Philippe Chanson
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Monica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yona Greenman
- Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Mark Gurnell
- University of Cambridge, Cambridge, UK
- Addenbrooke's Hospital, Cambridge, UK
| | - Ken K Y Ho
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | | | | | - Ursula B Kaiser
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Maya Lodish
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ann McCormack
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Mark Molitch
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Alberto M Pereira
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | | | - Kalmon Post
- Mount Sinai Health System, New York, NY, USA
| | - Gerald Raverot
- Department of Endocrinology, Reference Centre for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est" Hospices Civils de Lyon, Bron, France
| | | | | | - Ilan Shimon
- Tel Aviv University, Tel Aviv, Israel
- Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | | | - Greisa Vila
- Medical University of Vienna, Vienna, Austria
| | - John Wass
- University of Oxford, Oxford, UK
- Churchill Hospital, Oxford, UK
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Menyah E, Garcia SM, McCormack A, Taiwo B, Aly M, Kamel W, Dhinsa BS. Assessing Referrals to a Trauma and Orthopaedic Department: Evaluation of a Traffic Light System for Virtual Fracture Clinic in the Emergency Department and Urgent Care. Cureus 2023; 15:e41316. [PMID: 37539403 PMCID: PMC10395551 DOI: 10.7759/cureus.41316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Background The Trauma and Orthopaedic (T&O) on-call service receives referrals from the emergency department (ED), general practice (GP) and urgent treatment centres (UTCs) and requests for inpatient reviews. The virtual fracture clinic (VFC) pathway allows ED and UTC clinicians to assess, discharge and refer when necessary. For VFC, the on-call orthopaedic consultant reviews the cases the next working day and makes an appropriate plan. This pathway consists of a traffic light system, in which practitioners can either safely discharge with written advice (green), refer to the VFC (yellow) or refer to the on-call team (red). Method The aim of this study was to assess how the VFC pathway was being utilised. All referrals to the T&O on-call team over three weeks were evaluated retrospectively. The following referrals were excluded: fractured femur, head injury, trauma calls and back pain pathway. The following data were collected: patient details, diagnosis, referral source, reason for referral, plan, double booking with VFC and appropriateness. Results A total of 191 referrals were analysed. Most referrals are from the ED (51%) and UTC (23%). Of the referrals, 39% were deemed to be inappropriate. Of the inappropriate referrals, 35% should have been referred directly to the VFC rather than the on-call team. A significant minority (7%) of inappropriate referrals were referred to the on-call team and VFC. Conclusion Education and collaboration are required with the ED and UTC to ensure the proper use of the VFC pathway. Immediate radiograph reporting may also be beneficial.
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Affiliation(s)
- Effie Menyah
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Sean M Garcia
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Ann McCormack
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Babajide Taiwo
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Mohamed Aly
- Orthopaedics, Alexandria University, Alexandria, EGY
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Walid Kamel
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
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5
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Abstract
'Pituitary tumours' is an umbrella term for various tumours originating from different regions of the hypothalamic-pituitary system. The vast majority of pituitary tumours are pituitary adenomas, also recently referred to as pituitary neuroendocrine tumours. The prevalence of clinically relevant pituitary adenomas is approximately 1 in 1000; other pituitary tumours such as craniopharyngioma and pituicytoma are comparatively very rare. This review addresses the molecular and genetic aspects of pituitary adenomas. We first discuss the germline genetic variants underlying familial pituitary tumours, which account for approximately 5% of all pituitary adenoma cases. This includes variants in established pituitary adenoma/hyperplasia predisposition genes (MEN1, PRKAR1A, AIP, CDKN1B, GPR101, SDHA, SDHB, SDHC, SDHD, SDHAF2) as well as emerging genetic associations. In addition, we discuss McCune-Albright syndrome which lies between the germline and somatic pituitary tumour genes as the causative GNAS mutations are postzygotic rather than being inherited, and the condition is associated with multiglandular features due to the involvement of different cell lines rather than being limited to the pituitary. By contrast, somatic GNAS mutations contribute to sporadic acromegaly. USP8 is the only other gene where somatic driver mutations have been established in sporadic pituitary tumorigenesis. However, there are now known to be a variety of other somatic genetic and molecular changes underpinning sporadic pituitary adenomas which we review here, namely: copy number variation, molecular changes in signalling and hypoxia pathways, epithelial-mesenchymal transition, DNA repair, senescence, the immune microenvironment and epigenetics.
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Affiliation(s)
- Sunita M C De Sousa
- Endocrine & Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- South Australian Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Nèle F Lenders
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Lydia S Lamb
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia
- Academy for Medical Education, Faculty of Medicine, the University of Queensland, Brisbane, Australia
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
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6
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Trouillas J, Burman P, Losa M, McCormack A, Petersenn S, Popovic V, Theodoropoulou M, Dekkers OM, Raverot G. Initial pathology in aggressive pituitary tumours and carcinomas: 2b or not 2b?-that is the question. Eur J Endocrinol 2023; 188:C5-C8. [PMID: 36952293 DOI: 10.1093/ejendo/lvad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/27/2023] [Accepted: 03/22/2023] [Indexed: 03/24/2023]
Abstract
Abstract
From a cohort of 171 patients comprising 121 aggressive pituitary tumours (APT) and 50 pituitary carcinomas (PC), the clinicopathological or five-tiered classification based on tumour invasion and proliferation evaluated by at least 2 proliferative markers over the cut-offs (Ki-67 ≥3% or ≥10%, p53 positive or expressed in %, mitotic count >2%), could be applied on 43 tumours: 20 PC and 23 APT. At the initial surgery, 29/43 tumours (67.4%) were grade 2b (invasive and proliferative) of which 44.8% developed metastases during follow-up (PC, grade 3). Out of these 29 tumours, 55.1% had a Ki-67 ≥10%, and were classified grade 2b* (invasive and highly proliferative). There was one tumour grade 1b* (non-invasive and highly proliferative) which metastazed. Out of the 43 tumours, 30.2 % were grade 2a (invasive and non-proliferative). The sensitivity and the specificity of grade 2b for the diagnosis of APT at the initial surgery, were 68% and 90% respectively. The comparison of the high percentage (67.4%) of grade 2b tumours in this selected cohort of APT/PC with the low percentage (8.8%) in a surgical cohort of unselected tumours shows that the initial pathological diagnosis of grade 2b tumour may be considered, in the clinic, as representing a diagnosis of APT. In addition, a significant subgroup of tumours, which will develop metastases supports the proposal that an aggressive grade 2b tumour is “a tumour with malignant potential” or “a malignant tumour without metastases”. So, the clinician may take into account the pathological diagnosis, at the initial surgery, to propose a strict follow-up and to consider earlier use of radiotherapy and/or of temozolomide in the presence of tumours with aggressive behaviour.
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Affiliation(s)
- Jacqueline Trouillas
- Faculty of medicine Lyon-Est, University Claude Bernard Lyon 1, Lyon 69372, France
| | - Pia Burman
- Department of Endocrinology, Skåne University Hospital, Malmö, Lund University, Malmö 214 28, Sweden
| | - Marco Losa
- Department of Neurosurgery, IRCCS San Raffaele, Vita-Salute University, Milan 20132, Italy
| | - Ann McCormack
- Department of Endocrinology, St. Vincent's Hospital, Sydney 2010, Australia
| | - Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Erik-Blumenfeld-Platz 27a, Hamburg 22587, Germany
| | - Vera Popovic
- School of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Marily Theodoropoulou
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich 2333, Germany
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leids Universitair Medisch Centrum Centrum voor Humane en Klinische Genetica, Leiden 2300 RC, Netherlands
| | - Gerald Raverot
- Faculty of medicine Lyon-Est, University Claude Bernard Lyon 1, Lyon 69372, France
- Federation d'Endocrinologie, Hospices civils de Lyon, Bron 69677, France
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Meli A, McCormack A, Conte I, Chen Q, Streetley J, Rose ML, Bierings R, Hannah MJ, Molloy JE, Rosenthal PB, Carter T. Altered Storage and Function of von Willebrand Factor in Human Cardiac Microvascular Endothelial Cells Isolated from Recipient Transplant Hearts. Int J Mol Sci 2023; 24:ijms24054553. [PMID: 36901985 PMCID: PMC10003102 DOI: 10.3390/ijms24054553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
The assembly of von Willebrand factor (VWF) into ordered helical tubules within endothelial Weibel-Palade bodies (WPBs) is required for the efficient deployment of the protein at sites of vascular injury. VWF trafficking and storage are sensitive to cellular and environmental stresses that are associated with heart disease and heart failure. Altered storage of VWF manifests as a change in WPB morphology from a rod shape to a rounded shape and is associated with impaired VWF deployment during secretion. In this study, we examined the morphology, ultrastructure, molecular composition and kinetics of exocytosis of WPBs in cardiac microvascular endothelial cells isolated from explanted hearts of patients with a common form of heart failure, dilated cardiomyopathy (DCM; HCMECD), or from nominally healthy donors (controls; HCMECC). Using fluorescence microscopy, WPBs in HCMECC (n = 3 donors) showed the typical rod-shaped morphology containing VWF, P-selectin and tPA. In contrast, WPBs in primary cultures of HCMECD (n = 6 donors) were predominantly rounded in shape and lacked tissue plasminogen activator (t-PA). Ultrastructural analysis of HCMECD revealed a disordered arrangement of VWF tubules in nascent WPBs emerging from the trans-Golgi network. HCMECD WPBs still recruited Rab27A, Rab3B, Myosin-Rab Interacting Protein (MyRIP) and Synaptotagmin-like protein 4a (Slp4-a) and underwent regulated exocytosis with kinetics similar to that seen in HCMECc. However, secreted extracellular VWF strings from HCMECD were significantly shorter than for endothelial cells with rod-shaped WPBs, although VWF platelet binding was similar. Our observations suggest that VWF trafficking, storage and haemostatic potential are perturbed in HCMEC from DCM hearts.
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Affiliation(s)
- Athinoula Meli
- Transplant Immunology, Heart Science Centre, Harefield Hospital, Hill End Road, Harefield UB9 6JH, UK
| | - Ann McCormack
- Transplant Immunology, Heart Science Centre, Harefield Hospital, Hill End Road, Harefield UB9 6JH, UK
| | - Ianina Conte
- Molecular and Clinical Sciences Research Institute, St Georges University of London, London SW17 0RE, UK
| | - Qu Chen
- Structural Biology Science Technology Platform, The Francis Crick Institute, London NW1 1AT, UK
| | - James Streetley
- Structural Biology of Cells and Viruses Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Marlene L. Rose
- Transplant Immunology, Heart Science Centre, Harefield Hospital, Hill End Road, Harefield UB9 6JH, UK
| | - Ruben Bierings
- Hematology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Matthew J. Hannah
- High Containment Microbiology, UK Health Security Agency, London NW9 5EQ, UK
| | - Justin E. Molloy
- Single Molecule Enzymology Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Peter B. Rosenthal
- Structural Biology of Cells and Viruses Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Tom Carter
- Molecular and Clinical Sciences Research Institute, St Georges University of London, London SW17 0RE, UK
- Correspondence: ; Tel.: +44-(208)-7255961
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8
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Joseph M, Alvarado R, Jonker B, Winder M, Earls P, Campbell RG, Kalish L, Sacks R, Davidson A, McCormack A, Harvey RJ. Headache in Patients with Sellar Disease: Clinicomorphological Predictors of Headache and the Outcome of Endoscopic Transphenoidal Surgery. J Neurol Surg B Skull Base 2023. [DOI: 10.1055/a-2036-0652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Objectives: Sellar pathologies are frequently found on imaging performed to investigate headache. However, both headache and incidental sellar lesions are common. Hence, this study prospectively examined headache prevalence, phenotype and severity in patients with sellar pathologies and the impact of transphenoidal surgery on headache.
Methods: Patients undergoing transphenoidal resection of sellar lesions were consecutively recruited. At baseline, participants were defined as having headache or not and headache phenotype was characterised using validated questionnaires. Headache severity was assessed at baseline and 6-months postoperatively using the Headache Impact Test-6 (HIT-6) and Migraine Disability Assessment Score (MIDAS). Tumour characteristics were defined using radiological, histological and endocrine factors. Primary outcomes included baseline headache prevalence and severity and headache severity change at 6-months postoperatively. Correlation between headache and radiological, histological and endocrine characteristics was also of interest.
