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De Vincentis S, Brigante G, Ansaloni A, Madeo B, Zirilli L, Diazzi C, Belli S, Vezzani S, Simoni M, Rochira V. Value of repeated US-guided fine-needle aspiration (US-FNAB) in the follow-up of benign thyroid nodules: a real-life study based on the MoCyThy (Modena's Cytology of the Thyroid) DATABASE with a revision of the literature. Endocrine 2024; 84:193-202. [PMID: 38123877 DOI: 10.1007/s12020-023-03641-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE The utility of repeating ultrasound-guided fine-needle aspiration (US-FNAB) in the follow-up of benign (THY2) thyroid nodules is still debated. The aim of this study was to retrospectively investigate the diagnostic value of re-biopsy of thyroid nodules following an initially benign result. METHODS We retrospectively analyzed US-FNABs performed at the Unit of Endocrinology of Modena from 2006 to 2009. The firstly benign cytological result was compared with the cytological results of subsequent US-FNABs (2nd and/or 3rd) executed on the same nodule. RESULTS Among 10449 US-FNABs, 6270 (60%) received a THY2 cytological categorization. Of them, 278 (4.43%) underwent a subsequent US-FNAB: 86.7% maintained the same cytology, 32 (11.5%) changed to THY3 (indeterminate) and 5 (1.8%) to THY4 (suspicious of malignancy). Among the 24 nodules addressed to surgery, 9 (37%) were histologically malignant, with an overall miss rate of 3.2%. Male patients had higher risk of discordant results at subsequent US-FNAB (p = 0.005, OR:3.59, 95%CI:1.453-7.769) while dimensional increase above 5 mm was predictive of concordant benign cytology (p = 0.036, OR:0.249, 95%CI:0.068-0.915). Age, suspicious US characteristics, and distance between US-FNABs resulted not predictive. CONCLUSIONS Re-biopsy of benign nodules confirmed the benign nature in most cases. In case of discordant cytology, relocation in indeterminate category was the most common. The histological diagnosis of cancer occurred in one quarter of nodules surgically removed, with a low overall clinically significant miss rate. Thus, a small percentage of false negatives exists; males and subjects with US suspicious nodules should be carefully followed-up, considering case by case re-biopsy possibility.
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Affiliation(s)
- Sara De Vincentis
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Giulia Brigante
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Anna Ansaloni
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Lucia Zirilli
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Chiara Diazzi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Serena Belli
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Silvia Vezzani
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Manuela Simoni
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Vincenzo Rochira
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy.
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Vescini F, Borretta G, Chiodini I, Boniardi M, Carotti M, Castellano E, Cipriani C, Eller-Vainicher C, Giannini S, Iacobone M, Salcuni AS, Saponaro F, Spiezia S, Versari A, Zavatta G, Mitrova Z, Saulle R, Vecchi S, Antonini D, Basile M, Giovanazzi A, Paoletta A, Papini E, Persichetti A, Samperi I, Scoppola A, Novizio R, Calò PG, Cetani F, Cianferotti L, Corbetta S, De Rimini ML, Falchetti A, Iannetti G, Laureti S, Lombardi CP, Madeo B, Marcocci C, Mazzaferro S, Miele V, Minisola S, Palermo A, Pepe J, Scillitani A, Tonzar L, Grimaldi F, Cozzi R, Attanasio R. Italian Guidelines for the Management of Sporadic Primary Hyperparathyroidism. Endocr Metab Immune Disord Drug Targets 2023; 24:e141223224531. [PMID: 38644730 DOI: 10.2174/0118715303260423231122111705] [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: 07/19/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 04/23/2024]
Abstract
AIM This guideline (GL) is aimed at providing a clinical practice reference for the management of sporadic primary hyperparathyroidism (PHPT) in adults. PHPT management in pregnancy was not considered. METHODS This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology (AME) and Società Italiana dell'Osteoporosi, del Metabolismo Minerale e delle Malattie dello Scheletro (SIOMMMS) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" were considered in the systematic review of evidence. Those classified as "critical" were considered for the clinical practice recommendations. RESULTS The present GL provides recommendations about the roles of pharmacological and surgical treatment for the clinical management of sporadic PHPT. Parathyroidectomy is recommended in comparison to surveillance or pharmacologic treatment in any adult (outside of pregnancy) or elderly subject diagnosed with sporadic PHPT who is symptomatic or meets any of the following criteria: • Serum calcium levels >1 mg/dL above the upper limit of normal range. • Urinary calcium levels >4 mg/kg/day. • Osteoporosis disclosed by DXA examination and/or any fragility fracture. • Renal function impairment (eGFR <60 mL/min). • Clinic or silent nephrolithiasis. • Age ≤50 years. Monitoring and treatment of any comorbidity or complication of PHPT at bone, kidney, or cardiovascular level are suggested for patients who do not meet the criteria for surgery or are not operated on for any reason. Sixteen indications for good clinical practice are provided in addition to the recommendations. CONCLUSION The present GL is directed to endocrinologists and surgeons - working in hospitals, territorial services or private practice - and to general practitioners and patients. The recommendations should also consider the patient's preferences and the available resources and expertise.
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Affiliation(s)
- Fabio Vescini
- Endocrinology Unit, Azienda Sanitaria-Universitaria Friuli Centrale, P.O. Santa Maria della Misericordia, Udine, Italy
| | - Giorgio Borretta
- Department of Endocrinology, Diabetes and Metabolism, Ospedale Santa Croce and Carle Hospital, Cuneo, Italy
| | - Iacopo Chiodini
- Endocrinology Department, ASST Grande Ospedale Metropolitano di Niguarda, Milan, Italy
- Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Marco Boniardi
- General Oncologic and Mini-invasive Surgery Department, ASST Grande Ospedale Metropolitano di Niguarda, Milan, Italy
| | - Marina Carotti
- Department of Radiology, AOU delle Marche, Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Elena Castellano
- Department of Endocrinology, Diabetes and Metabolism, Ospedale Santa Croce and Carle Hospital, Cuneo, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, Padova, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Antonio Stefano Salcuni
- Endocrinology Unit, Azienda Sanitaria-Universitaria Friuli Centrale, P.O. Santa Maria della Misericordia, Udine, Italy
| | - Federica Saponaro
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Stefano Spiezia
- Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, Naples, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Guido Zavatta
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS AOU di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Debora Antonini
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | - Michele Basile
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | - Alexia Giovanazzi
- Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento, Trento, Italy
| | | | - Enrico Papini
- Endocrinology, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Agnese Persichetti
- Ministry of Interior - Department of Firefighters, Public Rescue and Civil Defense, Rome, Italy
| | | | | | - Roberto Novizio
- Endocrinology and Metabolism, Agostino Gemelli University Polyclinic (IRCCS), Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Giorgio Calò
- SIUEC President, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Filomena Cetani
- Endocrine Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luisella Cianferotti
- Bone Metabolic Diseases Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, AOU Careggi, Florence, Italy
| | - Sabrina Corbetta
- Bone Metabolism and Diabetes, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Alberto Falchetti
- Laboratory of Experimental Clinical Research on Bone Metabolism, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giovanni Iannetti
- SIUMB President, Ultrasound Unit, S. Spirito Hospital, Pescara, Italy
| | | | | | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Claudio Marcocci
- Endocrine Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sandro Mazzaferro
- Nephrology Unit at Policlinico Umberto I Hospital and Department of Translation and Precision Medicine, Sapienza University of Rome, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Baggiovara, Italy
| | - Salvatore Minisola
- UOC Medicina Interna A, Malattie Metaboliche dell'Osso, Ambulatorio Osteoporosi e Osteopatie Fragilizzanti, Sapienza University of Rome, Rome Italy
| | - Andrea Palermo
- Unit of Thyroid and Bone-Metabolic Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - Laura Tonzar
- Endocrinology Unit, Azienda Sanitaria-Universitaria Friuli Centrale, P.O. Santa Maria della Misericordia, Udine, Italy
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De Leo S, D'Elia S, Grani G, Dondi F, Bertagna F, Puxeddu E, Morelli S, Piovesan A, Nervo A, Zatelli MC, Gagliardi I, Samà MT, Aimaretti G, Crocetti U, Massa M, Deandrea M, Retta F, Pagano L, Rossi M, Solaroli E, Pezzullo L, Chiofalo MG, Pontecorvi A, Lombardi CP, Antonelli A, Patrizio A, Messuti I, Magri F, Spiazzi G, Ceresini G, Bruno R, Sparano C, Centanni M, Crescenzi A, Tallini G, Marotta V, Madeo B, Mian C, Filetti S, Durante C, Fugazzola L. A Prospective Multicenter Study Examining the Relationship Between Thyroid Cancer Treatment Outcomes and the Presence of Autoimmune Thyroiditis. Thyroid 2023; 33:1318-1326. [PMID: 37725571 DOI: 10.1089/thy.2023.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/21/2023]
Abstract
Background: There is some controversy on the potential relationship between autoimmune processes and clinicopathologic features as well as prognosis of differentiated thyroid cancer (DTC), and the evidence is limited by its largely retrospective nature. We examined the relationship between the presence of autoimmune thyroiditis (AT) and 1-year thyroid cancer treatment outcomes in a large multicenter study using prospectively collected data. Methods: We included data from consecutive DTC patients enrolled in the Italian Thyroid Cancer Observatory (ITCO) database (NCT04031339). We divided the groups according to the presence (AT) or absence (no autoimmune thyroiditis [noAT]) of associated AT. We used propensity score matching to compare the clinical features and outcomes between the two groups at 1-year follow-up. Results: We included data from 4233 DTC patients, including 3172 (75%) females. The American Thyroid Association (ATA) risk levels were as follows: 51% (2160/4233) low risk, 41.3% (1750/4233) intermediate risk, and 7.6% (323/4233) high risk. There were 1552 patients (36.7%) who had AT. Before propensity score matching, AT patients were significantly younger and had a smaller and bilateral tumor (p < 0.0001). Patients with AT more frequently fell into the low- and intermediate-risk categories, while the ATA high risk was more frequent among noAT patients (p = 0.004). After propensity score matching, patients with AT more frequently showed evidence of disease (structural/biochemical incomplete response) versus excellent/indeterminate response, compared with patients without AT (7.3% vs. 4.5%, p = 0.001), with an odds ratio of 1.86 ([confidence interval: 1.3-2.6], p = 0.0001). However, when considering only structural persistence as the outcome, no statistically significant differences were observed between patients with or without AT (3.4% vs. 2.7%, p = 0.35). The elevated risk associated with the ATA intermediate and high risk at diagnosis remained consistently statistically significant. Conclusions: In this large prospective series, biochemical persistence was more frequent, at 1-year follow-up, in AT patients. However, there was no significant association between the presence of AT and structural persistence of disease. These findings may be explained by the presence of a residual thyroid tissue.
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Affiliation(s)
- Simone De Leo
- Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia D'Elia
- Department of Statistical Sciences and Sapienza University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Dondi
- Nuclear Medicine Department, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine Department, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Efisio Puxeddu
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Silvia Morelli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessandro Piovesan
- Oncological Endocrinology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Alice Nervo
- Oncological Endocrinology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Teresa Samà
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Maggiore della Carità University Hospital, Novara, Italy
| | - Gianluca Aimaretti
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Maggiore della Carità University Hospital, Novara, Italy
| | - Umberto Crocetti
- Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Michela Massa
- Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maurilio Deandrea
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
| | - Francesca Retta
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
| | - Loredana Pagano
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mattia Rossi
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Erica Solaroli
- Unit of Endocrinology, Department of Medicine, AUSL Bologna, Bologna, Italy
| | - Luciano Pezzullo
- Thyroid Oncological Surgery Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Maria Grazia Chiofalo
- Thyroid Oncological Surgery Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Alfredo Pontecorvi
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Celestino Pio Lombardi
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Division of Endocrine Surgery, Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Armando Patrizio
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Ilaria Messuti
- Department of Endocrinology and Andrology, Humanitas Gradenigo, Turin, Italy
| | - Flavia Magri
- Unit of Internal Medicine and Endocrinology, Department of Internal Medicine and Therapeutics, University of Pavia and Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Giovanna Spiazzi
- Endocrinology and Diabetology Unit, Department of Medicine, Azienda Ospedaliera-Universitaria di Verona, Verona, Italy
| | - Graziano Ceresini
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Rocco Bruno
- Endocrine Unit, Tinchi Hospital-ASM, Matera, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- UOC Endocrinologia, AUSL Latina, Latina, Italy
| | - Anna Crescenzi
- Unit of Endocrine Organs and Neuromuscolar Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giovanni Tallini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Marotta
- UOC Clinica Endocrinologica e Diabetologica, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Caterina Mian
- Unit of Endocrinology, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | | | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Fugazzola
- Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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De Vincentis S, Del Sindaco G, Pagnano A, Brigante G, Moretti A, Zirilli L, Rochira V, Simoni M, Mantovani G, Madeo B. Application of calcium-to-phosphorus (Ca/P) ratio in the diagnosis of pseudohypoparathyroidism: another piece in the puzzle of diagnosis of Ca-P metabolism disorders. Front Endocrinol (Lausanne) 2023; 14:1268704. [PMID: 37854194 PMCID: PMC10580082 DOI: 10.3389/fendo.2023.1268704] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
Objective The serum calcium (Ca)-to-phosphorus (P) ratio has been proposed to identify patients with primary hyperparathyroidism and chronic hypoparathyroidism (HPT), but it has never been tested in pseudohypoparathyroidism (PHP). The aim of this study was to test the performance of Ca/P ratio in PHP diagnosis compared with that in healthy subjects and patients with HPT for differential diagnosis. Design A retrospective, cross-sectional, and observational study was carried out. Methods Serum Ca, P, creatinine, parathyroid hormone (PTH), and albumin were collected. Ca and P were expressed in mmol/L. Ca/P diagnostic performance was evaluated by receiver operating characteristic curve, sensitivity, specificity, and accuracy. Results A total of 60 patients with PHP, 60 patients with HPT, and 120 controls were enrolled. The Ca/P ratio was lower in patients with PHP and HPT than that in controls (p < 0.0001). The cutoff of 1.78 (2.32 if Ca and P measured in mg/dL) for Ca/P ratio could identify patients with PHP and HPT among the entire cohort (sensitivity and specificity of 76%). No valid cutoff of Ca/P was found to distinguish patients with PHP from patients with HPT; in this case, PTH above 53.0 ng/dL identified patients with PHP (sensitivity and specificity of 100%). The index (Ca/P × PTH) above 116 ng/L recognized patients with PHP from controls (sensitivity of 84.7% and specificity of 87.4%), whereas (Ca/P × PTH) below 34 ng/L recognized patients with HPT from controls (sensitivity of 88.9% and specificity of 90.8%). Conclusions The Ca/P ratio below 1.78 (2.32 CU) is highly accurate to identify patients with PHP and HPT, although it is not reliable to differentiate these two conditions. The index (Ca/P × PTH) is excellent to specifically recognize PHP or HPT from healthy subjects.