Results: 60 participants (62% female, 47.1±18.6 years) were recruited. 63% possessed baseline headache. HIT-6 scores were higher in patients with primary headache risk factors, including younger age (R2 =-0.417, p=0.010), smoking history (63.31±7.93 vs 54.44±9.21, p=0.006) and family headache history (68.13±7.01 vs 54.94±9.11, p=0.003). Headaches were more common in patients with dural invasion (55.70±12.14 vs 47.18±10.15, p=0.027) and sphenoid sinus invasion (58.87±8.97 vs 51.29±10.97, p=0.007). Postoperative severity scores improved more with higher baseline headache severity (HIT-6: R2=-0.682, p<0.001, MIDAS: R2=-0.880, p<0.001) and dural invasion (MIDAS: -53.00±18.68 vs 12.00±17.54, p=0.003).
Conclusions: Headaches in sellar disease are likely primary disorders triggered or exacerbated by sellar pathology. These may respond to surgery, particularly in patients with severe headache and dural invasion.
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Affiliation(s)
- Maria Joseph
- Neurosurgery, John Hunter Hospital, New Lambton Heights, Australia
- Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Benjamen Jonker
- Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Mark Winder
- Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Peter Earls
- Department of Anatomical Pathology and Cytopathology, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Raewyn G Campbell
- Otolaryngology, head and neck surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, Australia
- Department of Otolaryngology Head and Neck Surgery, Concord Repatriation General Hospital, Concord, Australia
| | - Raymond Sacks
- Applied Medical Research Centre, Rhinology and Skull Base Research Group, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Andrew Davidson
- Department of Neurosurgery, Macquarie University Hospital, Macquarie Park, Australia
| | - Ann McCormack
- Hormones and Cancer Group, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Richard John Harvey
- Applied Medical Research Centre, University of New South Wales, Sydney, Australia
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Arima H, Cheetham T, Christ-Crain M, Cooper D, Drummond J, Gurnell M, Levy M, McCormack A, Newell-Price J, Verbalis JG, Wass J. Changing the Name of Diabetes Insipidus: A Position Statement of the Working Group for Renaming Diabetes Insipidus. J Clin Endocrinol Metab 2022; 108:1-3. [PMID: 36355385 PMCID: PMC9759163 DOI: 10.1210/clinem/dgac547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Indexed: 11/12/2022]
Abstract
Recent data show that patients with a diagnosis of diabetes insipidus (DI) are coming to harm. Here we give the rationale for a name change to arginine vasopressin deficiency and resistance for central and nephrogenic DI, respectively.
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Affiliation(s)
- Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Timothy Cheetham
- Department of Pediatric Endocrinology, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Great North Children's Hospital (GNCH), Newcastle upon Tyne NE1 4LP, UK
| | - Mirjam Christ-Crain
- Correspondence: Mirjam Christ-Crain, MD, PhD, Division of Endocrinology and Diabetes, University hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. ; or Joseph G. Verbalis, MD, Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC 20007, USA.
| | | | - Juliana Drummond
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG CEP 31270-901, Brazil
| | - Mark Gurnell
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge & Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Miles Levy
- Department of Endocrinology, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, UK
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW 2010, Australia
- Garvan Institute of Medical Research, Sydney, NSW 2010, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - John Newell-Price
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Joseph G Verbalis
- Correspondence: Mirjam Christ-Crain, MD, PhD, Division of Endocrinology and Diabetes, University hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. ; or Joseph G. Verbalis, MD, Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC 20007, USA.
| | - John Wass
- Department of Endocrinology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
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Arima H, Bichet DG, Cheetham T, Christ-Crain M, Drummond J, Gurnell M, Levy M, McCormack A, Newell-Price J, Verbalis JG, Wass J, Cooper D. Changing the name of diabetes insipidus. Pituitary 2022; 25:777-779. [PMID: 36334185 DOI: 10.1007/s11102-022-01276-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Daniel G Bichet
- University of Montreal, Montreal, QC, H3T 1J4, Canada
- Hôpital du Sacré-Coeur de Montréal, Montreal, QC, H4J 1C5, Canada
| | - Timothy Cheetham
- Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
- Great North Children's Hospital (GNCH), Newcastle Upon Tyne, NE1 4LP, UK
| | - Mirjam Christ-Crain
- Department of Endocrinology, University Hospital and University of Basel, 4031, Basel, Switzerland
| | - Juliana Drummond
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, CEP 31270-901, Brazil
| | - Mark Gurnell
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge & Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Miles Levy
- Department of Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, LE3 9QP, UK
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, 2010, Australia
- Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia
| | - John Newell-Price
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Joseph G Verbalis
- Georgetown-Howard Universities Center for Clinical and Translational Science, Georgetown University, Washington, DC, 20007, USA
| | - John Wass
- Department of Endocrinology, Churchill Hospital, University of Oxford, Oxford, OX3 7LE, UK.
| | - Deborah Cooper
- PricewaterhouseCoopers LLP, 7 More London Riverside, London, SE1 2RT, UK
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Abstract
Survival for patients with aggressive pituitary tumours (APT) and pituitary carcinomas (PC) has significantly improved following the increasing use of temozolomide (TMZ) since the first reports of response in 2006. TMZ was established as first line chemotherapy for APT/PC in the 2018 ESE guidelines on the management of APT/PC. There is no controversy over its use as salvage therapy however there is increasing interest in exploring TMZ use earlier in the treatment algorithm for APT/PC. Overall response rates as reported in systematic reviews are around 40% but stable disease in another 25% illustrates the clinical effectiveness of TMZ. Response is higher among functional compared to non-functional tumours. Where maximal radiation thresholds have not been reached in a patient, combination radiotherapy and TMZ appears more effective. Whether combination TMZ and capecitabine (CAPTEM) offers increased benefit remains uncertain particularly given added toxicity. O6-methyl guanine DNA methyl transferase (MGMT) status is important in determining response to treatment, although examination via immunohistochemistry versus PCR-based promoter-methylation analysis remains somewhat controversial. Optimal duration of TMZ treatment has still not been determined although longer treatment courses have been associated with increased progression-free survival. Treatment options following disease progression after TMZ remain unclear but include a second course of TMZ, immunotherapy and targeted oncological agents such as bevacizumab and lapatinib as well as peptide receptor radionuclide treatment (PRRT). An experienced pituitary multidisciplinary team is essential to all management decisions in patients with APT/PC.
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Affiliation(s)
- Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia; Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
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12
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Arima H, Cheetham T, Christ-Crain M, Cooper DL, Drummond JB, Gurnell M, Levy M, McCormack A, Newell-Price JD, Verbalis JG, Wass J. Changing the name of diabetes insipidus: a position statement of the working group to consider renaming diabetes insipidus. Archives of Endocrinology and Metabolism 2022; 66:868-870. [PMID: 36219203 PMCID: PMC10118767 DOI: 10.20945/2359-3997000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
"What's in a name? That which we call a rose / By any other name would smell as sweet" (Juliet, from Romeo and Juliet by William Shakespeare). Shakespeare's implication is that a name is nothing but a word and it therefore represents a convention with no intrinsic meaning. Whilst this may be relevant to romantic literature, disease names do have real meanings, and consequences, in medicine. Hence, there must be a very good rational for changing the name of a disease that has a centuries-old historical context. A working group of representatives from national and international endocrinology and endocrine pediatric societies now proposes changing the name of "diabetes insipidus" to "Arginine Vasopressin Deficiency (AVP-D)" for central etiologies, and "Arginine Vasopressin Resistance (AVP-R)" for nephrogenic etiologies This editorial provides both the historical context and the rational for this proposed name change.
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13
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Burman P, Trouillas J, Losa M, McCormack A, Petersenn S, Popovic V, Theodoropoulou M, Raverot G, Dekkers OM. Aggressive pituitary tumours and carcinomas, characteristics and management of 171 patients. Eur J Endocrinol 2022; 187:593-605. [PMID: 36018781 PMCID: PMC9513638 DOI: 10.1530/eje-22-0440] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe clinical and pathological characteristics and treatment outcomes in a large cohort of aggressive pituitary tumours (APT)/pituitary carcinomas (PC). DESIGN Electronic survey August 2020-May 2021. RESULTS 96% of 171 (121 APT, 50 PC), initially presented as macro/giant tumours, 6 were microadenomas (5 corticotroph). Ninety-seven tumours, initially considered clinically benign, demonstrated aggressive behaviour after 5.5 years (IQR: 2.8-12). Of the patients, 63% were men. Adrenocorticotrophic hormone (ACTH)-secreting tumours constituted 30% of the APT/PC, and the gonadotroph subtypes were under-represented. Five out of 13 silent corticotroph tumours and 2/6 silent somatotroph tumours became secreting. Metastases were observed after median 6.3 years (IQR 3.7-12.1) from diagnosis. At the first surgery, the Ki67 index was ≥3% in 74/93 (80%) and ≥10% in 38/93 (41%) tumours. An absolute increase of Ki67 ≥ 10% after median of 6 years from the first surgery occurred in 18/49 examined tumours. Tumours with an aggressive course from outset had higher Ki67, mitotic counts, and p53. Temozolomide treatment in 156/171 patients resulted in complete response in 9.6%, partial response in 30.1%, stable disease in 28.1%, and progressive disease in 32.2% of the patients. Treatment with bevacizumab, immune checkpoint inhibitors, and peptide receptor radionuclide therapy resulted in partial regression in 1/10, 1/6, and 3/11, respectively. Median survival in APT and PC was 17.2 and 11.3 years, respectively. Tumours with Ki67 ≥ 10% and ACTH-secretion were associated with worse prognosis. CONCLUSION APT/PCs exhibit a wide and challenging spectrum of behaviour. Temozolomide is the first-line chemotherapy, and other oncological therapies are emerging. Treatment response continues to be difficult to predict with currently studied biomarkers.
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Affiliation(s)
- Pia Burman
- Department of Endocrinology, Skåne University Hospital Malmö, University of Lund, Lund, Sweden
- Correspondence should be addressed to P Burman;
| | | | - Marco Losa
- Marco Losa Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Ann McCormack
- St Vincent’s Hospital and Garvan Institute of Medical Research, Sydney, Australia
| | | | | | - Marily Theodoropoulou
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig-Maximilians-Universität München, Germany
| | - Gerald Raverot
- Fédération d’Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, University of Lyon-Est de Lyon, Bron, France
| | - Olaf M Dekkers
- Department of Internal Medicine (Section Endocrinology) & Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
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14
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Arima H, Cheetham T, Christ-Crain M, Cooper DL, Drummond JB, Gurnell M, Levy M, McCormack A, Newell-Price JD, Verbalis JG, Wass J. Changing the Name of Diabetes Insipidus: A Position Statement of the Working Group to Consider Renaming Diabetes Insipidus. Horm Res Paediatr 2022; 96:423-425. [PMID: 36183693 PMCID: PMC10534955 DOI: 10.1159/000527139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Timothy Cheetham
- Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital (GNCH), Newcastle upon Tyne, UK
| | - Mirjam Christ-Crain
- Department of Endocrinology, University Hospital and University of Basel, Basel, Switzerland
| | | | - Juliana B. Drummond
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mark Gurnell
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Miles Levy
- Department of Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - John D. Newell-Price
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - Joseph G. Verbalis
- Georgetown-Howard Universities Center for Clinical and Translational Science, Georgetown University, Washington, District of Columbia, USA
| | - John Wass
- Department of Endocrinology, University of Oxford, Churchill Hospital, Oxford, UK
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15
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Arima H, Cheetham T, Christ-Crain M, Cooper D, Drummond J, Gurnell M, Levy M, McCormack A, Newell-Price J, Verbalis JG, Wass J. Changing the name of diabetes insipidus: a position statement of the working group to consider renaming diabetes insipidus. Clin Endocrinol (Oxf) 2022. [PMID: 36030512 DOI: 10.1111/cen.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Timothy Cheetham
- Newcastle University, Newcastle upon Tyne, UK
- Great North Children s Hospital (GNCH), Newcastle upon Tyne, UK
| | - Mirjam Christ-Crain
- Department of Endocrinology, University Hospital and University of Basel, Basel, Switzerland
| | | | - Juliana Drummond
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Mark Gurnell
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge & Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Miles Levy
- Department of Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent s Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - John Newell-Price
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - Joseph G Verbalis
- Georgetown-Howard Universities Center for Clinical and Translational Science, Georgetown University, Washington, DC, USA
| | - John Wass
- Department of Endocrinology, University of Oxford, Churchill Hospital, Oxford, UK
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16
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Seabrook A, Wijewardene A, De Sousa S, Wong T, Sheriff N, Gill AJ, Iyer R, Field M, Luxford C, Clifton-Bligh R, McCormack A, Tucker K. MEN4, the MEN1 Mimicker: A Case Series of three Phenotypically Heterogenous Patients With Unique CDKN1B Mutations. J Clin Endocrinol Metab 2022; 107:2339-2349. [PMID: 35323929 PMCID: PMC9282358 DOI: 10.1210/clinem/dgac162] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Indexed: 12/29/2022]
Abstract
CONTEXT Germline CDKN1B pathogenic variants result in multiple endocrine neoplasia type 4 (MEN4), an autosomal dominant hereditary tumor syndrome variably associated with primary hyperparathyroidism, pituitary adenoma, and duodenopancreatic neuroendocrine tumors. OBJECTIVE To report the phenotype of 3 unrelated cases each with a unique germline CDKN1B variant (of which 2 are novel) and compare these cases with those described in the current literature. DESIGN/METHODS Three case studies, including clinical presentation, germline, and tumor genetic analysis and family history. SETTING Two tertiary University Hospitals in Sydney, New South Wales, and 1 tertiary University Hospital in Canberra, Australian Capital Territory, Australia. OUTCOME Phenotype of the 3 cases and their kindred; molecular analysis and tumor p27kip1 immunohistochemistry. RESULTS Family A: The proband developed multiglandular primary hyperparathyroidism, a microprolactinoma and a multifocal nonfunctioning duodenopancreatic neuroendocrine tumor. Family B: The proband was diagnosed with primary hyperparathyroidism from a single parathyroid adenoma. Family C: The proband was diagnosed with a nonfunctioning pituitary microadenoma and ectopic Cushing's syndrome from an atypical thymic carcinoid tumor. Germline sequencing in each patient identified a unique variant in CDKN1B, 2 of which are novel (c.179G > A, p.Trp60*; c.475G > A, p.Asp159Asn) and 1 previously reported (c.374_375delCT, p.Ser125*). CONCLUSIONS Germline CDKN1B pathogenic variants cause the syndrome MEN4. The phenotype resulting from the 3 pathogenic variants described in this series highlights the heterogenous nature of this syndrome, ranging from isolated primary hyperparathyroidism to the full spectrum of endocrine manifestations. We report the first described cases of a prolactinoma and an atypical thymic carcinoid tumor in MEN4.
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Affiliation(s)
- Amanda Seabrook
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
- The University of Sydney, Sydney, NSW, 2006, Australia
| | - Ayanthi Wijewardene
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
- The University of Sydney, Sydney, NSW, 2006, Australia
| | - Sunita De Sousa
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, 5000
- South Australian Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Tang Wong
- The University of New South Wales, Sydney, NSW, 2052, Australia
- The University of Western Sydney, Sydney, NSW, 2560, Australia
- Department of Endocrinology, Prince of Wales Hospital, Sydney, NSW, 2064, Australia
| | - Nisa Sheriff
- Department of Endocrinology, Hornsby Ku-ring-gai Hospital, Sydney, NSW, 2077, Australia
| | - Anthony J Gill
- The University of Sydney, Sydney, NSW, 2006, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, 2064, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, 2064, Australia
| | - Rakesh Iyer
- Calvary Public Hospital, Canberra, ACT, 2617, Australia
| | - Michael Field
- Familial Cancer Service, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Catherine Luxford
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
- The University of Sydney, Sydney, NSW, 2006, Australia
| | | | | | - Katherine Tucker
- Correspondence: Katherine Tucker, MBBS, FRACP, AO, Hereditary Cancer Service Nelune Comprehensive Cancer Centre (Bright Building), 64-66 High St, Randwick, NSW, 2031, Australia.
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17
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Latif N, Sarathchandra P, McCormack A, Yacoub MH, Chester AH. Atypical Expression of Smooth Muscle Markers and Co-activators and Their Regulation in Rheumatic Aortic and Calcified Bicuspid Valves. Front Cardiovasc Med 2022; 9:793666. [PMID: 35369286 PMCID: PMC8968087 DOI: 10.3389/fcvm.2022.793666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Objective We have previously reported that human calcified aortic cusps have abundant expression of smooth muscle (SM) markers and co-activators. We hypothesised that cells in bicuspid aortic valve (BAV) cusps and those affected by rheumatic heart valve (RHV) disease may follow a similar phenotypic transition into smooth muscle cells, a process that could be regulated by transforming growth factors (TGFs). Aims Cusps from eight patients with BAV and seven patients with RHV were analysed for early and late SM markers and regulators of SM gene expression by immunocytochemistry and compared to healthy aortic valves from 12 unused heart valve donors. The ability of TGFs to induce these markers in valve endothelial cells (VECs) on two substrates was assessed. Results In total, 7 out of 8 BAVs and all the RHVs showed an increased and atypical expression of early and late SM markers α-SMA, calponin, SM22 and SM-myosin. The SM marker co-activators were aberrantly expressed in six of the BAV and six of the RHV, in a similar regional pattern to the expression of SM markers. Additionally, regions of VECs, and endothelial cells lining the vessels within the cusps were found to be positive for SM markers and co-activators in three BAV and six RHV. Both BAVs and RHVs were significantly thickened and HIF1α expression was prominent in four BAVs and one RHV. The ability of TGFβs to induce the expression of SM markers and myocardin was greater in VECs cultured on fibronectin than on gelatin. Fibronectin was shown to be upregulated in BAVs and RHVs, within the cusps as well as in the basement membrane. Conclusion Bicuspid aortic valves and RHVs expressed increased numbers of SM marker-positive VICs and VECs. Concomittantly, these cells expressed MRTF-A and myocardin, key regulators of SM gene expression. TGFβ1 was able to preferentially upregulate SM markers and myocardin in VECs on fibronectin, and fibronectin was found to be upregulated in BAVs and RHVs. These findings suggest a role of VEC as a source of cells that express SM cell markers in BAVs and RHVs. The similarity between SM marker expression in BAVs and RHVs with our previous study with cusps from patients with aortic stenosis suggests the existance of a common pathological pathway between these different pathologies.
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Affiliation(s)
- Najma Latif
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- *Correspondence: Najma Latif,
| | | | - Ann McCormack
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
| | - Magdi H. Yacoub
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Adrian H. Chester
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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18
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Tikekar A, De Vicente F, McCormack A, Thomson D, Farrell M, Carmichael S, Chase D. Retrospective comparison of outcomes following tibial plateau leveling osteotomy and lateral fabello-tibial suture stabilisation of cranial cruciate ligament disease in small dogs with high tibial plateau angles. N Z Vet J 2022; 70:218-227. [DOI: 10.1080/00480169.2022.2052992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A Tikekar
- Veterinary Specialists Auckland, Mount Albert, Auckland, New Zealand
| | - F De Vicente
- Pride Veterinary Specialists, Derby, Derbyshire, UK
| | | | - D Thomson
- Chester Gates Veterinary Referrals, Chester, Cheshire, UK
| | | | - S Carmichael
- School of Veterinary Medicine, University of Surrey, Guildford, Surrey, UK
| | - D Chase
- Veterinary Specialists Auckland, Mount Albert, Auckland, New Zealand
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19
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Tritos NA, Fazeli PK, McCormack A, Mallea-Gil SM, Pineyro MM, Christ-Crain M, Frara S, Labadzhyan A, Ioachimescu AG, Shimon I, Takahashi Y, Gurnell M, Fleseriu M. Pituitary Society Delphi Survey: An international perspective on endocrine management of patients undergoing transsphenoidal surgery for pituitary adenomas. Pituitary 2022; 25:64-73. [PMID: 34283370 PMCID: PMC8294287 DOI: 10.1007/s11102-021-01170-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE In adults and children, transsphenoidal surgery (TSS) represents the cornerstone of management for most large or functioning sellar lesions with the exception of prolactinomas. Endocrine evaluation and management are an essential part of perioperative care. However, the details of endocrine assessment and care are not universally agreed upon. METHODS To build consensus on the endocrine evaluation and management of adults undergoing TSS, a Delphi process was used. Thirty-five statements were developed by the Pituitary Society's Education Committee. Fifty-five pituitary endocrinologists, all members of the Pituitary Society, were invited to participate in two Delphi rounds and rate their extent of agreement with statements pertaining to perioperative endocrine evaluation and management, using a Likert-type scale. Anonymized data on the proportion of panelists' agreeing with each item were summarized. A list of items that achieved consensus, based on predefined criteria, was tabulated. RESULTS Strong consensus (≥ 80% of panelists rating their agreement as 6-7 on a scale from 1 to 7) was achieved for 68.6% (24/35) items. If less strict agreement criteria were applied (ratings 5-7 on the Likert-type scale), consensus was achieved for 88% (31/35) items. CONCLUSIONS We achieved consensus on a large majority of items pertaining to perioperative endocrine evaluation and management using a Delphi process. This provides an international real-world clinical perspective from an expert group and facilitates a framework for future guideline development. Some of the items for which consensus was not reached, including the assessment of immediate postoperative remission in acromegaly or Cushing's disease, represent areas where further research is needed.
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Affiliation(s)
| | | | - Ann McCormack
- Garvan Institute of Medical Research, Darlinghurst, Australia
| | | | - Maria M. Pineyro
- Hospital de Clinicas, Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
| | | | | | | | | | | | | | - Mark Gurnell
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Box 289, Cambridge, CB2 0QQ UK
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20
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Tseng YT, Grace NF, Aguib H, Sarathchandra P, McCormack A, Ebeid A, Shehata N, Nagy M, El-Nashar H, Yacoub MH, Chester A, Latif N. Biocompatibility and Application of Carbon Fibers in Heart Valve Tissue Engineering. Front Cardiovasc Med 2022; 8:793898. [PMID: 35004904 PMCID: PMC8739227 DOI: 10.3389/fcvm.2021.793898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
The success of tissue-engineered heart valves rely on a balance between polymer degradation, appropriate cell repopulation, and extracellular matrix (ECM) deposition, in order for the valves to continue their vital function. However, the process of remodeling is highly dynamic and species dependent. The carbon fibers have been well used in the construction industry for their high tensile strength and flexibility and, therefore, might be relevant to support tissue-engineered hearts valve during this transition in the mechanically demanding environment of the circulation. The aim of this study was to assess the suitability of the carbon fibers to be incorporated into tissue-engineered heart valves, with respect to optimizing their cellular interaction and mechanical flexibility during valve opening and closure. The morphology and surface oxidation of the carbon fibers were characterized by scanning electron microscopy (SEM). Their ability to interact with human adipose-derived stem cells (hADSCs) was assessed with respect to cell attachment and phenotypic changes. hADSCs attached and maintained their expression of stem cell markers with negligible differentiation to other lineages. Incorporation of the carbon fibers into a stand-alone tissue-engineered aortic root, comprised of jet-sprayed polycaprolactone aligned carbon fibers, had no negative effects on the opening and closure characteristics of the valve when simulated in a pulsatile bioreactor. In conclusion, the carbon fibers were found to be conducive to hADSC attachment and maintaining their phenotype. The carbon fibers were sufficiently flexible for full motion of valvular opening and closure. This study provides a proof-of-concept for the incorporation of the carbon fibers into tissue-engineered heart valves to continue their vital function during scaffold degradation.