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Affiliation(s)
- Sara De Vincentis
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Del Sindaco
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Pagnano
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Brigante
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Antonio Moretti
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Zirilli
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Vincenzo Rochira
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Manuela Simoni
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Giovanna Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
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Greco C, Passerini F, Coluccia S, Teglio M, Bondi M, Mecheri F, Trapani V, Volpe A, Toschi P, Madeo B, Simoni M, Rochira V, Santi D. Long-term trajectories of bone metabolism parameters and bone mineral density (BMD) in obese patients treated with metabolic surgery: a real-world, retrospective study. J Endocrinol Invest 2023; 46:2133-2146. [PMID: 36971952 DOI: 10.1007/s40618-023-02066-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Potential negative effects of metabolic surgery on skeletal integrity remain a concern, since long-term data of different surgical approaches are poor. This study aimed to describe changes in bone metabolism in subjects with obesity undergoing both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS A single center, retrospective, observational clinical study on real-world data was performed enrolling subjects undergoing metabolic surgery. RESULTS 123 subjects were enrolled (males 31: females 92; ages 48.2 ± 7.9 years). All patients were evaluated until 16.9 ± 8.1 months after surgery, while a small group was evaluated up to 4.5 years. All patients were treated after surgery with calcium and vitamin D integration. Both calcium and phosphate serum levels significantly increased after metabolic surgery and remained stable during follow-up. These trends did not differ between RYGB and SG (p = 0.245). Ca/P ratio decreased after surgery compared to baseline (p < 0.001) and this decrease remained among follow-up visits. While 24-h urinary calcium remained stable across all visits, 24-h urinary phosphate showed lower levels after surgery (p = 0.014), also according to surgery technique. Parathyroid hormone decreased (p < 0.001) and both vitamin D (p < 0.001) and C-terminal telopeptide of type I collagen (p = 0.001) increased after surgery. CONCLUSION We demonstrated that calcium and phosphorous metabolism shows slight modification even after several years since metabolic surgery, irrespective of calcium and vitamin D supplementation. This different set point is characterized by a phosphate serum levels increase, together with a persistent bone loss, suggesting that supplementation alone may not ensure the maintenance of bone health in these patients.
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Affiliation(s)
- C Greco
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - F Passerini
- Division of Internal Medicine and Metabolism, Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
- Unit of Internal and Metabolic Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - S Coluccia
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - M Teglio
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
| | - M Bondi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - F Mecheri
- Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy
| | - V Trapani
- Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy
| | - A Volpe
- Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy
| | - P Toschi
- Department of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - B Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - M Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
| | - D Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
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6
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De Vincentis S, Domenici D, Ansaloni A, Boselli G, D'Angelo G, Russo A, Taliani E, Rochira V, Simoni M, Madeo B. COVID-19 lockdown negatively impacted on adherence to denosumab therapy: incidence of non-traumatic fractures and role of telemedicine. J Endocrinol Invest 2022; 45:1887-1897. [PMID: 35590044 PMCID: PMC9119380 DOI: 10.1007/s40618-022-01820-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Coronavirus disease (COVID-19) lockdowns have impacted on management of osteoporosis and the use of telemedicine is increasingly widespread albeit supported by little evidence so far. The aim of the study is to assess adherence to denosumab and incidence of non-traumatic fractures during the lockdown compared to the pre-COVID-19 year and to explore the effectiveness of telemedicine in the management of osteoporotic patients. METHODS Retrospective, longitudinal, single-center study on patients receiving subcutaneous denosumab therapy every 6 months. Each patient was scheduled to undergo 2 visits: one during the pre-COVID-19 period (March 2019-March 2020) and another visit during the lockdown period (March 2020-March 2021). Data on new fractures, adherence, risk factors for osteoporosis and the modality of visit (telemedicine or face-to-face) were collected. RESULTS The prevalence of non-adherent patients was higher during the lockdown (35 of 269 patients, 13.0%) than the pre-COVID-19 period (9 of 276 patients, 3.3%) (p < 0.0001). During the lockdown, the number of new non-traumatic fractures was higher than the pre-COVID-19 year (p < 0.0001): 10 patients out of 269 (3.7%) experienced a fragility fracture and 2 patients (0.7%) a probable rebound fracture during the lockdown period, whereas no patient had fragility/rebound fractures during the pre-COVID-19 period. No difference was found in the prevalence of non-adherence and new non-traumatic fractures comparing patients evaluated with tele-medicine to those evaluated with face-to-face visit. CONCLUSION Non-adherent patients and new non-traumatic fractures (including rebound fractures) were more prevalent during the lockdown in comparison to the pre-COVID-19 period, regardless of the modality of medical evaluation.
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Affiliation(s)
- S De Vincentis
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - D Domenici
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - A Ansaloni
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - G Boselli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - G D'Angelo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - A Russo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - E Taliani
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
| | - M Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - B Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
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Marcucci G, Beccuti G, Carosi G, Cetani F, Cianferotti L, Colao AM, Di Somma C, Duradoni M, Elefante A, Ghizzoni L, Giusti M, Lania AG, Lavezzi E, Madeo B, Mantovani G, Marcocci C, Masi L, Parri S, Pigliaru F, Santonati A, Spada A, Vera L, Brandi ML. Multicenter retro-prospective observational study on chronic hypoparathyroidism and rhPTH (1-84) treatment. J Endocrinol Invest 2022; 45:1653-1662. [PMID: 35460461 PMCID: PMC9360119 DOI: 10.1007/s40618-022-01800-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The main purpose of this study was to investigate the effects of 12 months of rhPTH (1-84) (Natpar®) treatment in a cohort of patients selected according to the indications of hypoparathyroidism guidelines. The use of recombinant human PTH (1-84) [rhPTH (1-84)] is approved as hormonal replacement therapy in patients with hypoparathyroidism not adequately controlled with conventional therapy. METHODS It is a multicenter, observational, retro-prospective, open label study. Eleven Italian Endocrinological centers, members of Hypoparathyroidism Working Group of the Italian Society of Endocrinology (HypoparaNET) were involved. Main outcome measures were serum and urinary calcium and phosphate concentration, calcium-phosphate product, renal function, oral calcium and vitamin D doses, and clinical manifestations. RESULTS Fourteen adult subjects, affected by chronic hypoparathyroidism, were treated with rhPTH (1-84) for 12 months. At 12 months of rhPTH (1-84) treatment, 61.5% of patients discontinued calcium supplement and 69.2% calcitriol. Mean albumin-adjusted total serum calcium levels quickly normalized after initiation of rhPTH (1-84) treatment compared to baseline (p = 0.009), remaining in the normal range until 12 months. Rare hypo-hypercalcemia episodes were reported. Renal function was maintained normal and no renal complications were reported. Serum and urinary phosphate and urinary calcium were maintained in the normal range. Mean phosphatemia levels linearly decreased from 3 months up to 12 months compared to baseline (p = 0.014). No severe adverse events were described. CONCLUSIONS Biochemical and clinical results confirm the efficacy and safety of rhPTH (1-84) therapy, which represents an important option for hypoparathyroid patients unresponsive to conventional therapy.
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Affiliation(s)
- G Marcucci
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - G Beccuti
- Department of Medical Sciences, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - G Carosi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - F Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Cianferotti
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - A M Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - C Di Somma
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - M Duradoni
- Department of Information Engineering, University of Florence, Florence, Italy
| | - A Elefante
- Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - L Ghizzoni
- Department of Medical Sciences, Division of Endocrinology, Diabetes and Metabolism, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Giusti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Italy
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center-IRCCS, 20089, Rozzano, Italy
| | - E Lavezzi
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center-IRCCS, 20089, Rozzano, Italy
| | - B Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - G Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Masi
- AUO-Careggi University Hospital, Florence, Italy
| | - S Parri
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - F Pigliaru
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Santonati
- Department of Endocrinology and Diabetology, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - A Spada
- Department of Endocrinology and Diabetology, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - L Vera
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M L Brandi
- Fondazione Italiana Di Ricerca Sulle Malattie Dell'osso: F.I.R.M.O, Via San Gallo 123, 50100, Florence, Italy.
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Decaroli MC, Ansaloni A, Monzani ML, Losa M, Zunarelli E, Rochira V, Madeo B. Long-Term Use of Temozolomide as Safe and Effective Therapy for an Aggressive Corticotroph Adenoma in a Very Old Patient. J Endocr Soc 2021; 5:bvab065. [PMID: 34195524 PMCID: PMC8237844 DOI: 10.1210/jendso/bvab065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 11/06/2020] [Indexed: 12/31/2022] Open
Abstract
Background Temozolomide (TMZ) is safe and effective in the treatment of aggressive pituitary adenomas (PAs). However, the optimal duration of TMZ therapy is still unknown. Moreover, data about administration of TMZ in elderly (≥65 years) people to treat aggressive PAs are scarce. We report the case of the oldest female patient undergoing the longest TMZ protocol described so far to treat an aggressive, initially silent corticotroph PA. Case report The patient initially underwent partial surgical removal of the PA. Subsequent treatment with cabergoline was applied, but it was unsuccessful in controlling the growth of the residual tumor. Pasireotide and external radiation also showed to be ineffective; therefore, treatment with TMZ was started at the standard dose of 200 mg/m2/day for 5 days every 4 weeks for a total of 47 cycles. At the time of treatment’s beginning, the patient was 83 years old. Radiological follow-up documented a progressive, remarkable reduction of the adenoma and the last imaging, after 39 cycles of TMZ, showed an intrasellar lesion with large areas of cystic degeneration. The patient also developed adrenal deficiency managed with glucocorticoid replacement. No major side effects were observed throughout the treatment, with exception of nausea, well controlled with anti-emetic medication. TMZ therapy was discontinued after 47 cycles; hormonal and imaging follow-up investigations documented sustained functional and dimensional response. Conclusions Our case supports the long-term use of TMZ, confirming its safety and efficacy also for elderly patients.
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Affiliation(s)
- Maria Chiara Decaroli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Anna Ansaloni
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Maria Laura Monzani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Marco Losa
- Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Zunarelli
- Anatomic Pathology Unit, Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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Piccoli M, Pecchini F, Serra F, Nigro C, Colli G, Gozzo D, Zirilli L, Madeo B, Rochira V, Mullineris B. Robotic Versus Laparoscopic Adrenalectomy: Pluriannual Experience in a High-Volume Center Evaluating Indications and Results. J Laparoendosc Adv Surg Tech A 2021; 31:375-381. [PMID: 33450160 PMCID: PMC8060876 DOI: 10.1089/lap.2020.0839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Robotic adrenalectomy offers several clinical benefits if compared with laparoscopic adrenalectomy; however, its superiority is still under debate. The aim of this study was the investigation of differences between the two techniques, and a comparison when approaching right or left side adrenal lesions was further conducted. Materials and Methods: All patients undergoing laparoscopic and robotic unilateral adrenalectomy at our institution from January 2006 to December 2019 were collected and retrospectively analyzed. Statistical analysis was conducted; differences between the two cohorts were reported. Results: A total of 160 cases were included (84 patients in laparoscopic adrenalectomy-group [LA-g] 76 cases in robotic adrenalectomy-group [RA-g]). The groups were homogeneous for demographic data. No intraoperative complications were reported; mean amount of intraoperative blood loss was comparable. No cases of conversion to open surgery were required. RA-g presented a longer operative time than LA-g for right adrenalectomy (P = .05), no differences were noted for left side (P = .187). Overall morbidity was 21% for LA-g and 10.5% for RA-g (P = .087), with an inferior rate of surgical complications for RA-g (P = .024), and for robotic left adrenalectomy than robotic right procedure (P = .03). Length of hospital stay was shorter for RA-g (P = .005). Conclusions: Robotic adrenalectomy presents similar outcomes as laparoscopic approach with some benefits for selected cases. Left adrenal lesions seem to receive greater advantages from robotic technique. Large randomized controlled trials are required to determine the role of robotic adrenal surgery and if the indication can be standardized based on the laterality of adrenal procedure.
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Affiliation(s)
- Micaela Piccoli
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Francesca Pecchini
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Francesco Serra
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Casimiro Nigro
- General Surgery Department, Torvergata University, Rome, Italy
| | - Giovanni Colli
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Davide Gozzo
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Lucia Zirilli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Mullineris
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
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Madeo B, De Vincentis S, Rochira V. Response to the Letter to the Editor by Dr. Rosario: "The calcium-to-phosphorous (Ca/P) ratio in the diagnosis of primary hyperparathyroidism and hypoparathyroidism: a multicentric study". Endocrine 2021; 71:261. [PMID: 33226537 DOI: 10.1007/s12020-020-02545-5] [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: 09/28/2020] [Accepted: 10/31/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
| | - Sara De Vincentis
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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De Vincentis S, Russo A, Milazzo M, Lonardo A, De Santis MC, Rochira V, Simoni M, Madeo B. How Much Vitamin D is Too Much? A Case Report and Review of the Literature. Endocr Metab Immune Disord Drug Targets 2020; 21:1653-1659. [PMID: 33030138 PMCID: PMC8811610 DOI: 10.2174/1871530320666201007152230] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 11/22/2022]
Abstract
Background The beneficial effects of vitamin D, together with the high prevalence of vitamin D deficiency, have led to an expanding use of vitamin D analogues. While inappropriate consumption is a recognized cause of harm, the determination of doses at which vitamin D becomes toxic remains elusive. Case Presentation A 56-year woman was admitted to our Hospital following a 3-week history of nausea, vomiting, and muscle weakness. The patient had been assuming a very high dose of cholecalciferol for 20 months (cumulative 78,000,000UI, mean daily 130,000UI), as indicated by a non-conventional protocol for multiple sclerosis. Before starting vitamin D integration, serum calcium and phosphorus levels were normal, while 25OH-vitamin D levels were very low (12.25 nmol/L). On admission, hypercalcemia (3.23 mmol/L) and acute kidney injury (eGFR 20 mL/min) were detected, associated with high concentrations of 25OH-vitamin D (920 nmol/L), confirming the suspicion of vitamin D intoxication. Vitamin D integration was stopped, and in a week, hypercalcemia normalized. It took about 6 months for renal function and 18 months for vitamin D values to go back to normal. Conclusion This case confirms that vitamin D intoxication is possible, albeit with a high dose. The doses used in clinical practice are far lower than these and, therefore, intoxication rarely occurs even in those individuals whose baseline vitamin D serum levels have never been assessed. Repeated measurements of vitamin D are not necessary for patients under standard integrative therapy. However, patients and clinicians should be aware of the potential dangers of vitamin D overdose.
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Affiliation(s)
- Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena. Italy
| | - Antonino Russo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena. Italy
| | - Marta Milazzo
- Unit of Metabolic Medicine, Azienda Ospedaliero- Universitaria di Modena, Modena. Italy
| | - Amedeo Lonardo
- Unit of Metabolic Medicine, Azienda Ospedaliero- Universitaria di Modena, Modena. Italy
| | | | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena. Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena. Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena. Italy
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Madeo B, De Vincentis S, Repaci A, Altieri P, Vicennati V, Kara E, Vescini F, Amadori P, Balestrieri A, Pagotto U, Simoni M, Rochira V. The calcium-to-phosphorous (Ca/P) ratio in the diagnosis of primary hyperparathyroidism and hypoparathyroidism: a multicentric study. Endocrine 2020; 68:679-687. [PMID: 32236819 DOI: 10.1007/s12020-020-02276-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Received: 02/07/2020] [Accepted: 03/17/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The diagnosis of primary hyperparathyroidism (PHPT) and chronic hypoparathyroidism (HypoPT) is still challenging, especially in patients asymptomatic or with non-classical phenotypes and for physicians not skilled in calcium-phosphorous (Ca-P) disorders. The serum calcium/phosphorous (Ca/P) ratio has been proposed as accurate index to identify PHPT, while it has never been tested in HypoPT. The aim of this study is to investigate the diagnostic power of the serum Ca/P ratio in the diagnosis of primary parathyroid dysfunctions (both PHPT and HypoPT) in a large series of data. METHODS A multicentric, retrospective, cross-sectional study (ClinicalTrials.gov: NCT03747029) was carried out including 432 PHPT patients and 217 HypoPT patients compared with 389 controls. Serum Ca, P, creatinine, parathyroid hormone and 25OH-vitamin D were collected. Serum Ca and P were expressed in mmol/L. Ca/P diagnostic performance was evaluated by receiver operating characteristic (ROC) curve, sensitivity, specificity and accuracy. RESULTS The Ca/P ratio was significantly higher in PHPT and lower in HypoPT patients than controls (p < 0.0001). At ROC curve analysis, the Ca/P ratio above 2.55 was defined to identify PHPT patients (sensitivity 85.7%, specificity 85.3%) and below 1.78 to identify HypoPT patients (sensitivity 88.2%, specificity 87.9%). CONCLUSIONS The Ca/P ratio is a highly accurate index to identify PHPT when Ca/P is above 2.55 and HypoPT when it is below 1.78. These results demonstrate the reliability of this index to rule in/out primary parathyroid dysfunctions and remark the importance of measuring serum P in clinical practice.
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Affiliation(s)
- Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41126, Modena, Italy.
| | - Sara De Vincentis
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41126, Modena, Italy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126, Modena, Italy
| | - Andrea Repaci
- Unit of Endocrinology, DIMEC Alma Mater Studiorum Bologna, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy
| | - Paola Altieri
- Unit of Endocrinology, DIMEC Alma Mater Studiorum Bologna, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy
| | - Valentina Vicennati
- Unit of Endocrinology, DIMEC Alma Mater Studiorum Bologna, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy
| | - Elda Kara
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126, Modena, Italy
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100, Udine, Italy
| | - Fabio Vescini
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100, Udine, Italy
| | - Pierluigi Amadori
- Unit of Endocrinology, Azienda Provinciale Servizi Sanitari Trento, 38122, Trento, Italy
| | - Antonio Balestrieri
- Endocrinology and Diabetology Unit, Department of Internal Medicine, M. Bufalini Hospital, 47521, Cesena, Italy
| | - Uberto Pagotto
- Unit of Endocrinology, DIMEC Alma Mater Studiorum Bologna, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41126, Modena, Italy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41126, Modena, Italy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126, Modena, Italy
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Brigante G, Monzani ML, Locaso M, Gnarini VL, Graziadei L, Kaleci S, De Santis MC, Tagliavini S, Simoni M, Rochira V, Madeo B. De novo Lesions Frequently Develop in Adult Normal Thyroid Over Almost Six Years. Front Endocrinol (Lausanne) 2020; 11:18. [PMID: 32082257 PMCID: PMC7001274 DOI: 10.3389/fendo.2020.00018] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: In order to understand how thyroid abnormalities emerge over time in adults, we evaluated incidence of thyroid diseases in healthy subjects, after almost 6 years from a previous negative ultrasound. Methods: Anamnestic and physical data were collected. Ultrasound neck evaluation was performed by an experienced endocrinologist, recording detailed thyroid and nodules characteristics. Nodules were classified according to American Thyroid Association classification for prediction of cancer risk. Serum samples were collected for subsequent evaluations (TSH, free thyroid hormones, calcitonin, anti-thyroid antibodies). Anamnestic, clinical, sonographic, and serological characteristics were analyzed with logistic regression analysis for subjects with nodules vs. those without. Results: One hundred and eleven subjects were enrolled (43M, 68F). Half of them developed nodules, mainly smaller than 1 cm and without suspicious characteristics. Ninety-seven percent were euthyroid. Only 4% had serological diagnosis of thyroiditis. Incidence of thyroid diseases was higher in women, especially nulliparous. Comparing clinical characteristics of subjects with and without nodules, the only statistically significant difference concerned thyroid volume adjusted for body weight or surface (p < 0.05), but not residual volume excluding nodules. Multivariate logistic regression analysis showed that female gender, higher BMI-adjusted thyroid volume and residual thyroid volume excluding nodules, nulliparity, age, and fT3 increase the risk of developing nodules. Conclusions: These results demonstrate that adult thyroid tissue undergoes changes that are already detectable by US after almost 6 years. Half of the enrolled subjects developed de novo nodules or colloid cysts of poor clinical relevance.
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Affiliation(s)
- Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Maria Laura Monzani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Michela Locaso
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Valentina Luisa Gnarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Graziadei
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Department of Diagnostic Medicine, Clinics and Public Health, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Maria Cristina De Santis
- Department of Laboratory Medicine and Pathology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Simonetta Tagliavini
- Department of Laboratory Medicine and Pathology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- *Correspondence: Bruno Madeo
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Madeo B, Brigante G, Ansaloni A, Taliani E, Kaleci S, Monzani ML, Simoni M, Rochira V. The Added Value of Operator's Judgement in Thyroid Nodule Ultrasound Classification Arising From Histologically Based Comparison of Different Risk Stratification Systems. Front Endocrinol (Lausanne) 2020; 11:434. [PMID: 32733383 PMCID: PMC7358458 DOI: 10.3389/fendo.2020.00434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/02/2020] [Indexed: 01/25/2023] Open
Abstract
Objective: Several ultrasound classifications for thyroid nodules were proposed but their accuracy is still debated, since mainly estimated on cytology and not on histology. The aim of this study was to test the diagnostic accuracy and the inter-classification agreement of AACE/ACE-AME, American Thyroid Association (ATA), British Thyroid Association (BTA), and Modena Ultrasound Thyroid Classification (MUT) that stratifies malignancy risk considering also the clinician subjective impression. Methods: A prospective study collecting thyroid nodule features at ultrasound and histological diagnosis was conducted. Ultrasound features were collected following a preformed checklist in candidates for surgery because of indeterminate, suspicious, or malignant cytology. All the nodules, besides the cytologically suspicious one, were blinded analyzed. MUT score was applied prospectively, and the others retrospectively. Sensitivity, specificity, diagnostic cut-off value, and accuracy of each classification were calculated. The overall agreement between classifications was tested by Bland-Altman, and agreement between single nodule analysis by different classifications by Weighted Cohen's Kappa. Results: In classifying a total of 457 nodules, MUT has the highest accuracy (AUC 0.808) and specificity (89%), followed by ATA and BTA, and finally by AACE/ACE-AME. ATA, BTA, and MUT are highly interchangeable. Considering agreement between single nodule analyses, ATA and BTA had the best (κ = 0.723); AACE/ACE-AME showed slight agreement with BTA (κ = 0.177) and MUT (κ = 0.183), and fair agreement with ATA (κ = 0.282); MUT had fair agreement with both ATA (κ = 0.291) and BTA (κ = 0.271). Conclusion: Classifications have an acceptable overall diagnostic accuracy, improved using a less rigid system that takes into consideration operator subjective impression.
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Affiliation(s)
- Bruno Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- *Correspondence: Bruno Madeo
| | - Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Anna Ansaloni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Erica Taliani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Shaniko Kaleci
- Department of Diagnostic Medicine, Clinics and Public Health, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Maria Laura Monzani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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15
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Greco C, Brigante G, Taliani E, Corrado S, Simoni M, Madeo B. Concomitant medullary thyroid carcinoma with paraganglioma-like pattern and papillary thyroid carcinoma. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190094. [PMID: 31778356 PMCID: PMC6893314 DOI: 10.1530/edm-19-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/03/2019] [Accepted: 11/06/2019] [Indexed: 11/23/2022] Open
Abstract
SUMMARY A 74-year-old man was referred to the Endocrinology Unit because of multinodular goiter. The dominant nodule (1.7 × 1.9 × 2.4 cm), at the medium-superior third of the left lobe, was inhomogeneously hypoechoic, with irregular margins, macrocalcifications and intranodular vascularization. Fine-needle aspiration biopsy (FNAB) was performed. The cytological diagnosis was TIR 2, benign, according to the 2013 Italian thyroid cytology classification system. Moderately high serum calcitonin (s-Ct) (61.5 pg/mL, n.r. 0-7.5) and normal CEA were detected. The Ct level in FNAB wash-out fluid (Ct-FNAB) was 1450 pg/mL. Based on s-Ct and Ct-FNAB levels, patient underwent total thyroidectomy. Macroscopically, a dominant circumscribed nodule of 2 ecm was described; the histological and immunohistochemical features identified medullary thyroid carcinoma (MTC) with paraganglioma (PG)-like pattern positive for Ct, CEA and chromogranin and negative for S-100 sustentacular cells (SC). Moreover, papillary carcinoma of 3 mm in the right lobe was also associated. No areas of hyperaccumulation of the tracer were documented at Ga68 PET/CT. No RET-proto-oncogene mutations were found. Post-surgery s-Ct levels were within normal range (4 pg/mL). Two years after thyroidectomy, the patient is still disease-free. We reported a case of sporadic and rare variant of MTC: this is the ninth described case of PG-like MTC. In this case, cytologically benign, the clinical suspicion arose from high Ct values at FNAB wash-out fluid. Even if clinical behavior of this variant seems indolent, additional studies are necessary to understand prognoses and predictive factors. LEARNING POINTS Several unusual histological variants of medullary thyroid carcinoma (MTC) have been described such as spindle cell, giant cell, clear cell, melanotic, squamous, angiosarcoma-like variants; even rarer is the paraganglioma (PG)-like pattern. We here describe a case of medullary PG-like thyroid carcinoma in a 74-year-old man. This is a rare histological variant of MTC hardly diagnosed by cytology, since immunohistochemical investigations are necessary. Measurement of calcitonin both in serum and in wash-out fluid from fine-needle aspiration could be an additional tool for an early and non-invasive identification of these variants.