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Affiliation(s)
- Yuan-Tsan Tseng
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom.,Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Nabil F Grace
- Centre for Innovative Materials Research, Lawrence Technological University, Southfield, MI, United States
| | - Heba Aguib
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom.,Imperial College London, National Heart and Lung Institute, London, United Kingdom.,Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | | | - Ann McCormack
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
| | - Ahmed Ebeid
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | - Nairouz Shehata
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | - Mohamed Nagy
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | - Hussam El-Nashar
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | - Magdi H Yacoub
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom.,Imperial College London, National Heart and Lung Institute, London, United Kingdom.,Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | - Adrian Chester
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom.,Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Najma Latif
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom.,Imperial College London, National Heart and Lung Institute, London, United Kingdom
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21
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Stroud A, Dhaliwal P, Harvey RJ, Alvarado R, Jonker BP, Winder MJ, Grayson JW, McCormack A. Low but not undetectable early postoperative nadir serum cortisol predicts sustained remission in Cushing's disease. Endocr Oncol 2022; 2:19-31. [PMID: 37435446 PMCID: PMC10259300 DOI: 10.1530/eo-21-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 07/13/2023]
Abstract
Objective Transsphenoidal surgery (TSS) is the first-line treatment for Cushing's disease. The objectives of the study were to determine remission and recurrence rates after TSS for Cushing's disease, identify factors that predict these outcomes, and define the threshold for postoperative morning serum cortisol (MSeC) that most accurately predicts sustained remission. Methods Records were retrospectively reviewed for consecutive adults undergoing TSS for Cushing's disease at a tertiary centre (1990-2019). Remission was defined as MSeC <138 nmol/L by 6 weeks postoperatively. Recurrence was defined as elevated 24-h urine free cortisol, lack of suppression after dexamethasone or elevated midnight salivary cortisol. Results In this study, 42 patients (age 47 ± 13 years, 83% female) were assessed with 55 ± 56 months of follow-up. Remission occurred after 77% of primary (n = 30) and 42% of revision operations (n = 12). After primary surgery, remission was associated with lower MSeC nadir (26 ± 36 nmol/L vs 347 ± 220 nmol/L, P < 0.01) and lower adrenocorticotropin nadir (2 ± 3 pmol/L vs 6 ± 3 pmol/L, P = 0.01). Sustained remission 5 years after surgery was predicted by MSeC <92 nmol/L within 2 weeks postoperatively (sensitivity 100% and specificity 100%). After revision surgery, remission was predicted by lower MSeC nadir (70 ± 45 nmol/L vs 408 ± 305 nmol/L, P = 0.03), smaller tumour diameter (3 ± 2 mm vs 15 ± 13 mm, P = 0.05) and absence of cavernous sinus invasion (0% vs 71%, P = 0.03). Recurrence after primary and revision surgery occurred in 17% and 20% of patients respectively. Conclusions Lower postoperative MSeC nadir strongly predicted remission after both primary and revision surgery. Following primary surgery, an MSeC <92 nmol/L within 2 weeks predicted sustained remission at 5 years. MSeC nadir was the most important prognostic marker following TSS for Cushing's disease.
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Affiliation(s)
- Anna Stroud
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, Sydney, Australia
- St Vincent’s Hospital Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Pearl Dhaliwal
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, Sydney, Australia
- St Vincent’s Hospital Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, Sydney, Australia
| | - Benjamin P Jonker
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, Notre Dame University, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mark J Winder
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, Sydney, Australia
- St Vincent’s Hospital Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - Jessica W Grayson
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, Sydney, Australia
- Department of Otolaryngology Head and Neck Surgery, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Ann McCormack
- St Vincent’s Hospital Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
- Department of Endocrinology, St Vincent’s Hospital, Sydney, Australia
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22
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Fleseriu M, Auchus R, Bancos I, Ben-Shlomo A, Bertherat J, Biermasz NR, Boguszewski CL, Bronstein MD, Buchfelder M, Carmichael JD, Casanueva FF, Castinetti F, Chanson P, Findling J, Gadelha M, Geer EB, Giustina A, Grossman A, Gurnell M, Ho K, Ioachimescu AG, Kaiser UB, Karavitaki N, Katznelson L, Kelly DF, Lacroix A, McCormack A, Melmed S, Molitch M, Mortini P, Newell-Price J, Nieman L, Pereira AM, Petersenn S, Pivonello R, Raff H, Reincke M, Salvatori R, Scaroni C, Shimon I, Stratakis CA, Swearingen B, Tabarin A, Takahashi Y, Theodoropoulou M, Tsagarakis S, Valassi E, Varlamov EV, Vila G, Wass J, Webb SM, Zatelli MC, Biller BMK. Consensus on diagnosis and management of Cushing's disease: a guideline update. Lancet Diabetes Endocrinol 2021; 9:847-875. [PMID: 34687601 PMCID: PMC8743006 DOI: 10.1016/s2213-8587(21)00235-7] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 12/19/2022]
Abstract
Cushing's disease requires accurate diagnosis, careful treatment selection, and long-term management to optimise patient outcomes. The Pituitary Society convened a consensus workshop comprising more than 50 academic researchers and clinical experts to discuss the application of recent evidence to clinical practice. In advance of the virtual meeting, data from 2015 to present about screening and diagnosis; surgery, medical, and radiation therapy; and disease-related and treatment-related complications of Cushing's disease summarised in recorded lectures were reviewed by all participants. During the meeting, concise summaries of the recorded lectures were presented, followed by small group breakout discussions. Consensus opinions from each group were collated into a draft document, which was reviewed and approved by all participants. Recommendations regarding use of laboratory tests, imaging, and treatment options are presented, along with algorithms for diagnosis of Cushing's syndrome and management of Cushing's disease. Topics considered most important to address in future research are also identified.
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Affiliation(s)
| | | | | | | | - Jerome Bertherat
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares de la Surrénale, Service d'Endocrinologie, Hôpital Cochin, Paris, France
| | - Nienke R Biermasz
- Leiden University Medical Center and European Reference Center for Rare Endocrine Conditions (Endo-ERN), Leiden, Netherlands
| | | | | | | | - John D Carmichael
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Felipe F Casanueva
- Santiago de Compostela University and Ciber OBN, Santiago de Compostela, Spain
| | - Frederic Castinetti
- Aix Marseille Université, Marseille Medical Genetics, INSERM, Marseille, France; Assistance Publique Hopitaux de Marseille, Marseille, France; Department of Endocrinology, La Conception Hospital, Marseille, France
| | - Philippe Chanson
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Mônica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliza B Geer
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Ashley Grossman
- University of London, London, UK; University of Oxford, Oxford, UK
| | - Mark Gurnell
- University of Cambridge, Cambridge, UK; NIHR Cambridge Biomedical Research Center, Cambridge, UK; Addenbrooke's Hospital, Cambridge, UK
| | - Ken Ho
- The Garvan Institute of Medical Research, Sydney, NSW, Australia
| | | | - Ursula B Kaiser
- Brigham & Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - André Lacroix
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Ann McCormack
- The Garvan Institute of Medical Research, Sydney, NSW, Australia
| | | | - Mark Molitch
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Alberto M Pereira
- Leiden University Medical Center and European Reference Center for Rare Endocrine Conditions (Endo-ERN), Leiden, Netherlands
| | - Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg, Germany and University of Duisburg-Essen, Essen, Germany
| | | | - Hershel Raff
- Medical College of Wisconsin, Milwaukee, WI, USA; Advocate Aurora Research Institute, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Martin Reincke
- Department of Medicine IV, University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
| | | | | | - Ilan Shimon
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | | | - Antoine Tabarin
- CHU de Bordeaux, Hôpital Haut Lévêque, University of Bordeaux, Bordeaux, France
| | | | - Marily Theodoropoulou
- Department of Medicine IV, University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Elena Valassi
- Endocrinology Unit, Hospital General de Catalunya, Barcelona, Spain; Research Center for Pituitary Diseases (CIBERER Unit 747), Hospital Sant Pau, Barcelona, Spain
| | | | - Greisa Vila
- Medical University of Vienna, Vienna, Austria
| | - John Wass
- Churchill Hospital, Oxford, United Kingdom
| | - Susan M Webb
- Research Center for Pituitary Diseases (CIBERER Unit 747), Hospital Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Abstract
CD4+ T cells expressing choline acetyltransferase (ChAT) have recently been shown to cause a drop in systemic blood pressure when infused into mice. The aim of this study was to determine if ChAT-expressing T cells could regulate coronary vascular reactivity. Preconstricted segments of epicardial and intramyocardial porcine coronary arteries relaxed in response to Jurkat T cells (JT) that overexpressed ChAT (JTChAT cells). The efficacy of the JTChAT cells was similar in epicardial and intramyocardial vessels with a maximum dilator response to 3 × 105 cells/mL of 38.0 ± 6.7% and 38.7 ± 7.25%, respectively. In contrast, nontransfected JT cells elicited a weak dilator response, followed by a weak contraction. The response of JTChAT cells was dependent on the presence of the endothelial cells. In addition, the response could be significantly reduced by Nω-nitro-l-arginine methyl ester (l-NAME) and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) in the presence of indomethacin. JTChAT cells, but not JT cells, increased the expression of phosphorylated endothelial nitric oxide synthase (eNOS). JTChAT cells contained significantly greater levels of acetylcholine compared with JT cells; however, the nonselective muscarinic antagonist atropine and the M1 receptor antagonist pirenzepine both failed to block the dilator effect of JTChAT cells. Exogenously added acetylcholine induced only a weak relaxation (∼10%) at low concentrations, which became a contractile response at higher concentrations. These data illustrate the capacity for cells that express ChAT to regulate coronary vascular reactivity, via mechanisms that are dependent on interaction with the endothelium and in part mediated by the release of nitric oxide.NEW & NOTEWORTHY This study shows ChAT-expressing T cells can induce vasodilation of the blood vessel in the coronary circulation and that this effect relies on a direct interaction between T cells and the coronary vascular endothelium. The study establishes a potential immunomodulatory role for T cells in the coronary circulation. The present findings offer an additional possibility that a deficiency of ChAT-expressing T cells could contribute to reduced coronary blood flow and ischemic events in the myocardium.
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Affiliation(s)
- Adrian H Chester
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ann McCormack
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
| | | | - Mohamed N Ahmed
- Department of Pediatrics, Steele Children's Research Center, The University of Arizona College of Medicine, Tucson, Arizona
| | - Magdi H Yacoub
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
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24
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Chester AH, Sarathchandra P, McCormack A, Yacoub MH. Organ Culture Model of Aortic Valve Calcification. Front Cardiovasc Med 2021; 8:734692. [PMID: 34660737 PMCID: PMC8517236 DOI: 10.3389/fcvm.2021.734692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/02/2021] [Indexed: 01/10/2023] Open
Abstract
A significant amount of knowledge has been gained with the use of cell-based assays to elucidate the mechanisms that mediate heart valve calcification. However, cells used in these studies lack their association with the extra-cellular matrix or the influence of other cellular components of valve leaflets. We have developed a model of calcification using intact porcine valve leaflets, that relies upon a biological stimulus to drive the formation of calcified nodules within the valve leaflets. Alizarin Red positive regions were formed in response to lipopolysaccharide and inorganic phosphate, which could be quantified when viewed under polarized light. Point analysis and elemental mapping analysis of electron microscope images confirmed the presence of nodules containing calcium and phosphorus. Immunohistochemical staining showed that the development of these calcified regions corresponded with the expression of RUNX2, osteocalcin, NF-kB and the apoptosis marker caspase 3. The formation of calcified nodules and the expression of bone markers were both inhibited by adenosine in a concentration-dependent manner, illustrating that the model is amenable to pharmacological manipulation. This organ culture model offers an increased level of tissue complexity in which to study the mechanisms that are involved in heart valve calcification.
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Affiliation(s)
- Adrian H Chester
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom.,National Heart & Lung Institute, Imperial College, Imperial College London, London, United Kingdom
| | - Padmini Sarathchandra
- National Heart & Lung Institute, Imperial College, Imperial College London, London, United Kingdom
| | - Ann McCormack
- National Heart & Lung Institute, Imperial College, Imperial College London, London, United Kingdom
| | - Magdi H Yacoub
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom.,National Heart & Lung Institute, Imperial College, Imperial College London, London, United Kingdom
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25
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McCormack A. Childhood-onset prolactinomas-Should earlier surgery be considered? Clin Endocrinol (Oxf) 2021; 95:571-573. [PMID: 33876444 DOI: 10.1111/cen.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia
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26
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Chang N, Grayson JW, Mangussi-Gomes J, Fung S, Alvarado R, Winder M, Jonker BP, McCormack A, Harvey RJ. Assessment of magnetic resonance imaging criteria for the diagnosis of cavernous sinus invasion by pituitary tumors. J Clin Neurosci 2021; 90:262-267. [PMID: 34275561 DOI: 10.1016/j.jocn.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/30/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
Cavernous sinus invasion (CSI) by pituitary tumors is associated with subtotal resection and persistent endocrinopathy. The Knosp classification is a magnetic resonance imaging (MRI) tool used to define CSI in the 2017 World Health Organization Classification. However, alternative criteria may have superior diagnostic performance. This study aimed to assess the diagnostic performance of four MRI criteria, using a combination of endoscopy and day 1 MRI as the reference standard for CSI. A cross-sectional study was conducted including patients treated with endoscopic endonasal transsphenoidal surgery for pituitary macroadenomas, recruited from a tertiary pituitary multidisciplinary center in Sydney, Australia between September 2013, and February 2021. The diagnostic performances of four MRI criteria were assessed: the Knosp criteria, percentage encasement of the internal carotid (PEICA), venous compartment obliteration (VCO), and the Fernandez-Miranda classification. Reference CSI was defined using a combination of intraoperative endoscopy and day 1 MRI. A total of 210 cavernous sinuses (105 patients), were analyzed, (51.7 ± 16.3yrs, 43% female), of which 18% had CSI. CSI was best diagnosed by Knosp ≥ 2 (63% sensitivity and 89% specificity), PEICA ≥ 28% (84% sensitivity and 77% specificity) and VCO of ≥ 3 compartments (65% sensitivity and 89% specificity). CSI was unlikely if any of the following signs were present: Knosp < 1, PEICA < 28%, preservation of the medial or superior compartments or sparing of the superior Fernandez-Miranda compartment (negative predictive value 95%, 95%, 94%, 91% and 92% respectively). In conclusion, alternatives to the Knops criteria including PEICA and VCO can aid CSI diagnosis.
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Affiliation(s)
- Nicholas Chang
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.
| | - Jessica W Grayson
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Department of Otolaryngology Head and Neck Surgery, University of Alabama Birmingham, Birmingham, AL, USA
| | - João Mangussi-Gomes
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Sebastian Fung
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Mark Winder
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Benjamin P Jonker
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia; Garvan Institute of Medical Research, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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27
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Al-Shammari H, Latif N, Sarathchandra P, McCormack A, Rog-Zielinska EA, Raja S, Kohl P, Yacoub MH, Peyronnet R, Chester AH. Expression and function of mechanosensitive ion channels in human valve interstitial cells. PLoS One 2020; 15:e0240532. [PMID: 33057457 PMCID: PMC7561104 DOI: 10.1371/journal.pone.0240532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/28/2020] [Indexed: 11/21/2022] Open
Abstract
Background The ability of heart valve cells to respond to their mechanical environment represents a key mechanism by which the integrity and function of valve cusps is maintained. A number of different mechanotransduction pathways have been implicated in the response of valve cells to mechanical stimulation. In this study, we explore the expression pattern of several mechanosensitive ion channels (MSC) and their potential to mediate mechanosensitive responses of human valve interstitial cells (VIC). Methods MSC presence and function were probed using the patch clamp technique. Protein abundance of key MSC was evaluated by Western blotting in isolated fibroblastic VIC (VICFB) and in VIC differentiated towards myofibroblastic (VICMB) or osteoblastic (VICOB) phenotypes. Expression was compared in non-calcified and calcified human aortic valves. MSC contributions to stretch-induced collagen gene expression and to VIC migration were assessed by pharmacological inhibition of specific channels. Results Two MSC types were recorded in VICFB: potassium selective and cation non-selective channels. In keeping with functional data, the presence of both TREK-1 and Kir6.1 (potassium selective), as well as TRPM4, TRPV4 and TRPC6 (cationic non-selective) channels was confirmed in VIC at the protein level. Differentiation of VICFB into VICMB or VICOB phenotypes was associated with a lower expression of TREK-1 and Kir6.1, and a higher expression of TRPV4 and TRPC6. Differences in MSC expression were also seen in non-calcified vs calcified aortic valves where TREK-1, TRPM4 and TRPV4 expression were higher in calcified compared to control tissues. Cyclic stretch-induced expression of COL I mRNA in cultured VICFB was blocked by RN-9893, a selective inhibitor of TRPV4 channels while having no effect on the stretch-induced expression of COL III. VICFB migration was blocked with the non-specific MSC blocker streptomycin and by GSK417651A an inhibitor of TRPC6/3. Conclusion Aortic VIC express a range of MSC that play a role in functional responses of these cells to mechanical stimulation. MSC expression levels differ in calcified and non-calcified valves in ways that are in part compatible with the change in expression seen between VIC phenotypes. These changes in MSC expression, and associated alterations in the ability of VIC to respond to their mechanical environment, may form novel targets for intervention during aortic valvulopathies.
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Affiliation(s)
- Hessah Al-Shammari
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Najma Latif
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
| | | | - Ann McCormack
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
| | - Eva A. Rog-Zielinska
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Shahzad Raja
- Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Harefield, United Kingdom
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Magdi H. Yacoub
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
| | - Rémi Peyronnet
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg, Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Adrian H. Chester
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Heart Science Centre, Magdi Yacoub Institute, Harefield, United Kingdom
- * E-mail:
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28
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Stroud A, Dhaliwal P, Alvarado R, Winder MJ, Jonker BP, Grayson JW, Hamizan A, Harvey RJ, McCormack A. Outcomes of pituitary surgery for Cushing's disease: a systematic review and meta-analysis. Pituitary 2020; 23:595-609. [PMID: 32691356 DOI: 10.1007/s11102-020-01066-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Transsphenoidal surgery (TSS) is the first-line treatment for Cushing's disease (CD). This review aimed to synthesize the remission and recurrence rates following TSS for CD and identify predictors of these outcomes. METHODS Medline (1946-) and Embase (1947-) were searched until 23rd January 2019 for original studies. A meta-analysis was performed of remission and recurrence rates. Studies were excluded if patients had prior radiosurgery/radiotherapy, mixed pathologies or interventions without separated data, follow-up not reported or population size < 20. For recurrence rate syntheses, studies with follow-up < 6 months were excluded. RESULTS The search produced 2663 studies, of which n = 68 were included, involving 5664 patients. Remission rates after primary and revision TSS were 80% [77-82] and 58% [50-66] at last follow-up. After primary TSS, predictors of remission were micro- v macroadenomas (83% v 68%, p < 0.01), imaging-visible adenomas (81% v 69%, p < 0.01), adenomas confirmed on histopathology (87% v 45%, p < 0.01), absence of cavernous sinus invasion (80% v 30%, p < 0.01), postoperative serum cortisol (MSeC) nadir < 2 μg/dL (< 55 nmol/L; 95% v 46%, p < 0.01) and lower preoperative 24-h urine free cortisol (1250 nmol v 1726 nmol, p < 0.01). For revision TSS, predictors of remission were postoperative MSeC nadir < 2 μg/dL (< 55 nmol/L; 100% v 38%, p < 0.01) and operations for recurrence v persistence (80% v 54%, p < 0.01). Recurrence rates after primary and revision TSS were 18% [14-22] and 28% [16-42]. CONCLUSIONS TSS is most effective in primary microadenomas, visible on preoperative imaging and without CS invasion, lower preoperative 24-h urine free cortisol and postoperative MSeC nadir < 2 μg/dL (< 55 nmol/L).
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Affiliation(s)
- Anna Stroud
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.
- Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, NSW, Australia.
| | - Pearl Dhaliwal
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Mark J Winder
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Notre Dame University, Sydney, NSW, Australia
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Benjamin P Jonker
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jessica W Grayson
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | | | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Ann McCormack
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
- Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, NSW, Australia
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Fleseriu M, Buchfelder M, Cetas JS, Fazeli PK, Mallea-Gil SM, Gurnell M, McCormack A, Pineyro MM, Syro LV, Tritos NA, Marcus HJ. Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic-an international perspective. Pituitary 2020; 23:327-337. [PMID: 32556793 PMCID: PMC7300368 DOI: 10.1007/s11102-020-01059-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the viral strain that has caused the coronavirus disease 2019 (COVID-19) pandemic, has presented healthcare systems around the world with an unprecedented challenge. In locations with significant rates of viral transmission, social distancing measures and enforced 'lockdowns' are the new 'norm' as governments try to prevent healthcare services from being overwhelmed. However, with these measures have come important challenges for the delivery of existing services for other diseases and conditions. The clinical care of patients with pituitary disorders typically involves a multidisciplinary team, working in concert to deliver timely, often complex, disease investigation and management, including pituitary surgery. COVID-19 has brought about major disruption to such services, limiting access to care and opportunities for testing (both laboratory and radiological), and dramatically reducing the ability to safely undertake transsphenoidal surgery. In the absence of clinical trials to guide management of patients with pituitary disease during the COVID-19 pandemic, herein the Professional Education Committee of the Pituitary Society proposes guidance for continued safe management and care of this population.
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Affiliation(s)
- Maria Fleseriu
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA.
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Justin S Cetas
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Veterans Affairs Medical Center, Portland, OR, USA
| | - Pouneh K Fazeli
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susana M Mallea-Gil
- Division de Endocrinología, Hospital Militar Central, Buenos Aires, Argentina
| | - Mark Gurnell
- Addenbrooke's Hospital, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, UK.
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Maria M Pineyro
- Facultad de Medicina, Hospital de Clínicas, Clínica de Endocrinología Y Metabolismo, Universidad de La República, Montevideo, Uruguay
| | - Luis V Syro
- Department of Neurosurgery, Hospital Pablo Tobon Uribe and Clinica Medellin - Grupo Quirónsalud, Medellin, Colombia
| | - Nicholas A Tritos
- Neuroendocrine Unit and Neuroendocrine and Pituitary Tumor Clinical Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, London, UK
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30
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Wang M, Jonker B, Killen L, Bogum Y, McCormack A, Bishay RH. Fatal high-grade skull osteosarcoma 30 years following radiotherapy for Cushing's disease. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200062. [PMID: 32698127 PMCID: PMC7354738 DOI: 10.1530/edm-20-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 11/09/2022] Open
Abstract
SUMMARY Cushing's disease is a rare disorder characterised by excessive cortisol production as a consequence of a corticotroph pituitary tumour. While the primary treatment is surgical resection, post-operative radiation therapy may be used in cases of ongoing inadequate hormonal control or residual or progressive structural disease. Despite improved outcomes, radiotherapy for pituitary tumours is associated with hypopituitarism, visual deficits and, rarely, secondary malignancies. We describe an unusual case of a 67-year-old female with presumed Cushing's disease diagnosed at the age of 37, treated with transsphenoidal resection of a pituitary tumour with post-operative external beam radiotherapy (EBRT), ketoconazole for steroidogenesis inhibition, and finally bilateral adrenalectomy for refractory disease. She presented 30 years after her treatment with a witnessed generalised tonic-clonic seizure. Radiological investigations confirmed an extracranial mass infiltrating through the temporal bone and into brain parenchyma. Due to recurrent generalised seizures, the patient was intubated and commenced on dexamethasone and anti-epileptic therapy. Resection of the tumour revealed a high-grade osteoblastic osteosarcoma. Unfortunately, the patient deteriorated in intensive care and suffered a fatal cardiac arrest following a likely aspiration event. We describe the risk factors, prevalence and treatment of radiation-induced osteosarcoma, an exceedingly rare and late complication of pituitary irradiation. To our knowledge, this is the longest reported latency period between pituitary irradiation and the development of an osteosarcoma of the skull. LEARNING POINTS Cushing's disease is treated with transsphenoidal resection as first-line therapy, with radiotherapy used in cases of incomplete resection, disease recurrence or persistent hypercortisolism. The most common long-term adverse outcome of pituitary tumour irradiation is hypopituitarism occurring in 30-60% of patients at 10 years, and less commonly, vision loss and oculomotor nerve palsies, radiation-induced brain tumours and sarcomas. Currently proposed characteristics of radiation-induced osteosarcomas include: the finding of a different histological type to the primary tumour, has developed within or adjacent to the path of the radiation beam, and a latency period of at least 3 years. Treatment of osteosarcoma of the skull include complete surgical excision, followed by systemic chemotherapy and/or radiotherapy. Overall prognosis in radiation-induced sarcoma of bone is poor. Newer techniques such as stereotactic radiosurgery may reduce the incidence of radiation-induced malignancies.
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Affiliation(s)
- Mawson Wang
- Department of Endocrinology and Diabetes, Blacktown Hospital, Sydney, Australia
- Blacktown Clinical School, School of Medicine, Western Sydney University, Sydney, Australia
| | - Benjamin Jonker
- Department of Neurosurgery, St. Vincent’s Hospital, Sydney, Australia
| | - Louise Killen
- Department of Pathology, St. Vincent’s Hospital, Sydney, Australia
| | - Yvonne Bogum
- NSW Health Pathology East, Prince of Wales Hospital, Sydney, Australia
| | - Ann McCormack
- Department of Endocrinology, St. Vincent’s Hospital, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
- St. Vincent’s Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Ramy H Bishay
- Department of Endocrinology and Diabetes, Blacktown Hospital, Sydney, Australia
- Blacktown Clinical School, School of Medicine, Western Sydney University, Sydney, Australia
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Abstract
The use of temozolomide (TMZ) for the management of aggressive pituitary tumours (APT) has revolutionised clinical practice in this field with significantly improved clinical outcomes and long-term survival. Its use is now well established however a large number of patients do not respond to treatment and recurrence after cessation of TMZ is common. A number of challenges remain for clinicians such as appropriate patient selection, treatment duration and the role of combination therapy. This review will examine the use of TMZ to treat APT including mechanism of action, treatment regimen and duration; biomarkers predicting response to treatment and patient selection; and current evidence for administration of TMZ in combination with other agents.