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Affiliation(s)
- C Greco
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - G Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - E Taliani
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - S Corrado
- Department of Diagnostic, Clinical Medicine and Public Health, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - M Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - B Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
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Madeo B, De Vincentis S, Kara E, Vescini F, Trenti T, Guaraldi G, Rochira V. Reliability of calcium-phosphorus (Ca/P) ratio as a new, accurate and inexpensive tool in the diagnosis of some Ca-P disorders. J Endocrinol Invest 2019; 42:1041-1049. [PMID: 30796757 DOI: 10.1007/s40618-019-01025-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/31/2018] [Accepted: 02/13/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The serum calcium/phosphorus (Ca/P) ratio is an accurate tool to differentiate patients with primary hyperparathyroidism (PHPT) from healthy subjects. However, other disorders of the Ca-P metabolism might impair the Ca/P ratio, such as hypophosphatemia (HypoP) not PHPT related. The aim of this study is to examine the diagnostic value of Ca/P ratio in the diagnosis of PHPT and HypoP not PHPT related. METHODS Single-center, retrospective, case-control study, including 150 patients with PHPT and 306 patients with HypoP, compared with 150 controls. HypoP patients were enrolled among HIV-infected patients by selecting those with Fanconi-like syndrome due to antiretroviral treatment. Parameters which were measured were serum Ca, P, parathyroid hormone (PTH), 25-OH vitamin D, albumin and creatinine). RESULTS The Ca/P ratio was significantly higher in PHPT and HypoP patients, compared to controls (p < 0.0001). At receiver operator characteristic (ROC) curve analysis, the cut-off of 3.56 (2.75 SI) for Ca/P ratio was able to identify patients with PHPT and HypoP (sensitivity 95%; specificity 93%). Among patients with Ca/P ratio above 3.56, the thresholds of 10.3 mg/dL (2.6 mmol/L) for serum Ca (sensitivity 93%; specificity 98%) and 80.5 pg/mL for PTH (sensitivity 91%; specificity 91%) were defined for the specific diagnosis of PHPT. CONCLUSIONS The Ca/P ratio above 3.56 (2.75 SI) is a highly accurate tool to identify PHPT and HypoP not PHPT-related patients. Thanks to its simplicity, this index can be proposed as a screening and first-line examination in the diagnostic work-up when a disorder of Ca-P metabolism is suspected or should be ruled out.
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Affiliation(s)
- B Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile di Baggiovara, Modena, Italy.
| | - S De Vincentis
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile di Baggiovara, Modena, Italy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Kara
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Endocrinology and Metabolism Unit, University Hospital of Udine, Udine, Italy
| | - F Vescini
- Endocrinology and Metabolism Unit, University Hospital of Udine, Udine, Italy
| | - T Trenti
- Department of Laboratory Medicine and Pathological Anatomy, Azienda USL of Modena, Modena, Italy
| | - G Guaraldi
- Multidisciplinary Metabolic Clinic, Unit of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile di Baggiovara, Modena, Italy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Pignatti E, Vighi E, Magnani E, Kara E, Roncati L, Maiorana A, Santi D, Madeo B, Cioni K, Carani C, Rochira V, Simoni M, Brigante G. Expression and clinicopathological role of miR146a in thyroid follicular carcinoma. Endocrine 2019; 64:575-583. [PMID: 30701447 DOI: 10.1007/s12020-019-01845-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/31/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Dysregulation of microRNA expression has been involved in the development and progression of follicular thyroid carcinoma (FTC). The aim of this work was to study the expression of miRNA146a in FTC and the association with clinicopathological features of the disease. METHODS Thirty-eight patients affected by FTC were included in the study. Twenty patients carrying follicular thyroid adenoma (FA) were also enroled as the benign counterpart of FTC. Total RNA including miRNA146a was extracted from formalin-fixed paraffin-embedded (FFPE) pairs of affected/unaffected tissue and its expression was assessed by real-time PCR. Two selected target genes, TRAF6 (tumour necrosis factor receptor-associated factor 6) and IRAK1 (Il-1 receptor-associated kinase 1/2), were also analysed. RESULTS miR146a expression in FTC tissue was overall not downregulated in malignant versus unaffected tissue, but its expression was inversely correlated with clinicopathological features of FTCs at diagnosis. A decreased expression of miR146a became apparent in FTC thyroid tissue of widely compared to minimally invasive tumours. However, miR146a expression differences between contralateral unaffected tissue (extra-FTC) and FTC were not observed regardless of clinicopathological features. IRAK1, a known target for miR146a, was upregulated in FTC and the increase was mainly appreciable in Hurtle FTC variant. Unexpectedly, miR146a did not correlate with TRAF6 showing an inverse trend compared to IRAK1 although both genes regulate the activity of nuclear factor- kB (NF-kB). CONCLUSION The results of this study indicate that downregulation of miR146a, inversely correlated with clinicopathological features of FTCs at diagnosis and suggest a possible involvement of miR146a in FTC development. IRAK1 over-expression in FTC may be related to tumour development/progression. In vitro experiments are needed to support this hypothesis.
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Affiliation(s)
- Elisa Pignatti
- Department of Biomedical, Metabolic and Neural Sciences, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Eleonora Vighi
- Department of Life Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Magnani
- Department of Biomedical, Metabolic and Neural Sciences, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elda Kara
- Department of Biomedical, Metabolic and Neural Sciences, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Roncati
- Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Antonino Maiorana
- Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Department of Diagnostic and Clinical Medicine, and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniele Santi
- Department of Biomedical, Metabolic and Neural Sciences, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Bruno Madeo
- Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Katia Cioni
- Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Cesare Carani
- Department of Biomedical, Metabolic and Neural Sciences, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Department of Biomedical, Metabolic and Neural Sciences, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Manuela Simoni
- Department of Biomedical, Metabolic and Neural Sciences, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy.
- Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy.
- Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
| | - Giulia Brigante
- Department of Biomedical, Metabolic and Neural Sciences, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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Brigante G, Monzani ML, Michela L, Gnarini VL, Graziadei L, Kaleci S, De Santis MC, Tagliavini S, Simoni M, Rochira V, Madeo B. MON-576 Ultrasound Changes of Healthy Thyroides over Six Years in Adults. J Endocr Soc 2019. [PMCID: PMC6551068 DOI: 10.1210/js.2019-mon-576] [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] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Manuela Simoni
- Dept of Medicine, Endocrinology and Metabolism, University of Modena and Reggio Emilia, Modena, , Italy
| | - Vincenzo Rochira
- Dept of Biomedical, Metabolic & Neural Sciences, University of Modena and Reggio Emilia, Modena, , Italy
| | - Bruno Madeo
- University of Modena and Reggio Emilia, Modena, , Italy
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Madeo B, Brigante G, Ansaloni A, Taliani E, Kaleci S, Monzani ML, Simoni M, Rochira V. MON-580 Diagnostic Accuracy of Different Thyroid Ultrasound Classification Systems and the Added Value of Operator Subjective Impression in Stratifying Nodule Risk. J Endocr Soc 2019. [PMCID: PMC6550902 DOI: 10.1210/js.2019-mon-580] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and aim. Several ultrasound (US) classifications for thyroid nodules have been proposed. Since most of them are hardly applicable in clinical practice, we set up the Modena US Thyroid Classification (MUT) that stratifies the risk of malignancy based on knowledge derived from scientific literature and on clinician subjective impression. The aim of the present study was to test the diagnostic accuracy of different thyroid US classification systems, AACE/ACE-AME, American Thyroid Association (ATA), British Thyroid Association (BTA), and MUT, and to evaluate inter-classification agreement. Methods. We prospectively enrolled 111 patients (33M, 78F; age 19-75) with indeterminate, suspicious or malignant cytology. All the patients underwent neck US before surgery and a score according to MUT was assigned: 1 not certainly nodular; 2 not suspect; 3 indeterminate; 4 suspect; 5 very suspect. Then, we retrospectively classified nodules according to AACE/ACE-AME, ATA and BTA. US pattern was related to hystology. Sensitivity, specificity, diagnostic cut-off value and accuracy of each classification were calculated. The overall agreement between classifications was quantified by Bland-Altman test. The agreement between single nodule analysis by different classifications was evaluated considering Weighted Cohen's Kappa. Results. Fifteen patients had uninodular and 96 multinodular goiter, for a total of 457 nodules. MUT has the highest accuracy (AUC 0.808) and specificity (89%), followed by ATA and BTA, and finally by AACE/ACE-AME. ATA and BTA are highly interchangeable and MUT is comparable to both of them. AACE/ACE-AME is the least interchangeable with all the other classifications. Considering agreement between single nodule analysis by different classifications, ATA and BTA had the best (k=0.723); AACE/ACE-AME showed slight agreement with BTA (k=0.177) and MUT (k=0.183), and fair agreement with ATA (k=0.282); MUT had fair agreement with both ATA (k=0.291) and BTA (k=0.271). Conclusions. Our findings bring out the limit in specificity of the current reference classifications, which improves when the subjective impression of the clinician is considered.
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Affiliation(s)
- Bruno Madeo
- University of Modena and Reggio Emilia, Modena, , Italy
| | | | - Anna Ansaloni
- University of Modena and Reggio Emilia, Modena, , Italy
| | - Erica Taliani
- University of Modena and Reggio Emilia, Modena, , Italy
| | | | | | - Manuela Simoni
- Dept of Medicine, Endocrinology and Metabolism, University of Modena and Reggio Emilia, Modena, , Italy
| | - Vincenzo Rochira
- Dept of Biomedical, Metabolic & Neural Sciences, University of Modena and Reggio Emilia, Modena, , Italy
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Elli FM, de Sanctis L, Madeo B, Maffini MA, Bordogna P, Pirelli A, Arosio M, Mantovani G. 2q37 Deletions in Patients With an Albright Hereditary Osteodystrophy Phenotype and PTH Resistance. Front Endocrinol (Lausanne) 2019; 10:604. [PMID: 31555217 PMCID: PMC6727065 DOI: 10.3389/fendo.2019.00604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 05/28/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Pseudohypoparathyroidism (PHP) is a rare endocrine disorder derived from the defective activation of the cAMP pathway by the parathyroid hormone secondary to GNAS molecular defects. PHP subtypes are defined by the presence/absence of specific clinical/biochemical features. PHP1A is characterized by resistance to multiple hormones with features of Albright hereditary osteodystrophy (AHO), while pseudopseudohypoparathyroidism (PPHP) is characterized by AHO in the absence of PTH resistance. Small subsets of PHP and PPHP patients without known molecular defects have been re-diagnosed as being affected by the brachydactyly-mental retardation syndrome (BDMR), also known as the AHO-like syndrome. This study aimed to analyse 24 PHP1A and 51 PPHP patients without a molecular diagnosis for the presence of BDMR-associated 2q37 deletions to improve the differential diagnosis and to identify features that might help to avoid a misdiagnosis. Molecular investigations identified 4 deletions in 4 unrelated patients. The affected patients showed a combination of the most pathognomonic AHO features. Of note, 3 of the patients also displayed mild PTH resistance, and none of the patients developed ectopic ossifications. Our work confirmed the rarity of the misdiagnosis of BDMR in PHP patients through the identification of 4 patients bearing a 2q37 deletion in a cohort of 73 PHP patients (5.3%). Three patients with the deletion presented a PHP1A phenotype in the absence of any BDMR-specific findings. Further studies on larger case series are needed to elucidate the overlap between these clinical entities and to allow the early identification of patients.
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Affiliation(s)
- Francesca Marta Elli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital-AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Maria A. Maffini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Bordogna
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Arianna Pirelli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Giovanna Mantovani
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21
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Saponaro F, Cetani F, Repaci A, Pagotto U, Cipriani C, Pepe J, Minisola S, Cipri C, Vescini F, Scillitani A, Salcuni A, Palmieri S, Eller-Vainicher C, Chiodini I, Madeo B, Kara E, Castellano E, Borretta G, Gianotti L, Romanelli F, Camozzi V, Faggiano A, Corbetta S, Cianferotti L, Brandi ML, De Feo ML, Palermo A, Vezzoli G, Maino F, Scalese M, Marcocci C. Clinical presentation and management of patients with primary hyperparathyroidism in Italy. J Endocrinol Invest 2018; 41:1339-1348. [PMID: 29616419 DOI: 10.1007/s40618-018-0879-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 01/24/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure. METHOD From January 2014-January 2016, we performed a prospective, multicenter study in patients with newly diagnosed PHPT. Biochemical and instrumental data were collected at baseline and during 1-year follow-up. RESULTS Over the first year we enrolled 604 patients (age 61 ± 14 years), mostly women (83%), referred for further evaluation and treatment advice. Five hundred sixty-six patients had sporadic PHPT (93.7%, age 63 ± 13 years), the remaining 38 (6.3%, age 41 ± 17 years) had familial PHPT. The majority of patients (59%) were asymptomatic. Surgery was advised in 281 (46.5%). Follow-up data were available in 345 patients. Eighty-seven of 158 (55.1%) symptomatic patients underwent PTx. Sixty-five (53.7%) of 121 asymptomatic patients with at least one criterion for surgery underwent PTx and 56 (46.3%) were followed without surgery. Negative parathyroid imaging studies predicted a conservative approach [symptomatic PHPT: OR 18.0 (95% CI 4.2-81.0) P < 0.001; asymptomatic PHPT: OR 10.8, (95% CI 3.1-37.15) P < 0.001). PTx was also performed in 16 of 66 (25.7%) asymptomatic patients without surgical criteria. Young age, serum calcium concentration, 24 h urinary calcium, positive parathyroid imaging (either ultrasound or MIBI scan positive in 75% vs. 16.7%, P = 0.001) were predictors of parathyroid surgery. Almost all (94%) of patients were cured by PTx. CONCLUSIONS Italian endocrinologists do not follow guidelines for the management of PHPT. Negative parathyroid imaging studies are strong predictors of a non-surgical approach. PTx is successful in almost all patients.
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Affiliation(s)
- F Saponaro
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - F Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - A Repaci
- Division of Endocrinology Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - U Pagotto
- Division of Endocrinology Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - C Cipriani
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - J Pepe
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - S Minisola
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - C Cipri
- Endocrinology and Metabolism, Unit University-Hospital of Udine, Udine, Italy
| | - F Vescini
- Endocrinology and Metabolism, Unit University-Hospital of Udine, Udine, Italy
| | - A Scillitani
- Endocrinology Unit, "Casa Sollievo della Sofferenza," IRCCS, San Giovanni Rotondo, Italy
| | - A Salcuni
- Endocrinology Unit, "Casa Sollievo della Sofferenza," IRCCS, San Giovanni Rotondo, Italy
| | - S Palmieri
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - C Eller-Vainicher
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - I Chiodini
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - B Madeo
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - E Kara
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - E Castellano
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - G Borretta
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - L Gianotti
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - F Romanelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - V Camozzi
- Endocrine Unit, University of Padova, Padua, Italy
| | - A Faggiano
- Endocrinology, Federico II University of Naples, Naples, Italy
| | - S Corbetta
- Endocrinology Service, Department of Biomedical Sciences for Health, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - L Cianferotti
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - M L Brandi
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - M L De Feo
- Endocrinology Unit, Careggi Hospital and University of Florence, Florence, Italy
| | - A Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - G Vezzoli
- Nephrology and Dialysis Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - M Scalese
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy.
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Kara E, Della Valle E, De Vincentis S, Rochira V, Madeo B. Cured primary hyperparathyroidism after fine-needle aspiration biopsy-induced parathyroid disappearance. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170125. [PMID: 29204278 PMCID: PMC5704442 DOI: 10.1530/edm-17-0125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/24/2017] [Accepted: 11/02/2017] [Indexed: 12/11/2022] Open
Abstract
Spontaneous or fine-needle aspiration (FNAB)-induced remission of primary hyperparathyroidism (PHPT) may occur, especially for cystic lesions. However, the disease generally relapses over a short time period. We present a case of PHPT due to an enlarged hyperfunctioning parathyroid that underwent long-term (almost 9 years) clinical and ultrasonographic remission after the disappearance of the lesion following ultrasound (US)-assisted FNAB. A 67-year-old woman with PHPT underwent biochemical and US examinations that confirmed the diagnosis and showed a lesion suggestive for parathyroid adenoma or hyperplasia. US-FNAB of the lesion confirmed its parathyroid nature by means of elevated levels of parathyroid hormone within the needle washing fluid. At the second visit, the patient referred slight neck swelling that resolved spontaneously in the days after the US-FNAB. At subsequent follow-up, the enlarged parathyroid was not found; it was visible neither with US nor with magnetic resonance imaging. Biochemical remission persists after 9 years. This is the first reported case of cure of PHPT after US-FNAB performed on a hyperfunctioning parathyroid resulting in its complete disappearance over a period of 9 years of negative biochemical and ultrasonographic follow-up.
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Affiliation(s)
- Elda Kara
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Della Valle
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
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23
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Madeo B, Kara E, Cioni K, Vezzani S, Trenti T, Santi D, Simoni M, Rochira V. Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism. JBMR Plus 2017; 2:109-117. [PMID: 30283895 PMCID: PMC6124174 DOI: 10.1002/jbm4.10019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/08/2017] [Accepted: 09/24/2017] [Indexed: 01/13/2023] Open
Abstract
Primary hyperparathyroidism (PHPT) diagnosis is challenging and is based on serum calcium (Ca) and parathyroid hormone (PTH). Because serum Ca and phosphorous (P) are inversely related in PHPT, we investigated the diagnostic value of the serum Ca/P ratio in the diagnosis of PHPT. We report a single‐center, case‐controlled, retrospective study including 97 patients with documented PHPT and compared them with those of 96 controls (C). The main outcome measures were: serum PTH, 25‐OH vitamin D, Ca, P, albumin, and creatinine. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the serum Ca/P ratio were calculated. The results were verified using an independent, anonymous set of data extracted from a laboratory database containing over 900 million entries. A total of 35 (36.1%) PHPT patients had normocalcemic PHPT (NCHPT). Ca and PTH were significantly higher in PHPT than in C (p < 0.0001). P was significantly lower in PHPT than in C (p < 0.0001). The Ca/P ratio was significantly higher in PHPT than in C (p < 0.0001). Receiver‐operating characteristic (ROC) curves analyses identified a cutoff of 2.71 (3.5 if Ca and P are expressed in mg/dL) for Ca/P ratio with a sensitivity and specificity of 86% and 87%, respectively (p < 0.0001), confirmed by the independent, big data approach. In conclusion, Ca/P is a valuable tool for the diagnosis of PHPT and is of superior value compared to serum Ca alone, especially in NCPHT. Because Ca/P is simple, inexpensive, and easily accessible worldwide, this ratio is useful for PHPT diagnosis, especially in laboratory/medical settings relying on limited resources, such as low‐income countries. © 2017 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Bruno Madeo
- Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara Modena Italy
| | - Elda Kara
- Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara Modena Italy
| | - Katia Cioni
- Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara Modena Italy
| | - Silvia Vezzani
- Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara Modena Italy
| | - Tommaso Trenti
- Department of Laboratory Medicine and Pathological Anatomy Azienda Unità Sanitaria Locale (USL) of Modena Modena Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara Modena Italy.,Department of Biomedical Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara Modena Italy.,Department of Biomedical Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy.,Center for Genomic Research University of Modena and Reggio Emilia Modena Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara Modena Italy.,Department of Biomedical Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
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Vescini F, Attanasio R, Balestrieri A, Bandeira F, Bonadonna S, Camozzi V, Cassibba S, Cesareo R, Chiodini I, Francucci CM, Gianotti L, Grimaldi F, Guglielmi R, Madeo B, Marcocci C, Palermo A, Scillitani A, Vignali E, Rochira V, Zini M. Italian association of clinical endocrinologists (AME) position statement: drug therapy of osteoporosis. J Endocrinol Invest 2016; 39:807-34. [PMID: 26969462 PMCID: PMC4964748 DOI: 10.1007/s40618-016-0434-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/22/2016] [Indexed: 12/17/2022]
Abstract
Treatment of osteoporosis is aimed to prevent fragility fractures and to stabilize or increase bone mineral density. Several drugs with different efficacy and safety profiles are available. The long-term therapeutic strategy should be planned, and the initial treatment should be selected according to the individual site-specific fracture risk and the need to give the maximal protection when the fracture risk is highest (i.e. in the late life). The present consensus focused on the strategies for the treatment of postmenopausal osteoporosis taking into consideration all the drugs available for this purpose. A short revision of the literature about treatment of secondary osteoporosis due both to androgen deprivation therapy for prostate cancer and to aromatase inhibitors for breast cancer was also performed. Also premenopausal females and males with osteoporosis are frequently seen in endocrine settings. Finally particular attention was paid to the tailoring of treatment as well as to its duration.
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Affiliation(s)
- F. Vescini
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, P.le S.M. della Misericordia, 15, 33100 Udine, Italy
| | - R. Attanasio
- Endocrinology Service, Galeazzi Institute IRCCS, Milan, Italy
| | - A. Balestrieri
- Unit of Endocrinology and Diabetology, Department of Internal Medicine, M. Bufalini Hospital, Cesena, Italy
| | - F. Bandeira
- Division of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | | | - V. Camozzi
- Unit of Endocrinology, Department of Medicine, University of Padova, Padua, Italy
| | - S. Cassibba
- Endocrinology and Diabetology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - R. Cesareo
- Endocrinology, S. Maria Goretti Hospital, Latina, Italy
| | - I. Chiodini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C. Maria Francucci
- Post Acute and Long Term Care Department, I.N.R.C.A., Ancona, Italy
- San Pier Damiano Hospital, Villa Maria Group Care and Research, Faenza, Ravenna Italy
| | - L. Gianotti
- Endocrinology and Metabolic Diseases, S. Croce e Carle Hospital, Cuneo, Italy
| | - F. Grimaldi
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, P.le S.M. della Misericordia, 15, 33100 Udine, Italy
| | - R. Guglielmi
- Endocrinology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome Italy
| | - B. Madeo
- Integrated Department of Medicine, Endocrinology and Metabolism, Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - C. Marcocci
- Endocrine Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - A. Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - A. Scillitani
- Endocrinology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - E. Vignali
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - V. Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M. Zini
- Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
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25
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Santi D, Madeo B, Carli F, Zona S, Brigante G, Vescini F, Guaraldi G, Rochira V. Serum total estradiol, but not testosterone is associated with reduced bone mineral density (BMD) in HIV-infected men: a cross-sectional, observational study. Osteoporos Int 2016; 27:1103-1114. [PMID: 26510848 DOI: 10.1007/s00198-015-3383-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 04/30/2015] [Accepted: 10/21/2015] [Indexed: 01/24/2023]
Abstract
SUMMARY By investigating the relationship between serum testosterone, estradiol, and bone mineral density (BMD) in a large cohort of HIV-infected men, estradiol was associated with BMD, relative estrogen deficiency being involved in bone loss in men with hypogonadism, in addition to all HIV-related factors. Increased aromatization in adipose tissue does not counteract HIV-related bone loss. INTRODUCTION The purpose of this study is to evaluate the relationship between serum testosterone, estradiol, and BMD in a large cohort of HIV-infected men. METHODS We investigated biochemical, hormonal parameters, and BMD in 1204 HIV-infected men (age 45.64 ± 7.33 years) participating in a cross-sectional, observational study. Among other parameters, the main outcome measures were serum total testosterone and estradiol, gonadotropins, 25-hydroxyvitamin D [25(OH)D], parathormone (PTH), calcium, phosphorous, femoral, and lumbar BMD. RESULTS In men with HIV, the prevalence of osteoporosis and osteopenia is 15.1 and 63.2% with 25(OH)D insufficiency being very common (60.1%). After age adjustment, BMD is positively associated with estradiol, but not testosterone, at linear (p < 0.001) and stepwise (p < 0.05) multiple regression. Lumbar BMD significantly increases across the estradiol quartiles but not among testosterone quartiles. Femoral and lumbar BMD are significantly higher in men with estradiol ≥ 27 pg/mL than in those with estradiol <27 pg/mL. Apart from estradiol, only age, calcium, and BMI predict BMD at stepwise linear multiple regression, but the strength of this association is weak. CONCLUSIONS Estradiol, but not testosterone, is associated with BMD in HIV-infected men and exerts a protective role on bone especially when it is above 27 pg/mL. Relative estrogen deficiency is a potential mechanism involved in bone loss in hypogonadal HIV-infected men, in addition to all HIV-related factors. Increased aromatization in adipose tissue does not counteract HIV-related bone loss. Finally, reduced BMD in young-to-middle-aged HIV-infected men might be considered a peculiar hallmark of HIV infection due to its relevant prevalence, representing one of the several pieces composing the complicated puzzle of premature aging related to HIV infection.
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Affiliation(s)
- D Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via P. Giardini 1355, 41126, Modena, Italy
- Azienda USL of Modena, NOCSAE, Via P. Giardini 1355, 41126, Modena, Italy
| | - B Madeo
- Azienda USL of Modena, NOCSAE, Via P. Giardini 1355, 41126, Modena, Italy
| | - F Carli
- Metabolic Clinic, Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - S Zona
- Metabolic Clinic, Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - G Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via P. Giardini 1355, 41126, Modena, Italy
| | - F Vescini
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, P.za S. Maria della Misericordia 15, 33100, Udine, Italy
| | - G Guaraldi
- Metabolic Clinic, Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via P. Giardini 1355, 41126, Modena, Italy.
- Azienda USL of Modena, NOCSAE, Via P. Giardini 1355, 41126, Modena, Italy.