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Affiliation(s)
- Pia Burman
- Department of Endocrinology, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Lydia Lamb
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia.
- Garvan Institute of Medical Research, Sydney, NSW, Australia.
- St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia.
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32
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Trouillas J, Jaffrain-Rea ML, Vasiljevic A, Dekkers O, Popovic V, Wierinckx A, McCormack A, Petersenn S, Burman P, Raverot G, Villa C. Are aggressive pituitary tumors and carcinomas two sides of the same coin? Pathologists reply to clinician's questions. Rev Endocr Metab Disord 2020; 21:243-251. [PMID: 32504268 DOI: 10.1007/s11154-020-09562-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pituitary adenohypophyseal tumors are considered as benign and termed "adenomas". However, many tumors are invasive and a proportion of these exhibit an "aggressive behavior" with premature death due to progressive growth. Only very rare (0.2%) tumors with metastases are considered malignant and termed "carcinomas". Taking into account this variability in behavior and the oncological definition, pathologists have proposed changing the term adenoma to tumor. Here we explain why use the term tumor instead of adenoma and identify tumor characteristics, associated with a high risk for poor prognosis. In a cohort of 125 tumors with aggressive behavior (APT) and 40 carcinomas with metastases (PC), clinical and pathological features were very similar. The comparison of this cohort (APT+PC) with a reference surgical cohort of 374 unselected patients clearly shows that the two cohorts differ greatly, especially the percentage of tumors with Ki67 ≥ 10% (35%vs3%; p < 0.001). A five-tiered prognostic classification, associating invasion and proliferation, identified grade 2b tumors (invasive and proliferative), with a high risk of recurrence/progression. Because half of the APT+ PC tumors have a Ki67 index ≥10%, and 80% of them show 2 or 3 positive markers of proliferation, we suggest that tumors that are clinically aggressive, invasive and highly proliferative with a Ki67 ≥ 10%, represent tumors with malignant potential. The percentage of grade 2b tumors, suspected of malignancy, which will become aggressive tumors or carcinomas is unknown. It is probably very low, but higher than 0.2% in surgical series. Early identification and active treatment of these aggressive tumors is needed to decrease morbidity and prolong survival.
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Affiliation(s)
- Jacqueline Trouillas
- University of Lyon 1, University of Lyon, F-69000, Lyon, France.
- Faculty of Medicine Lyon-Est, F-69372, Lyon, France.
| | - Marie-Lise Jaffrain-Rea
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
- Neuroendocrinology, Neuromed Institute, IRCCS, 86077, Pozzilli, Italy
| | - Alexandre Vasiljevic
- University of Lyon 1, University of Lyon, F-69000, Lyon, France
- Faculty of Medicine Lyon-Est, F-69372, Lyon, France
- Cancer Research Center of Lyon (CRCL), INSERM U1052, CNRS UMR5286, University of Lyon, 69008, Lyon, France
- Pathology Department, Groupement Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France
| | - Olaf Dekkers
- Department of Clinical Epidemiology and Endocrinology, Leids Universitair Medisch Centrum Ringgold Standard Institution, Leiden, Zuid-Holland, Netherlands
| | - Vera Popovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anne Wierinckx
- University of Lyon 1, University of Lyon, F-69000, Lyon, France
- Cancer Research Center of Lyon (CRCL), INSERM U1052, CNRS UMR5286, University of Lyon, 69008, Lyon, France
- ProfileXpert, SFR-Est, CNRS UMR-S3453, INSERM US7, Cedex, 69373, Lyon, France
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Hormone and Cancer Group, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Stephan Petersenn
- Endoc Center for Endocrine Tumors, Erik-Blumenfeld-Platz 27a, 22587, Hamburg, Germany
| | - Pia Burman
- Endocrinology, Skane university Hospital, Malmo, Sweden
- Endocrinology, University of Lund, Malmo, Sweden
| | - Gérald Raverot
- University of Lyon 1, University of Lyon, F-69000, Lyon, France
- Faculty of Medicine Lyon-Est, F-69372, Lyon, France
- Cancer Research Center of Lyon (CRCL), INSERM U1052, CNRS UMR5286, University of Lyon, 69008, Lyon, France
- Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, 59 Pinel Boulevard, 69677, Bron, France
- Fédération d'Endocrinologie Pôle Est, Groupement Hospitalier Est, 59 Boulevard Pinel, 69677, Bron, France
| | - Chiara Villa
- Pathology Department, Foch Hospital, 40 rue Worth, 92151, Suresnes, France
- INSERM U1016, CNRS UMR 8104, Cochin Institute, Paris Descartes University, rue du faubourg Saint-Jacques, 75014, Paris, France
- Endocrinology Department CHU de Liège, University of Liège, Sart Tilman B35, 4000, Liège, Belgium
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33
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Cho J, Grayson JW, Christensen J, Winder MJ, Sheehy J, Steel T, Bentivoglio P, Barham HP, McCormack A, Harvey RJ. Long-Term Sinonasal Function Following Transnasal Pituitary Surgery: A Comparison of Surgical Approach. Am J Rhinol Allergy 2020; 34:361-368. [PMID: 31918556 DOI: 10.1177/1945892419896788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Surgical approaches to the pituitary have undergone significant changes from transcranial, sublabial, direct transnasal microscopic, and now endoscopic. This study compares sinonasal outcomes from patients from these techniques. Methods A cross-sectional study of patients who underwent pituitary surgery in a tertiary setting was conducted. Patients were recruited via phone, mail, e-mail, and in person. Surveys with questions on nasal function, subsequent nasal treatment, the Nasal Symptom Score (NSS), Sinonasal Outcome Test-22 (SNOT-22), Chronic Sinusitis Survey (CSS), and Short Form 36 version 2 (SF-36v2) were obtained. Results A total of 252 surveys were sent, of which 165 were returned (65.48% response rate) and 16 were excluded (3 records destroyed, 13 transcranial approach). A total of 149 patients (age 60.10 ± 13.99 years, 47.83% female) were assessed with the following breakdown: sublabial (n = 69), transnasal microscopic (n = 28), and endoscopic (n = 52) approaches. Sublabial and transnasal microscopic, compared to endoscopic, had more sinus treatment (30.43%, 39.29%, and 15.38%; P = .05), medication use (28.99%, 32.14%, and 11.54%; P = .04), and new allergy symptoms (21.74%, 7.14%, and 1.92%; P < .01). Compared to sublabial and transnasal microscopic, endoscopic patients had superior NSSs (0.40 [1.00], 0.60 [1.75], and 0.20 [0.60]; P = .05), SNOT-22 total scores (1.02 ± 0.58, 1.40 ± 0.78, and 1.00 ± 0.59; P < .01), and CSS medication subscores (100.00 [8.33], 100.00 [8.33], and 100.00 [0.00]; P = .03). Endoscopic patients also reported superior SF-36v2 physical subscores (44.02 ± 11.14, 41.13 ± 9.86, and 47.60 ± 10.12; P = .03). Conclusion Nasal function was superior, and further sinus therapy and medication use was lower in patients with endoscopic approaches. Disease-specific quality of life was superior and the endoscopic approach resulted in reduced long-term sinonasal morbidity.
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Affiliation(s)
- Jemma Cho
- Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Jessica W Grayson
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Jenna Christensen
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Mark J Winder
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
| | - John Sheehy
- Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
| | - Tim Steel
- Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
| | - Peter Bentivoglio
- Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
| | - Henry P Barham
- Sinus and Nasal Specialists of Louisiana, Baton Rouge, Louisiana
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, Australia
- Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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34
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Grayson JW, Nayak A, Winder M, Jonker B, Alvarado R, Barham H, McCormack A, Harvey RJ. Multidisciplinary Team Care in the Surgical Management of Pituitary Adenoma. J Neurol Surg B Skull Base 2019; 82:295-302. [PMID: 34026405 DOI: 10.1055/s-0039-1700498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/13/2019] [Indexed: 12/24/2022] Open
Abstract
Objective Despite multidisciplinary care being commonly recommended, there remains limited evidence supporting its benefits in pituitary disease management. This study aimed to assess the impact of multidisciplinary care in pituitary surgery. Methods A retrospective cohort study was performed comparing pituitary surgery outcomes among consecutive patients within a quaternary referral center in 5 years before and after introduction of a multidisciplinary team (MDT). Primary outcomes were endocrine (transient diabetes insipidus [DI], syndrome of inappropriate antidiuretic hormone [SIADH], and new hypopituitarism) and surgical (cerebrospinal fluid [CSF] leak, epistaxis, intracranial hemorrhage, and meningitis) complications, length of hospital stay, and intrasellar residual tumor. Results 279 patients (89 pre-MDT vs. 190 post-MDT) were assessed (age 54 ± 17 years, 48% female). Nonfunctioning adenomas were most common (54%). In the post-MDT era, more clinically functioning tumors (42 vs. 28%, p = 0.03) were treated. Transient DI and SIADH occurred less often post-MDT (20 vs. 36%, p < 0.01 and 18 vs. 39%, p < 0.01), as well as new hypothyroidism (5 vs. 15, p < 0.01). Hospital stay was shorter post-MDT (5[3] vs. 7[5] days, p < 0.001) and intrasellar residuals were less common (8 vs. 35%, p < 0.001). Complications were more frequent pre-MDT independent of tumor size, hormone status, and surgical technique (odds ratio [OR] = 2.14 [1.05-4.32], p = 0.04). Conclusion Outcomes of pituitary surgery improved after the introduction of an MDT. Pituitary MDTs may benefit both patients and the health system by improving quality of care and reducing hospital stays.
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Affiliation(s)
- Jessica W Grayson
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Agnish Nayak
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Mark Winder
- Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
| | - Benjamin Jonker
- Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia.,Department of Neurosurgery, Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Brain and Mind Centre, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Henry Barham
- Sinus and Nasal Specialists of Louisiana, Louisiana, United States
| | - Ann McCormack
- Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Endocrinology, St Vincent's Hospital, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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35
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Stroud A, Zhang J, McCormack A. Diagnosing Cushing's disease in the context of chronic kidney disease: a case report and literature review. Eur J Endocrinol 2019; 181:K29-K35. [PMID: 31382242 DOI: 10.1530/eje-19-0326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/05/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The diagnosis of Cushing's disease (CD) is particularly challenging in patients with chronic kidney disease (CKD) due to abnormalities of the hypothalamo-pituitary-adrenal axis associated with the latter. This case report presents discrepant biochemical findings in a patient with CKD who was subsequently diagnosed with CD, and outlines principles which may guide the definitive diagnosis of CD in this context. METHODS The case of a patient with Stage 4 CKD who underwent transsphenoidal surgery for pituitary-dependent CD is presented. A literature review was conducted to identify similar cases and characterise features of hypothalamo-pituitary-adrenal axis dysfunction in CKD. RESULTS The patient discussed herein presented with markedly elevated plasma adrenocorticotrophic hormone (ACTH) due to a pituitary macroadenoma, with normal 24-h urine free cortisol (24-UFC) but abnormal overnight dexamethasone suppression testing and elevated midnight salivary cortisol. He experienced biochemical remission after undergoing transsphenoidal adenomectomy. A literature review revealed that CKD can be associated with elevated serum cortisol, reduced UFC and elevated plasma ACTH. Only four other cases of CD being diagnosed in a patient with CKD have been published. The loss of a circadian rhythm of cortisol secretion was the most common feature among all cases. CONCLUSIONS To establish a definitive diagnosis of CD in the context of pre-existing CKD, the absence of circadian rhythms of cortisol and ACTH is a more sensitive indicator than 24-UFC and low-dose dexamethasone suppression testing.