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Marino M, Monzani ML, Brigante G, Cioni K, Madeo B, Santi D, Maiorana A, Bettelli S, Moriondo V, Pignatti E, Bonacini L, Carani C, Rochira V, Simoni M. High-Resolution Melting Is a Sensitive, Cost-Effective, Time-Saving Technique for BRAF V600E Detection in Thyroid FNAB Washing Liquid: A Prospective Cohort Study. Eur Thyroid J 2015; 4:73-81. [PMID: 26279992 PMCID: PMC4521072 DOI: 10.1159/000430092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 12/22/2014] [Revised: 04/09/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The diagnostic accuracy of thyroid fine needle aspiration biopsy (FNAB) can be improved by the combination of cytological and molecular analysis. In this study, washing liquids of FNAB (wFNAB) were tested for the BRAF V600E mutation, using the sensitive and cost-effective technique called high-resolution melting (HRM). The aim was to demonstrate the feasibility of BRAF analysis in wFNAB and its diagnostic utility, combined with cytology. DESIGN Prospective cohort study. METHODS 481 patients, corresponding to 648 FNAB samples, were subjected to both cytological (on cells smeared onto a glass slide) and molecular analysis (on fluids obtained washing the FNAB needle with 1 ml of saline) of the same aspiration. BRAF V600E analysis was performed by HRM after methodological validation for application to wFNAB (technique sensitivity: 5.4%). RESULTS The cytological results of the FNAB were: 136 (21%) nondiagnostic (THY1); 415 (64%) benign (THY2); 80 (12.4%) indeterminate (THY3); 9 (1.4%) suspicious for malignancy (THY4); 8 (1.2%) diagnostic of malignancy (THY5). The BRAF V600E mutation was found in 5 THY2, 2 THY3, 6 THY4 and 6 THY5 samples. Papillary carcinoma diagnosis was histologically confirmed in all BRAF+ thyroidectomized patients. BRAF combined with cytology improved the diagnostic value compared to cytology alone in a subgroup of 74 operated patients. CONCLUSIONS HRM was demonstrated to be a feasible method for BRAF analysis in wFNAB. Thanks to its sensitivity and cost-effectiveness, it might be routinely used on a large scale in clinical practice. In perspective, standby wFNAB samples could be analyzed a posteriori in case of indeterminate cytology and/or suspicious findings on ultrasound.
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Affiliation(s)
- Marco Marino
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
| | - Maria Laura Monzani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Katia Cioni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Antonino Maiorana
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Italy
| | - Stefania Bettelli
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Italy
| | - Valeria Moriondo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
| | - Elisa Pignatti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
| | - Lara Bonacini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Cesare Carani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
- *Vincenzo Rochira, MD, PhD, Unit of Endocrinology, NOCSAE, Via Giardini 1355, IT-41126 Modena (Italy), E-Mail
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
- Azienda USL of Modena, Modena, Italy
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Gnarini VL, Brigante G, Della Valle E, Diazzi C, Madeo B, Carani C, Rochira V, Simoni M. Very high prevalence of ultrasound thyroid scan abnormalities in healthy volunteers in Modena, Italy. J Endocrinol Invest 2013; 36:722-8. [PMID: 23579962 DOI: 10.3275/8931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Italy is characterized by high prevalence of goiter. To date, only limited data about the prevalence of goiter in the Italian adult population are available. AIM To investigate the prevalence of thyroid ultrasound abnormalities in adults unaware of any thyroid disease and evaluate the rate of differentiated thyroid cancer (DTC) obtained by this intervention. METHODS Ultrasound (US) thyroid scan was performed in adult volunteers recruited by advertisement in Modena, Italy. One hundred and thirty-five women and 66 men (no.= 201), unaware of any thyroid disease (mean age of 46 ± 10.7 yr) underwent their first thyroid US scan. RESULTS US thyroid abnormalities were found in 101 subjects (50.3%): 91 nodular goiters (45.2%) and 13 US-thyroiditis (6.5%) associated with positive auto-antibodies in 11 of them. Seventeen subjects (18%) with nodules underwent US-fine needle aspiration biopsy with the following cytological class (C) outcome: 14 patients C2 (82%), 1 patient C3 (6%), 2 patients had C4 (12%), the latter received histological confirmation. CONCLUSIONS The prevalence of thyroid abnormalities is very high in subjects unaware of any thyroid disease. DTC was found in 1% of subjects and in 2% of those affected by nodular goiter. Compared to the detection rate of the well-established screening programs for breast (0.45%) and colorectal (0.27%) cancer, the prevalence of DTC seems to be much higher. Thyroid US screening could allow the detection of DTC in asymptomatic subjects and this diagnosis often includes DTC at an advanced stage. Thus, US screening not necessarily results in the over-diagnosis of clinically not relevant thyroid diseases.
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Affiliation(s)
- V L Gnarini
- Unit and Chair of Endocrinology & Metabolism, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Marino M, Cirello V, Gnarini V, Colombo C, Pignatti E, Casarini L, Diazzi C, Rochira V, Cioni K, Madeo B, Carani C, Simoni M, Fugazzola L. Are pre-miR-146a and PTTG1 associated with papillary thyroid cancer? Endocr Connect 2013; 2:178-85. [PMID: 24145614 PMCID: PMC3847917 DOI: 10.1530/ec-13-0066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 12/20/2022]
Abstract
Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy, with a steadily increasing incidence in the last few decades worldwide. The predisposition to developing this carcinoma by the heterozygous state of rs2910164 within the precursor of the miR-146a has been reported, but recently not confirmed. Interestingly, on the same chromosome, almost 50 kb separate the pre-miR-146a from the pituitary tumor-transforming gene 1 (PTTG1), a proto-oncogene involved in several tumors, including thyroid cancers. In this study, we analyzed, using a case-control design, the genetic association between PTC and the genomic region encompassing pre-miR-146a rs2910164 and PTTG1 rs1862391 and rs2910202. We enrolled 307 affected patients and 206 healthy controls. The possible presence of thyroid nodules in controls was excluded by ultrasonography. All the cases were submitted to single-nucleotide polymorphism (SNP) genotyping of pre-miR-146a and PTTG1, and risk association analyses were carried out. The genotypic and allelic frequencies of pre-miR-146a rs2910164 were not statistically different in the patients and controls, and this SNP was not in linkage disequilibrium with the investigated PTTG1 SNPs. Consistently, meta-analyses, the first including all the affected cases published to date, did not confirm the previously reported association of the heterozygous CG genotype with PTC. The PTTG1 SNPs exhibited the same allelic frequency in the patients and controls and were not associated with the disease. In conclusion, in a well-selected Italian population, neither pre-miR-146a rs2910164 nor PTTG1 rs1862391 and rs2910202 were found to be associated with the risk of developing PTC.
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Affiliation(s)
- Marco Marino
- Unit and Chair of Endocrinology and Metabolism, NOCSAE, Department of Biomedical Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaVia Pietro Giardini 135541126, ModenaItaly
- Center for Genomic ResearchUniversity of Modena and Reggio EmiliaModenaItaly
| | - Valentina Cirello
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Endocrine UnitFondazione IRCCS Ca' Granda MilanMilanItaly
| | - Valentina Gnarini
- Unit and Chair of Endocrinology and Metabolism, NOCSAE, Department of Biomedical Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaVia Pietro Giardini 135541126, ModenaItaly
| | - Carla Colombo
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Endocrine UnitFondazione IRCCS Ca' Granda MilanMilanItaly
| | - Elisa Pignatti
- Unit and Chair of Endocrinology and Metabolism, NOCSAE, Department of Biomedical Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaVia Pietro Giardini 135541126, ModenaItaly
- Center for Genomic ResearchUniversity of Modena and Reggio EmiliaModenaItaly
| | - Livio Casarini
- Unit and Chair of Endocrinology and Metabolism, NOCSAE, Department of Biomedical Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaVia Pietro Giardini 135541126, ModenaItaly
- Center for Genomic ResearchUniversity of Modena and Reggio EmiliaModenaItaly
| | - Chiara Diazzi
- Unit and Chair of Endocrinology and Metabolism, NOCSAE, Department of Biomedical Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaVia Pietro Giardini 135541126, ModenaItaly
| | - Vincenzo Rochira
- Unit and Chair of Endocrinology and Metabolism, NOCSAE, Department of Biomedical Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaVia Pietro Giardini 135541126, ModenaItaly
- Azienda USL of ModenaModenaItaly
| | | | | | - Cesare Carani
- Unit and Chair of Endocrinology and Metabolism, NOCSAE, Department of Biomedical Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaVia Pietro Giardini 135541126, ModenaItaly
- Azienda USL of ModenaModenaItaly
| | - Manuela Simoni
- Unit and Chair of Endocrinology and Metabolism, NOCSAE, Department of Biomedical Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaVia Pietro Giardini 135541126, ModenaItaly
- Center for Genomic ResearchUniversity of Modena and Reggio EmiliaModenaItaly
- Azienda USL of ModenaModenaItaly
- Correspondence should be addressed to M Simoni
| | - Laura Fugazzola
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Endocrine UnitFondazione IRCCS Ca' Granda MilanMilanItaly
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Della Valle E, Vezzani S, Rochira V, Granata ARM, Madeo B, Genovese E, Pignatti E, Marino M, Carani C, Simoni M. Prevalence of olfactory and other developmental anomalies in patients with central hypogonadotropic hypogonadism. Front Endocrinol (Lausanne) 2013; 4:70. [PMID: 23760293 PMCID: PMC3675377 DOI: 10.3389/fendo.2013.00070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 05/24/2013] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Hypogonadotropic hypogonadism (HH) is a heterogeneous disease caused by mutations in several genes. Based on the presence of hyposmia/anosmia it is distinguished into Kallmann syndrome (KS) and isolated HH. The prevalence of other developmental anomalies is not well established. METHODS We studied 36 patients with HH (31 males, 5 females, mean age 41.5), 9 with familial and 27 with sporadic HH (33 congenital, 3 adult-onset), by physical examination, smell test (BSIT Sensonics), audiometry, renal ultrasound, and magnetic resonance imaging of the olfactory structures. RESULTS Based on the smell test, patients were classified as normosmic (n = 21, 58.3%) and hypo/anosmic (n = 15, 41.6%). Hypoplasia/agenesis of olfactory bulbs was found in 40% of patients (10/25; 75% hypo/anosmic, 7.6% normosmic, p < 0.01, Fisher's test). Remarkably, olfactory structures were normal in two anosmic patients, while one normosmic patient presented a unilateral hypoplastic bulb. Fourteen of 33 patients (42.4%) presented neurosensorial hearing loss of various degrees (28.5% hypo/anosmic, 52.6% normosmic, p = NS). Renal ultrasound revealed 27.7% of cases with renal anomalies (26.6% hypo/anosmic, 28.5% normosmic, p = NS). At least one midline defect was found in 50% of the patients (53.3% hypo/anosmic, 47.6% normosmic, p = NS), including abnormal palate, dental anomalies, pectus excavatum, bimanual synkinesis, iris coloboma, and absent nasal cartilage. Anamnestically 4/31 patients reported cryptorchidism (25% hypo/anosmic, 5.2% normosmic, p = NS). CONCLUSION Hypo/anosmia is significantly related to anatomical anomalies of the olfactory bulbs/tracts but the prevalence of other developmental anomalies, especially midline defects and neurosensorial hearing loss, is high both in HH and KS and independent of the presence of anosmia/hyposmia. From the clinical standpoint KS and normosmic HH should be considered as the same complex, developmental disease.
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Affiliation(s)
- Elisa Della Valle
- Unit and Chair of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Vezzani
- Unit and Chair of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit and Chair of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy
| | | | - Bruno Madeo
- Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy
| | - Elisabetta Genovese
- Department of Otolaryngology and Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Elisa Pignatti
- Unit and Chair of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Marino
- Unit and Chair of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cesare Carani
- Unit and Chair of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy
| | - Manuela Simoni
- Unit and Chair of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy
- *Correspondence: Manuela Simoni, Section of Endocrinology, Geriatrics and Metabolism, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, NOCSAE, Via Giardini 1355, Modena 41126, Italy e-mail:
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Terzolo M, Reimondo G, Chiodini I, Castello R, Giordano R, Ciccarelli E, Limone P, Crivellaro C, Martinelli I, Montini M, Disoteo O, Ambrosi B, Lanzi R, Arosio M, Senni S, Balestrieri A, Solaroli E, Madeo B, De Giovanni R, Strollo F, Battista R, Scorsone A, Giagulli VA, Collura D, Scillitani A, Cozzi R, Faustini-Fustini M, Pia A, Rinaldi R, Allasino B, Peraga G, Tassone F, Garofalo P, Papini E, Borretta G. Screening of Cushing's syndrome in outpatients with type 2 diabetes: results of a prospective multicentric study in Italy. J Clin Endocrinol Metab 2012; 97:3467-75. [PMID: 22767639 DOI: 10.1210/jc.2012-1323] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [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] [Indexed: 11/19/2022]
Abstract
CONTEXT Cushing's syndrome may remain unrecognized among patients referred for metabolic syndrome; thus, a proactive screening has been suggested in certain patient populations with features of the disorder. However, conflicting data have been reported on the prevalence of Cushing's syndrome in patients with type 2 diabetes. OBJECTIVE Our aim was to evaluate the prevalence of unsuspected Cushing's syndrome among outpatients with type 2 diabetes. DESIGN AND SETTING This was a cross-sectional prospective study in 24 diabetes clinics across Italy. PATIENTS Between June 2006 and April 2008, 813 patients with known type 2 diabetes without clinically overt hypercortisolism were evaluated. Follow-up of the study was closed in September 2010. Patients were not selected for characteristics conferring a higher pretest probability of hypercortisolism. Patients underwent a first screening step with the 1-mg overnight dexamethasone suppression test. RESULTS Forty patients failed to suppress serum cortisol less than 5.0 μg/dl (138 nmol/liter) and underwent a standard 2-d, 2-mg dexamethasone suppression test, after which six patients (0.6% of the overall series) failed to suppress cortisol less than 1.8 μg/dl (50 nmol/liter), receiving a definitive diagnosis of Cushing's syndrome that was adrenal dependent in five patients. Four patients were cured, being able to discontinue, or reduce, the glucose-lowering agents. CONCLUSIONS The present data do not support widespread screening of patients with type 2 diabetes for Cushing's syndrome; however, the disorder is less rare than previously thought when considering epidemiology of type 2 diabetes. Our results support a case-finding approach in patients with uncontrolled diabetes and hypertension despite appropriate treatment.