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Affiliation(s)
- Anna Stroud
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - John Zhang
- St Vincent's Hospital, Sydney, Australia
| | - Ann McCormack
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
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36
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Wade AJ, McCormack A, Roder C, McDonald K, Davies M, Scott N, Wardrop M, Athan E, Hellard ME. Aiming for elimination: Outcomes of a consultation pathway supporting regional general practitioners to prescribe direct-acting antiviral therapy for hepatitis C. J Viral Hepat 2018; 25:1089-1098. [PMID: 29660212 DOI: 10.1111/jvh.12910] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 03/01/2018] [Indexed: 12/09/2022]
Abstract
To increase access to treatment, the Australian government enabled general practitioners (GPs) to prescribe direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV)-in consultation with a specialist if inexperienced in HCV management. This study describes the establishment and outcomes of a remote consultation pathway supporting GPs to treat HCV. Key stakeholders from primary and tertiary healthcare services in the Barwon South Western region developed and implemented an HCV remote consultation pathway. Pharmaceutical Benefits Schedule prescription data were used to evaluate GP DAA prescription 12 months pre-and post- pathway implementation. A retrospective review of patients referred for remote consultation for 12 months post- pathway inception was undertaken to determine the care cascade. HCV treatment initiation by GPs increased after implementation of the remote consultation pathway. In the 12-month study period, 74 GPs referred 169 people for remote consultation; 114 (67%) were approved for GP DAA treatment; 48 (28%) were referred for specialist assessment. In total, 119 (71%) patients commenced DAA; 69 were eligible for SVR12 assessment. Post-treatment HCV RNA data were available for 52 (75%) people; 37 achieved SVR12; 15 achieved SVR ranging from week 5 to 11 post-treatment. No treatment failure was detected. Collaborative development and implementation of a remote consultation pathway has engaged regional GPs in managing HCV. Follow-up post-treatment could be improved; however, no treatment failure has been documented. To eliminate HCV as a public health threat, it is vital that specialists support GPs to prescribe DAA.
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Affiliation(s)
- A J Wade
- Department of Infectious Disease, Barwon Health, Geelong, Vic., Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - A McCormack
- School of Medicine, Deakin University, Geelong, Vic., Australia
| | - C Roder
- School of Medicine, Deakin University, Geelong, Vic., Australia
| | - K McDonald
- Western Victoria Primary Health Network, Geelong, Vic., Australia
| | - M Davies
- Western Victoria Primary Health Network, Geelong, Vic., Australia.,Drug and Alcohol Services, Barwon Health, Geelong, Vic., Australia
| | - N Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia
| | - M Wardrop
- Department of Infectious Disease, Barwon Health, Geelong, Vic., Australia
| | - E Athan
- Department of Infectious Disease, Barwon Health, Geelong, Vic., Australia.,School of Medicine, Deakin University, Geelong, Vic., Australia
| | - M E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Trouillas J, Burman P, McCormack A, Petersenn S, Popovic V, Dekkers O, Raverot G. Aggressive pituitary tumours and carcinomas: two sides of the same coin? Eur J Endocrinol 2018; 178:C7-C9. [PMID: 29588294 DOI: 10.1530/eje-18-0250] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 11/08/2022]
Abstract
The European Society of Endocrinology (ESE) survey reported on the largest cohort of 125 aggressive pituitary tumours (APT) and 40 pituitary carcinomas (PC). Whilst the survey focused on treatment effectiveness, all pathological data were not explored in detail. Here, we comment on some interesting pathological findings, notably the difference between APT and PC.
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Affiliation(s)
| | - Pia Burman
- Endocrinology, Skåne University Hospital, Malmo, Sweden
- Endocrinology, University of Lund, Malmo, Sweden
| | - Ann McCormack
- Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | | | - Vera Popovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olaf Dekkers
- Departments of Clinical Epidemiology and Endocrinology, Leids Universitair Medisch Centrum Ringgold Standard Institution, Leiden, Zuid-Holland, Netherlands
| | - Gerald Raverot
- Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
- Fédération d'Endocrinologie, Centre de Référence des Maladies Rares Hypophysaires HYPO, Hospices Civils de Lyon, Bron, France
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38
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Abstract
Non-functioning pituitary carcinomas (NFPC) are defined as tumours of adenophyseal origin with craniospinal or systemic dissemination, with the absence of a hormonal hypersecretion syndrome. These are a histologically heterogenous group of tumours, comprising gonadotroph, null cell, "silent" tumours of corticotroph, somatotroph or lactotroph cell lineages as well as plurihormonal Pit-1 tumours. NFPC are exceedingly rare, and hence few cases have been described. This review has identified 38 patients with NFPC reported in the literature. Recurrent invasive non-functioning pituitary adenomas (NFPA) were observed in a majority of patients. Various factors have been identified as markers of the potential for aggressive behaviour, including rapid tumour growth, growth after radiotherapy, gain or shift of hormone secretion and raised proliferative markers. Typically, there is a latency of several years from the original presentation with an NFPA to identification of metastases and only 5 cases reported with rapidly progressive malignant disease within 1 month of presentation. Therapeutic options include debulking surgery, radiation therapy and chemotherapy with temozolomide recommended as first line systemic treatment. Although long-term survivors are described, prognosis remains generally very poor (median survival 8 months). Improvements in molecular tumour profiling may assist in predicting tumour behaviour, guide therapeutic choices and identify novel therapies.
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Affiliation(s)
- Nèle Lenders
- Garvan Institute of Medical Research, Sydney, Australia
- Department of Endocrinology, St Vincent's Hospital, University of New South Wales, Sydney, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Ann McCormack
- Garvan Institute of Medical Research, Sydney, Australia.
- Department of Endocrinology, St Vincent's Hospital, University of New South Wales, Sydney, Australia.
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39
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McCormack A, Dekkers OM, Petersenn S, Popovic V, Trouillas J, Raverot G, Burman P. Treatment of aggressive pituitary tumours and carcinomas: results of a European Society of Endocrinology (ESE) survey 2016. Eur J Endocrinol 2018; 178:265-276. [PMID: 29330228 DOI: 10.1530/eje-17-0933] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/08/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To collect outcome data in a large cohort of patients with aggressive pituitary tumours (APT)/carcinomas (PC) and specifically report effects of temozolomide (TMZ) treatment. DESIGN Electronic survey to ESE members Dec 2015-Nov 2016. RESULTS Reports on 166 patients (40 PC, 125 APT, 1 unclassified) were obtained. Median age at diagnosis was 43 (range 4-79) years. 69% of the tumours were clinically functioning, and the most frequent immunohistochemical subtype were corticotroph tumours (45%). Ki-67 index did not distinguish APT from PC, median 7% and 10% respectively. TMZ was first-line chemotherapy in 157 patients. At the end of the treatment (median 9 cycles), radiological evaluation showed complete response (CR) in 6%, partial response (PR) in 31%, stable disease (SD) in 33% and progressive disease in 30%. Response was more frequent in patients receiving concomitant radiotherapy and TMZ. CR was seen only in patients with low MGMT expression. Clinically functioning tumours were more likely to respond than non-functioning tumours, independent of MGMT status. Of patients with CR, PR and SD, 25, 40 and 48% respectively progressed after a median of 12-month follow-up. Other oncological drugs given as primary treatment and to TMZ failures resulted in PR in 20%. CONCLUSION This survey confirms that TMZ is established as first-line chemotherapeutic treatment of APT/PC. Clinically functioning tumours, low MGMT and concurrent radiotherapy were associated with a better response. The limited long-term effect of TMZ and the poor efficacy of other drugs highlight the need to identify additional effective therapies.
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Affiliation(s)
- Ann McCormack
- St Vincent's Hospital and Garvan Institute of Medical Research, Sydney, Australia
| | - Olaf M Dekkers
- Department of Internal Medicine (Section Endocrinology) & Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Jacqueline Trouillas
- Centre de Pathologie et de Biologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Gerald Raverot
- Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université de Lyon, Bron, France
| | - Pia Burman
- Department of Endocrinology, Skåne University Hospital Malmö, University of Lund, Lund, Sweden
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40
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Raverot G, Burman P, McCormack A, Heaney A, Petersenn S, Popovic V, Trouillas J, Dekkers OM. European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol 2018; 178:G1-G24. [PMID: 29046323 DOI: 10.1530/eje-17-0796] [Citation(s) in RCA: 317] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pituitary tumours are common and easily treated by surgery or medical treatment in most cases. However, a small subset of pituitary tumours does not respond to standard medical treatment and presents with multiple local recurrences (aggressive pituitary tumours) and in rare occasion with metastases (pituitary carcinoma). The present European Society of Endocrinology (ESE) guideline aims to provide clinical guidance on diagnosis, treatment and follow-up in aggressive pituitary tumours and carcinomas. METHODS We decided upfront, while acknowledging that literature on aggressive pituitary tumours and carcinomas is scarce, to systematically review the literature according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The review focused primarily on first- and second-line treatment in aggressive pituitary tumours and carcinomas. We included 14 single-arm cohort studies (total number of patients = 116) most on temozolomide treatment (n = 11 studies, total number of patients = 106). A positive treatment effect was seen in 47% (95% CI: 36-58%) of temozolomide treated. Data from the recently performed ESE survey on aggressive pituitary tumours and carcinomas (165 patients) were also used as backbone for the guideline. SELECTED RECOMMENDATION: (i) Patients with aggressive pituitary tumours should be managed by a multidisciplinary expert team. (ii) Histopathological analyses including pituitary hormones and proliferative markers are needed for correct tumour classification. (iii) Temozolomide monotherapy is the first-line chemotherapy for aggressive pituitary tumours and pituitary carcinomas after failure of standard therapies; treatment evaluation after 3 cycles allows identification of responder and non-responder patients. (iv) In patients responding to first-line temozolomide, we suggest continuing treatment for at least 6 months in total. Furthermore, the guideline offers recommendations for patients who recurred after temozolomide treatment, for those who did not respond to temozolomide and for patients with systemic metastasis.
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Affiliation(s)
- Gerald Raverot
- Fédération d'Endocrinologie, Centre de Référence des Maladies Rares Hypophysaires HYPO, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
- INSERM U1052, CNRS UMR5286, Cancer Research Centre of Lyon, Lyon, France
| | - Pia Burman
- Department of Endocrinology, Skane University Hospital Malmö, University of Lund, Lund, Sweden
| | - Ann McCormack
- Garvan Institute, Sydney, Australia
- Department of Endocrinology, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Anthony Heaney
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Vera Popovic
- Medical Faculty, University Belgrade, Belgrade, Serbia
| | - Jacqueline Trouillas
- Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
- Centre de Pathologie et de Biologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Olaf M Dekkers
- Departments of Internal Medicine (Section Endocrinology) & Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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41
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Wade A, McCormack A, Roder C, McDonald K, Wardrop M, Athan E, Hellard M. P36 Outcomes of general practitioner prescription of direct acting antiviral therapy utilising a remote consultation referral pathway in Western Victoria. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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42
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Krishnamoorthy N, Tseng YT, Gajendrarao P, Sarathchandra P, McCormack A, Carubelli I, Sohier J, Latif N, Chester AH, Yacoub MH. A Strategy to Enhance Secretion of Extracellular Matrix Components by Stem Cells: Relevance to Tissue Engineering. Tissue Eng Part A 2017; 24:145-156. [PMID: 28467727 DOI: 10.1089/ten.tea.2017.0060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The ability of cells to secrete extracellular matrix proteins is an important property in the repair, replacement, and regeneration of living tissue. Cells that populate tissue-engineered constructs need to be able to emulate these functions. The motifs, KTTKS or palmitoyl-KTTKS (peptide amphiphile), have been shown to stimulate production of collagen and fibronectin in differentiated cells. Molecular modeling was used to design different forms of active peptide motifs to enhance the efficacy of peptides to increase collagen and fibronectin production using terminals KTTKS/SKTTK/SKTTKS connected by various hydrophobic linkers, V4A3/V4A2/A4G3. Molecular dynamic simulations showed SKTTKS-V4A3-SKTTKS (P3), with palindromic (SKTTKS) motifs and SKTTK-V4A2-KTTKS (P5), maintained structural integrity and favorable surface electrostatic distributions that are required for functionality. In vitro studies showed that peptides, P3 and P5, showed low toxicity to human adipose-derived stem cells (hADSCs) and significantly increased the production of collagen and fibronectin in a concentration-dependent manner compared with the original active peptide motif. The 4-day treatment showed that stem cell markers of hADSCs remained stable with P3. The molecular design of novel peptides is a promising strategy for the development of intelligent biomaterials to guide stem cell function for tissue engineering applications.