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Affiliation(s)
- Massimo Terzolo
- Medicina Interna I, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole, 10, 10043 Orbassano, Italy.
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Zona S, Guaraldi G, Luzi K, Beggi M, Santi D, Stentarelli C, Madeo B, Rochira V. Erectile Dysfunction Is More Common in Young to Middle‐Aged HIV‐Infected Men than in HIV‐Uninfected Men. J Sex Med 2012; 9:1923-30. [DOI: 10.1111/j.1743-6109.2012.02750.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zirilli L, Orlando G, Carli F, Madeo B, Cocchi S, Diazzi C, Carani C, Guaraldi G, Rochira V. GH response to GHRH plus arginine is impaired in lipoatrophic women with human immunodeficiency virus compared with controls. Eur J Endocrinol 2012; 166:415-24. [PMID: 22189998 DOI: 10.1530/eje-11-0829] [Citation(s) in RCA: 14] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE GH secretion is impaired in lipodystrophic human immunodeficiency virus (HIV) patients and inversely related to lipodystrophy-related fat redistribution in men. Less is known about the underlying mechanisms involved in reduced GH secretion in HIV-infected women. DESIGN A case-control, cross-sectional study comparing GH/IGF1 status, body composition, and metabolic parameters in 92 nonobese women with HIV-related lipodystrophy and 63 healthy controls matched for age, ethnicity, sex, and body mass index (BMI). METHODS GH, IGF1, IGF binding protein 3 (IGFBP3), GH after GHRH plus arginine (GHRH+Arg), several metabolic variables, and body composition were evaluated. RESULTS GH response to GHRH+Arg was lower in HIV-infected females than in controls. Using a cutoff of peak GH ≤ 7.5 μg/l, 20.6% of HIV-infected females demonstrated reduced peak GH response after GHRH+Arg. In contrast, none of the control subjects demonstrated a peak GH response ≤ 7.5 μg/l. Bone mineral density (BMD), quality of life, IGF1, and IGFBP3 were lowest in the HIV-infected females with a GH peak ≤ 7.5 μg/l. BMI was the main predictive factor of GH peak in stepwise multiregression analysis followed by age, with a less significant effect of visceral fat in the HIV-infected females. CONCLUSIONS This study establishes that i) GH response to GHRH+Arg is lower in lipoatrophic HIV-infected women than in healthy matched controls, ii) BMI more than visceral adipose tissue or trunk fat influences GH peak in this population, and iii) HIV-infected women with a GH peak below or equal to 7.5 μg/l demonstrate reduced IGF1, IGFBP3, BMD, and quality of life.
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Affiliation(s)
- Lucia Zirilli
- Integrated Department of Medicine, University of Modena and Reggio Emilia, Via Giardini 1355, 41100 Modena, Italy
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Rochira V, Zirilli L, Madeo B, Maffei L, Carani C. Testosterone action on erythropoiesis does not require its aromatization to estrogen: Insights from the testosterone and estrogen treatment of two aromatase-deficient men. J Steroid Biochem Mol Biol 2009; 113:189-94. [PMID: 19159688 DOI: 10.1016/j.jsbmb.2008.12.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [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: 02/21/2008] [Revised: 11/27/2008] [Accepted: 12/22/2008] [Indexed: 11/20/2022]
Abstract
Androgens act on erythropoiesis, but the relative role of testosterone (T) and estradiol (E(2)) on erythropoietic parameters in men is a poorly investigated issue. In order to evaluate separately the effects on erythropoiesis of high-dose T administration alone and of physiological dose of E(2) administration alone two adult men with aromatase deficiency were assessed before and during each treatment. Blood cell count, hemoglobin (Hb), hematocrit (Hct), erythrocyte mean cell volume (MCV), erythrocyte mean corpuscular hemoglobin (MCH), erythrocyte mean corpuscular hemoglobin concentration (MCHC), serum ferritin, iron and total iron-binding capacity (TIBC), serum erythropoietin, serum total testosterone and estradiol were evaluated. Hb, Hct and red cell count rose during testosterone treatment, consistently with the increase in circulating testosterone, but failed to increase during estradiol treatment. A decrease in Hb, Hct and red cell count was recorded in one of the two subjects during estradiol treatment, with a concomitant decrease in serum testosterone. Circulating T alone is capable of and sufficient to influence erythropoiesis, especially at supraphysiological dosage, while circulating E(2) have not the same effect on erythropoietic parameters, suggesting the hypothesis that the erythropoietic changes induced by androgens are not mediated via its aromatization to estrogens.
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Affiliation(s)
- Vincenzo Rochira
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Argentina.
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Madeo B, Bettica P, Milleri S, Balestrieri A, Granata AR, Carani C, Rochira V. The Effects of Citalopram and Fluoxetine on Sexual Behavior in Healthy Men: Evidence of Delayed Ejaculation and Unaffected Sexual Desire. A Randomized, Placebo‐Controlled, Double‐Blind, Double‐Dummy, Parallel Group Study. J Sex Med 2008; 5:2431-41. [DOI: 10.1111/j.1743-6109.2008.00843.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Balestrieri A, Zirilli L, Madeo B, Pignatti E, Rossi G, Carani C, Rochira V. 21-hydroxylase deficiency and klinefelter syndrome in an adult man: striking a balance between androgen excess and insufficiency. ACTA ACUST UNITED AC 2008; 29:605-9. [PMID: 18772490 DOI: 10.2164/jandrol.107.004648] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- A Balestrieri
- Department of Medicine, ASL Cesena, Ospedale M. Bufalini, Cesena, Italy
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Rochira V, Madeo B, Zirilli L, Caffagni G, Maffei L, Carani C. Oestradiol replacement treatment and glucose homeostasis in two men with congenital aromatase deficiency: evidence for a role of oestradiol and sex steroids imbalance on insulin sensitivity in men. Diabet Med 2007; 24:1491-5. [PMID: 17976198 DOI: 10.1111/j.1464-5491.2007.02304.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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] [Indexed: 11/28/2022]
Abstract
AIMS The role of sex steroids in glucose and insulin metabolism in men remains unclear. To investigate the effects of sex steroids and oestrogen on insulin sensitivity in men, we studied two male adults with aromatase deficiency (subject 1 and subject 2). METHODS The effects of transdermal oestradiol (tE(2)) treatment at different dosages on insulin sensitivity were studied before tE(2) treatment (phase 1), and after 6 months (phase 2) and 12 months of tE(2) treatment (phase 3) by means of homeostasis model assessment-insulin resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI), insulin tolerance test (ITT), and oral glucose tolerance test (OGTT). The latter was performed only in subject 1, as subject 2 suffered from Type 2 diabetes. RESULTS The restoration of normal serum oestradiol led to improved insulin sensitivity, as shown by changes in HOMA-IR and QUICKI. The ITT provided evidence of improved insulin sensitivity during tE(2) treatment. Insulin secretion after OGTT was reduced during tE(2) treatment in subject 1. After 12 months of tE(2) treatment, insulin sensitivity was improved compared with in phases 1 and 2. CONCLUSIONS The study suggests a direct involvement of oestrogens in insulin sensitivity, and supports a possible role of oestradiol : testosterone ratio, which may be as influencial as the separate actions of each sex steroid on glucose homeostasis.
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Affiliation(s)
- V Rochira
- Integrated Department of Medicine, Endocrinology, Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Italy.
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Rochira V, Zirilli L, Madeo B, Aranda C, Caffagni G, Fabre B, Montangero VE, Roldan EJA, Maffei L, Carani C. Skeletal effects of long-term estrogen and testosterone replacement treatment in a man with congenital aromatase deficiency: evidences of a priming effect of estrogen for sex steroids action on bone. Bone 2007; 40:1662-8. [PMID: 17400043 DOI: 10.1016/j.bone.2007.01.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [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: 10/26/2006] [Revised: 01/09/2007] [Accepted: 01/31/2007] [Indexed: 11/18/2022]
Abstract
The relative contribution of each sex steroid (i.e. estrogen and androgen) on bone in men and the relationships among sex steroids and changes in BMD and bone strength are still unknown. A defective BMD of bone tissue is constantly present in men with aromatase deficiency. This study evaluates the effects of different regimens of treatment with sex steroids over 7.3 years follow-up on BMD in an adult man affected by aromatase deficiency and by a concomitant mild hypogonadism, as previously described. The aim of the study is to provide additional data on the relative roles of androgens and estrogens in male bone metabolism. The effects of testosterone (T) treatment alone and estrogen (tE(2)) treatment alone as well as the effects of the combined treatment with testosterone and estradiol (T plus tE(2)) on areal BMD (aBMD) at dual-energy X-ray absorptiometry (DXA) and the effects of T plus tE(2) on volumetric BMD (vBMD), particular at cortical site, measured by peripheral quantitative computed tomography (pQCT), are investigated. Hormones and markers of bone turnover were monitored during all phases of the study. Treatment with tE(2) normalized serum estradiol, but only the combined treatment with T plus tE(2) normalized both serum estradiol and testosterone. Markers of bone turnover reached a pattern close to normality during T plus tE(2). The aBMD was little modified by T, but increased more during tE(2). T plus tE(2) resulted in a further increase in both aBMD at DXA and vBMD at pQCT. Cortical thickness increased during T plus tE(2) both in radius and tibia. Only the combined treatment led to optimal parameters of aBMD suggesting that testosterone needs estrogens as a permissive factor for a direct androgen anabolic action on bone in men.
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Affiliation(s)
- Vincenzo Rochira
- Department of Medicine, University of Modena and Reggio Emilia, Ospedale S. Agostino-Estense di Baggiovara, Via Giardini 1355, Baggiovara, 41100 Modena, Italy
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Madeo B, Zirilli L, Caffagni G, Diazzi C, Sanguanini A, Pignatti E, Carani C, Rochira V. The osteoporotic male: overlooked and undermanaged? Clin Interv Aging 2007; 2:305-12. [PMID: 18044181 PMCID: PMC2685264] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Age-related bone loss in men is a poorly understood phenomenon, although increasing data on the pathophysiology of bone in men is becoming available. Most of what we know on bone pathophysiology derives from studies on women. The well-known association between menopause and osteoporosis is far from been disproven. However, male osteoporosis is a relatively new phenomenon. Its novelty is in part compensated for by the number of studies on female osteoporosis and bone pathophysiology. On the other hand, the deeper understanding of female osteoporosis could lead to an underestimation of this condition in the male counterpart. The longer life-span exposes a number of men to the risk of mild-to-severe hypogonadism which in turn we know to be one of the pathogenetic steps toward the loss of bone mineral content in men and in women. Hypogonadism might therefore be one among many corrigible risk factors such as cigarette smoking and alcohol abuse against which clinicians should act in order to prevent osteoporosis and its complications. Treatments with calcium plus vitamin D and bisphophonates are widely used in men, when osteoporosis is documented and hypogonadism has been excluded. The poor knowledge on male osteoporosis accounts for the lack of well shared protocols for the clinical management of the disease. This review focuses on the clinical approach and treatment strategy for osteoporosis in men with particular attention to its relationship with male hypogonadism.
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Affiliation(s)
- Bruno Madeo
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Ospedale S.Agostino – Estense di Baggiovara, Modena, Italy
| | - Lucia Zirilli
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Ospedale S.Agostino – Estense di Baggiovara, Modena, Italy
| | - Giovanni Caffagni
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Ospedale S.Agostino – Estense di Baggiovara, Modena, Italy
| | - Chiara Diazzi
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Ospedale S.Agostino – Estense di Baggiovara, Modena, Italy
| | - Alessia Sanguanini
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Ospedale S.Agostino – Estense di Baggiovara, Modena, Italy
| | - Elisa Pignatti
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Ospedale S.Agostino – Estense di Baggiovara, Modena, Italy
| | - Cesare Carani
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Ospedale S.Agostino – Estense di Baggiovara, Modena, Italy
| | - Vincenzo Rochira
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Ospedale S.Agostino – Estense di Baggiovara, Modena, Italy
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Rochira V, Balestrieri A, Madeo B, Granata ARM, Carani C. Sildenafil Improves Sleep-Related Erections in Hypogonadal Men: Evidence From a Randomized, Placebo-Controlled, Crossover Study of a Synergic Role for Both Testosterone and Sildenafil on Penile Erections. ACTA ACUST UNITED AC 2006; 27:165-75. [PMID: 16278367 DOI: 10.2164/jandrol.05077] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To study the effects of sildenafil on human sleep-related erections according to the state of androgenization, we evaluated the effects of sildenafil on sleep-related erections in hypogonadal men before and during testosterone replacement treatment and in control subjects. We enrolled 24 hypogonadal men and 24 healthy men as a control group. All hypogonadal subjects had very low testosterone levels (<200 ng/dL [6.9 nmol/L]) [corrected] All subjects underwent nocturnal penile tumescence and rigidity monitoring (NPTRM) for 3 consecutive nights and were randomly assigned to consume either 50 mg of sildenafil or placebo 1 hour before bedtime on the second or third night of nocturnal penile monitoring. The hypogonadal subjects were tested twice, first without replacement treatment (H-T) and then after at least 6 months of testosterone replacement therapy (H+T). The subjects of the control group (C) were tested once. The following parameters of sleep-related erections were analyzed: total number of valid erections, total duration of both rigidity greater than or equal 70% and increase in penile circumference greater than or equal 30 mm, maximum rigidity, and maximum increase in penile circumference. NPTRM parameters were reduced in hypogonadal men before testosterone treatment (H-T+P) when compared with control subjects taking placebo (C+P). NPTRM parameters after testosterone (H+T+P) and sildenafil (H-T+S) administration were similar to that of control subjects taking placebo (C+P). When the statistical analysis was restricted to the hypogonadal men before testosterone treatment, sildenafil alone significantly increased NPTRM parameters when compared with placebo (H-T+S vs H-T+P). Testosterone restored normal erections when administered to hypogonadal subjects (H+T+P vs H-T+P); in hypogonadal men, however, the combined treatment (sildenafil plus testosterone) resulted in the maximum positive effect on NPTRM parameters. When the increase from baseline was analyzed, the effects of testosterone plus sildenafil were greater than the sum of the effects of each drug used alone. In conclusion, sildenafil administered at bedtime improves sleep-related erections in hypogonadal men, suggesting that the nitric oxide pathway may be pharmacologically enrolled and enhanced despite low serum testosterone. Furthermore, these data strongly support the idea of a synergic effect on sleep-related erections of sildenafil and testosterone.
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Affiliation(s)
- Vincenzo Rochira
- Department of Medicine and Medical Specialties, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy.
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Rochira V, Balestrieri A, Madeo B, Zirilli L, Granata ARM, Carani C. Osteoporosis and male age-related hypogonadism: role of sex steroids on bone (patho)physiology. Eur J Endocrinol 2006; 154:175-85. [PMID: 16452530 DOI: 10.1530/eje.1.02088] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [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] [Indexed: 11/08/2022]
Abstract
Male age-related bone loss is caused, at least in part, by hypogonadism that occurs with advancing age. The study of the effects of sex steroids on bone physiology in men has recently highlighted the central role of estrogens on bone pathophysiology. This review focuses on particular aspects of bone physiology and pathophysiology in aging men, noting both the similarities to and the differences from female counterparts. In particular, the role of sex steroids on bone sexual dimorphism in health and disease has been analyzed.
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Affiliation(s)
- V Rochira
- Department of Medicine and Medical Specialties, University of Modena and Reggio Emilia, Policlinico, Via del Pozzo 71, 41100 Modena, Italy.
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Pellegrini E, Maurantonio M, D'Amico R, Madeo B, Giannico I, Ganazzi D, Carulli L, Loria P, Bertolotti M, Carulli N. Mo-P1:4 Risk for cardiovascular events in a local population of diabetic patients. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80142-x] [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: 10/23/2022]
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Abstract
This review focuses on the role of estrogen in men, mainly in male reproduction. The continuing increase in data obtained, and recent discoveries in this area will enable a better understanding of male physiology; these, in turn, will have important clinical implications.
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Affiliation(s)
- Vincenzo Rochira
- Integrated Department of Medicine and Medical Specialties, University of Modena and Reggio Emilia, Modena 41100, Italy.
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Rochira V, Balestrieri A, Madeo B, Zirilli L, Granata ARM, Carani C. Bone loss, sex steroids and male age related hypogonadism. J Endocrinol Invest 2005; 28:46-8. [PMID: 16760625] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Male age-related bone loss is caused at least in part from hypogonadism that occurs with advancing age. Recently, the study of sex steroids on bone physiology in men has highlighted the central role of estrogens on bone pathophysiology. This review focuses on the relative role of sex steroids on bone loss in aging men.
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Affiliation(s)
- V Rochira
- Department of Medicine and Medical Specialties, University of Modena and Reggio Emilia, Policlinico, 41100 Modena, Italy.
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Balestrieri A, Madeo B, Rochira V, Baldini L, Carani C. Bilateral osteonecrosis of the femoral head in an adult man affected by congenital estrogen deficiency. J Endocrinol Invest 2003; 26:762-4. [PMID: 14669833 DOI: 10.1007/bf03347361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Indexed: 10/25/2022]
Abstract
Osteonecrosis of femoral head is related to different predisposing factors. The pathogenesis is not completely understood, but an ischemic impairment seems to be one of the major determinants of bone necrosis. The association of bilateral necrosis of femoral heads and congenital aromatase deficiency is here reported. The absence of estrogen activity, as well as the persistence of unfused epiphyses for a long period of life, may be involved in the determinism of bilateral necrosis of bone femoral heads. The possibility of development of bone necrosis in patients affected by congenital estrogen deficiency needs to be considered and magnetic resonance imaging can be a useful method for an early detection of this disease.
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Affiliation(s)
- A Balestrieri
- Department of Internal Medicine, Chair of Endocrinology, University of Modena and Reggio Emilia, Policlinico, Modena, Italy
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Rochira V, Zirilli L, Madeo B, Balestrieri A, Granata ARM, Carani C. Sex steroids and sexual desire mechanism. J Endocrinol Invest 2003; 26:29-36. [PMID: 12834018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Sexual behavior is mainly controlled by cognitive functions in men, though hormones, particularly sex steroids, may modulate some aspects of male sexuality. This review focuses on the role of both estrogens and androgens on male sexual desire, starting from both animal and human studies. Estrogens could play a role in human male sexual activity, similarly to what happens in animals, but even though physiological levels of estrogens could be probably required for a completely normal male sexual behavior, testosterone remains the major determinant of human male sexual behavior.
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Affiliation(s)
- V Rochira
- Department of Internal Medicine, University of Modena and Reggio Emilia, Policlinico, Modena, Italy.
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Rochira V, Balestrieri A, Madeo B, Spaggiari A, Carani C. Congenital estrogen deficiency in men: a new syndrome with different phenotypes; clinical and therapeutic implications in men. Mol Cell Endocrinol 2002; 193:19-28. [PMID: 12160998 DOI: 10.1016/s0303-7207(02)00092-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [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] [Indexed: 11/22/2022]
Abstract
The report focuses on the role of estrogens in human male, dealing with two human models of congenital estrogen deficiency: estrogen resistance and aromatase deficiency. Similarities and differences of clinical phenotypes of these models are described and progresses of estrogen treatment of aromatase-deficient men are reported. Finally, the putative use of estrogen in men and the use of aromatase inhibitors and antiestrogen for male disorders are discussed.
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Affiliation(s)
- Vincenzo Rochira
- Department of Internal Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41100 Modena, Italy.
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Rochira V, Granata ARM, Balestrieri A, Madeo B, Carani C. Effects of sildenafil on nocturnal penile tumescence and rigidity in normal men: randomized, placebo-controlled, crossover study. J Androl 2002; 23:566-71. [PMID: 12065465] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We studied the effects of sildenafil on sleep-related erections in 44 adult healthy men not affected by erectile dysfunction (mean age +/- SD: 39.3 +/- 10.5 years). No subjects were administered any medication the first night, but all were randomly administered sildenafil 50 mg or placebo the second night and vice versa the third night. Sildenafil and placebo were administered 1 hour before bedtime. The following parameters of sleep-related erections, after taking sildenafil or placebo, were analyzed: total number of valid erections, total duration of rigidity more than or equal to 70% of a tightening force of 2.8 N applied by the recording device, total duration of increase in penile circumference more than or equal to 30 mm, maximum rigidity, mean of maximum rigidity, and maximum increase of tumescence. Apart from the maximum increase of tumescence, all the parameters analyzed were significantly higher after sildenafil than after placebo administration during the first 4 hours of monitoring in all subjects (n = 44) (study 1). All the parameters were significantly higher after sildenafil than after placebo administration during the whole 8 hours of monitoring in 25 of 44 subjects (study 2A) who slept at least 8 hours. Comparing both the first and the second 4 hours in the 25 of 44 subjects who slept at least 8 hours (study 2B), all the parameters were significantly higher after sildenafil than after placebo administration, apart from maximum rigidity and mean of maximum rigidity during the first 4 hours. Our data suggest that sildenafil, administered at bedtime, is efficacious in improving sleep-related erections in normal men, indirectly confirming that the nitric oxide pathway is crucial in the physiology of erections during sleep. The effect of sildenafil is prolonged up to 8-9 hours after its administration.
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Affiliation(s)
- Vincenzo Rochira
- Department of Internal Medicine, Chair of Endocrinology, University of Modena, and Reggio Emilia, Modena, Italy
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Rochira V, Balestrieri A, Madeo B, Baraldi E, Faustini-Fustini M, Granata AR, Carani C. Congenital estrogen deficiency: in search of the estrogen role in human male reproduction. Mol Cell Endocrinol 2001; 178:107-15. [PMID: 11403900 DOI: 10.1016/s0303-7207(01)00432-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [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] [Indexed: 11/24/2022]
Abstract
Recently, a remarkable progress has been made in our understanding about the role of sex steroids in male physiology. In this paper, we consider the clinical aspects of congenital estrogen deficiency - notably, estrogen resistance and aromatase deficiency - in men and we discuss both well-established and supposed estrogen roles in the human male reproductive function. These topics include the role of estrogens in the control of gonadotropin secretion, in male fertility determination and psychosexual behavior. Briefly, estrogens play a pivotal role in the control of serum gonadotropin concentrations in the human male. Furthermore, a possible role of estrogens on both human male fertility and sexuality has also been suggested by recent studies, even though the available data are far from being conclusive. Conversely, for what concern fertility and sexual behavior, a well-established effect of estrogens has been provided by recent studies on male rodents, which show impaired sexual behavior and fertility as a consequence of estrogen defect.
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Affiliation(s)
- V Rochira
- Department of Internal Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, Policlinico, 41100, Modena, Italy.
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Bettuzzi S, Davalli P, Astancolle S, Carani C, Madeo B, Tampieri A, Corti A, Saverio B, Pierpaola D, Serenella A, Cesare C, Bruno M, Auro T, Arnaldo C. Tumor progression is accompanied by significant changes in the levels of expression of polyamine metabolism regulatory genes and clusterin (sulfated glycoprotein 2) in human prostate cancer specimens. Cancer Res 2000; 60:28-34. [PMID: 10646846] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Using Northern blotting, the expression levels of the genes for polyamine metabolism regulatory proteins and clusterin have been measured in a series of 23 human prostate cancers (CaPs) dissected from radical prostatectomy specimens. Patient matched, nontumor tissue was dissected from benign areas of the gland. The results indicate that transcripts encoding ornithine decarboxylase (ODC), ODC antizyme, adenosylmethionine decarboxylase, and spermidine/spermine N1-acetyltransferase (SSAT) were significantly higher, whereas clusterin (sulfated glycoprotein 2) mRNA was significantly lower in tumors compared with the benign tissue. All mRNA levels were compared with those of histone H3 and growth arrest-specific gene 1, markers of cell proliferation and cell quiescence, respectively, and glyceraldehyde 3-phosphate dehydrogenase, a housekeeping gene. In poorly differentiated and locally invasive CaPs and in tumors with unfavorable prognosis or total prostate-specific antigen (PSA) levels > 10.0 ng/ml at diagnosis, an overall increase in the levels of H3 mRNA and a decrease in growth arrest-specific gene 1 mRNA was detected, indicative of higher proliferation activity, whereas the differences in expression levels for the polyamine metabolism and clusterin genes were higher. ODC and SSAT changes were positively correlated in normal tissue but not in high-grade cancer, whereas ODC antizyme and SSAT changes were positively correlated in more malignant CaPs but not in normal tissue. Tumor classification based on the changes in expression levels of all of the genes studied could be correlated to differentiation grade and local invasiveness classification systems in 72.2 and 83.3% of the cases, respectively. In a 1-year follow-up period, three patients whose CaPs ranked as less aggressive according to clinical staging, but classified as advanced cancers with the proposed molecular classification, showed increases in total PSA levels, indicative of tumor relapse. Thus, molecular classification, based on gene expression, may enhance the available prognostic tools for prostate tumors.
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Affiliation(s)
- S Bettuzzi
- Department of Scienze Biomediche, Università di Modena e Reggio Emilia, Modena, Italy
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