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Affiliation(s)
- Navaneethakrishnan Krishnamoorthy
- 1 Division of Cardiovascular Research (QCRC), Qatar Foundation, Sidra Medical and Research Centre , Doha, Qatar .,2 Division of Translational Medicine (Experimental Genetics), Sidra Medical and Research Centre , Doha, Qatar .,3 National Heart and Lung Institute, Heart Science Centre, Imperial College London , Middlesex, United Kingdom
| | - Yuan-Tsan Tseng
- 1 Division of Cardiovascular Research (QCRC), Qatar Foundation, Sidra Medical and Research Centre , Doha, Qatar .,3 National Heart and Lung Institute, Heart Science Centre, Imperial College London , Middlesex, United Kingdom
| | - Poornima Gajendrarao
- 1 Division of Cardiovascular Research (QCRC), Qatar Foundation, Sidra Medical and Research Centre , Doha, Qatar .,3 National Heart and Lung Institute, Heart Science Centre, Imperial College London , Middlesex, United Kingdom
| | - Padmini Sarathchandra
- 3 National Heart and Lung Institute, Heart Science Centre, Imperial College London , Middlesex, United Kingdom
| | - Ann McCormack
- 3 National Heart and Lung Institute, Heart Science Centre, Imperial College London , Middlesex, United Kingdom
| | - Ivan Carubelli
- 3 National Heart and Lung Institute, Heart Science Centre, Imperial College London , Middlesex, United Kingdom
| | - Jerome Sohier
- 4 INSERM U 791, Laboratory for Osteoarticular and Dental Tissue Engineering (LIOAD), University of Nantes , Nantes, France
| | - Najma Latif
- 3 National Heart and Lung Institute, Heart Science Centre, Imperial College London , Middlesex, United Kingdom
| | - Adrian H Chester
- 3 National Heart and Lung Institute, Heart Science Centre, Imperial College London , Middlesex, United Kingdom
| | - Magdi H Yacoub
- 1 Division of Cardiovascular Research (QCRC), Qatar Foundation, Sidra Medical and Research Centre , Doha, Qatar .,3 National Heart and Lung Institute, Heart Science Centre, Imperial College London , Middlesex, United Kingdom
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43
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McCormack A, Dekkers OM, Petersenn S, Popovic V, Trouillas J, Raverot G, Burman P. Use of temozolomide in a large cohort of patients with aggressive pituitary tumours and pituitary carcinomas: Results from a European Society of Endocrinology (ESE) survey. ACTA ACUST UNITED AC 2017. [DOI: 10.1530/endoabs.49.oc12.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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44
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Porras AM, van Engeland NCA, Marchbanks E, McCormack A, Bouten CVC, Yacoub MH, Latif N, Masters KS. Robust Generation of Quiescent Porcine Valvular Interstitial Cell Cultures. J Am Heart Assoc 2017; 6:JAHA.116.005041. [PMID: 28292746 PMCID: PMC5524027 DOI: 10.1161/jaha.116.005041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Valvular interstitial cells (VICs) in the healthy aortic valve leaflet exhibit a quiescent phenotype, with <5% of VICs exhibiting an activated phenotype. Yet, in vitro culture of VICs on tissue culture polystyrene surfaces in standard growth medium results in rapid transformation to an activated phenotype in >90% of cells. The inability to preserve a healthy VIC phenotype during in vitro studies has hampered the elucidation of mechanisms involved in calcific aortic valve disease. This study describes the generation of quiescent populations of porcine VICs in 2‐dimensional in vitro culture and their utility in studying valve pathobiology. Methods and Results Within 4 days of isolation from fresh porcine hearts, VICs cultured in standard growth conditions were predominantly myofibroblastic (activated VICs). This myofibroblastic phenotype was partially reversed within 4 days, and fully reversed within 9 days, following application of a combination of a fibroblast media formulation with culture on collagen coatings. Specifically, culture in this combination significantly reduced several markers of VIC activation, including proliferation, apoptosis, α‐smooth muscle actin expression, and matrix production, relative to standard growth conditions. Moreover, VICs raised in a fibroblast media formulation with culture on collagen coatings exhibited dramatically increased sensitivity to treatment with transforming growth factor β1, a known pathological stimulus, compared with VICs raised in either standard culture or medium with a fibroblast media formulation. Conclusions The approach using a fibroblast media formulation with culture on collagen coatings generates quiescent VICs that more accurately mimic a healthy VIC population and thus has the potential to transform the study of the mechanisms of VIC activation and dysfunction involved in the early stages of calcific aortic valve disease.
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Affiliation(s)
- Ana M Porras
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
| | - Nicole C A van Engeland
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Evelyn Marchbanks
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, CO
| | - Ann McCormack
- Tissue Engineering, Magdi Yacoub Institute, Imperial College, London, United Kingdom
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Magdi H Yacoub
- Tissue Engineering, Magdi Yacoub Institute, Imperial College, London, United Kingdom
| | - Najma Latif
- Tissue Engineering, Magdi Yacoub Institute, Imperial College, London, United Kingdom
| | - Kristyn S Masters
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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45
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McCormack A, Chegeni N, Chegini F, Colella A, Power J, Keating D, Chataway T. Purification of α-synuclein containing inclusions from human post mortem brain tissue. J Neurosci Methods 2016; 266:141-50. [DOI: 10.1016/j.jneumeth.2016.03.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 11/28/2022]
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46
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Shrosbree J, Pokorny A, Stone E, Epstein R, McCormack A, Greenfield JR. Ectopic Cushing syndrome due to neuroendocrine prostatic cancer. Intern Med J 2016; 46:630-2. [PMID: 27170243 DOI: 10.1111/imj.13063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/04/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- J Shrosbree
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - A Pokorny
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - E Stone
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - R Epstein
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - A McCormack
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - J R Greenfield
- St Vincent's Hospital, Sydney, New South Wales, Australia
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47
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McCormack A. Urine free cortisol measurement: Clinical perspective. Pathology 2016. [DOI: 10.1016/j.pathol.2015.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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48
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Latif N, Quillon A, Sarathchandra P, McCormack A, Lozanoski A, Yacoub MH, Chester AH. Modulation of human valve interstitial cell phenotype and function using a fibroblast growth factor 2 formulation. PLoS One 2015; 10:e0127844. [PMID: 26042674 PMCID: PMC4456368 DOI: 10.1371/journal.pone.0127844] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/21/2015] [Indexed: 12/04/2022] Open
Abstract
Valve interstitial cells (VICs) are fibroblastic in nature however in culture it is widely accepted that they differentiate into a myofibroblastic phenotype. This study assessed a fibroblast culture media formulation for its ability to maintain the phenotype and function of VICs as in the intact healthy valve. Normal human VICs were cultured separately in standard DMEM and in fibroblast media consisting of FGF2 (10ng/ml), insulin (50ng/ml) and 2% FCS for at least a week. Cell morphology, aspect ratio, size, levels and distribution of protein expression, proliferation, cell cycle, contraction and migration were assessed. Some VICs and some valve endothelial cells expressed FGF2 in valve tissue and this expression was increased in calcified valves. VICs in DMEM exhibited large, spread cells whereas VICs in fibroblast media were smaller, elongated and spindly. Aspect ratio and size were both significantly higher in DMEM (p<0.01). The level of expression of α-SMA was significantly reduced in fibroblast media at day 2 after isolation (p<0.01) and the expression of α-SMA, SM22 and EDA-fibronectin was significantly reduced in fibroblast media at days 7 and 12 post-isolation (p<0.01). Expression of cytoskeletal proteins, bone marker proteins and extracellular matrix proteins was reduced in fibroblast media. Proliferation of VICs in fibroblast media was significantly reduced at weeks 1 (p<0.05) and 2 (p<0.01). Collagen gel contraction was significantly reduced in fibroblast media (p<0.05). VICs were found to have significantly fewer and smaller focal adhesions in fibroblast media (p<0.01) with significantly fewer supermature focal adhesions in fibroblast media (p<0.001). Ultrastructurally, VICs in fibroblast media resembled native VICs from intact valves. VICs in fibroblast media demonstrated a slower migratory ability after wounding at 72 hours (p<0.01). Treatment of human VICs with this fibroblast media formulation has the ability to maintain and to dedifferentiate the VICs back to a fibroblastic phenotype with phenotypic and functional characteristics ascribed to cells in the intact valve. This methodology is fundamental in the study of normal valve biology, pathology and in the field of tissue engineering.
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Affiliation(s)
- Najma Latif
- Imperial College, Heart Science Centre, Harefield Hospital, Harefield, Middx, UB9 6JH, United Kingdom
- QCRC, Qatar Cardiovascular Research Centre, Qatar Foundation, Doha, Qatar
- * E-mail:
| | - Alfred Quillon
- Département de Biologie, École Normale Supérieure de Lyon, Université de Lyon, UCB Lyon1, 46 Allée d’Italie, Lyon, France
| | - Padmini Sarathchandra
- Imperial College, Heart Science Centre, Harefield Hospital, Harefield, Middx, UB9 6JH, United Kingdom
| | - Ann McCormack
- Imperial College, Heart Science Centre, Harefield Hospital, Harefield, Middx, UB9 6JH, United Kingdom
| | - Alec Lozanoski
- Imperial College, Heart Science Centre, Harefield Hospital, Harefield, Middx, UB9 6JH, United Kingdom
| | - Magdi H. Yacoub
- Imperial College, Heart Science Centre, Harefield Hospital, Harefield, Middx, UB9 6JH, United Kingdom
- QCRC, Qatar Cardiovascular Research Centre, Qatar Foundation, Doha, Qatar
| | - Adrian H. Chester
- Imperial College, Heart Science Centre, Harefield Hospital, Harefield, Middx, UB9 6JH, United Kingdom
- QCRC, Qatar Cardiovascular Research Centre, Qatar Foundation, Doha, Qatar
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49
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Trainer P, Newell-Price J, Ayuk J, Aylwin S, Rees A, Drake W, Chanson P, Brue T, Webb S, Fajardo C, Aller J, McCormack A, Torpy D, Tachas G, Atley L, Bidlingmaier M. A phase 2 study of antisense oligonucleotide therapy directed at the GH receptor demonstrates lowering of serum IGF1 in patients with acromegaly. ACTA ACUST UNITED AC 2015. [DOI: 10.1530/endoabs.37.gp.19.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Wong HH, Gounaris I, McCormack A, Berman M, Davidson D, Horan G, Pepke-Zaba J, Jenkins D, Earl HM, Hatcher HM. Presentation and management of pulmonary artery sarcoma. Clin Sarcoma Res 2015; 5:3. [PMID: 25628857 PMCID: PMC4307142 DOI: 10.1186/s13569-014-0019-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy that leads to heart failure and death without treatment. Here we reviewed the presentation and management of patients treated at a national centre for pulmonary endarterectomy (PEA) and its associated hospital in Cambridge, UK. METHODS Details of PAS patients treated at Papworth and Addenbrooke's Hospitals between 2000 and 2014 were reviewed. RESULTS Twenty patients were diagnosed with PAS (11 males, 9 females), with a median age of presentation of 57 years (range 27-77). Presenting symptoms include dyspnoea (20), chest pain/tightness (7), oedema (5), constitutional symptoms (5), cough (3) and haemoptysis (3). Twelve patients were in group III/IV of the NYHA functional classification of symptoms. Initial CT scans were suggestive of thromboembolism in seven patients. Histological findings were of intimal sarcoma (13) and high grade sarcoma NOS (6). Median overall survival (OS) was 17 months. Fourteen patients underwent PEA to relieve vascular obstruction, while six had inoperable and/or metastatic disease. There were three peri-operative deaths. Although there was no difference in median OS between patients who had PEA and those who did not (20 vs 17 months, P = 0.2488), surgery provided significant symptomatic improvement and some with long-term survival. Five patients received post-surgical chemotherapy (anthracycline +/- ifosfamide), and after completion four also had radiotherapy. Patients who received post-operative chemo- and radio-therapy showed a trend towards better survival compared to those who had surgery alone (24 vs 8 months, P = 0.3417). For palliative chemotherapy, partial responses were observed with the VID regimen and pegylated liposomal doxorubicin. Stable disease was achieved in a patient with intimal sarcoma with rhabdomyosarcomatous differentiation on third-line cisplatin and topotecan. The longest surviving patient (102 months) has had PEA, adjuvant epirubicin and radiotherapy. She developed lung metastases 7 years later, which were treated with radiofrequency ablation. CONCLUSIONS PAS often presents with symptoms mimicking pulmonary hypertension, heart failure or thromboembolic disease. PEA provides good symptomatic relief and in some cases, offers a chance of long-term survival. Although outcome appears to be better when PEA is combined with post-operative chemo- and radio-therapy, further studies are warranted.
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Affiliation(s)
- Han Hsi Wong
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 193, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Ioannis Gounaris
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 193, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Ann McCormack
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE UK
| | - Marius Berman
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE UK
| | - Dochka Davidson
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 193, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Gail Horan
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 193, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Joanna Pepke-Zaba
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE UK
| | - David Jenkins
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE UK
| | - Helena M Earl
- University of Cambridge Department of Oncology and NIHR Cambridge Biomedical Research Centre, Hills Road, Cambridge, CB2 0QQ UK
| | - Helen M Hatcher
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 193, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
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