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Casini B, Spagnolo AM, Sartini M, Tuvo B, Scarpaci M, Barchitta M, Pan A, Agodi A, Cristina ML, Castiglia P, De Giusti M, Distefano M, Longhitano A, Laganà P, Mentore B, Canale F, Mantero F, Opezzi M, Marciano E, Zurlo L, Segata A, Torre I, Vay D, Vecchi E, Vincenti S. Microbiological surveillance post-reprocessing of flexible endoscopes used in digestive endoscopy: a national study. J Hosp Infect 2023; 131:139-147. [PMID: 36244520 DOI: 10.1016/j.jhin.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/17/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Microbiological surveillance of endoscopes is a safety measure for verifying the quality of reprocessing procedures and identifying contaminated devices, but duodenoscope-related outbreaks are still reported. AIM To assess the effectiveness of duodenoscope reprocessing procedures in Italy. METHODS Between December 2019 and April 2020, data obtained from microbiological surveillance post-reprocessing in 15 Italian endoscopy units were collected. Sampling was carried out after reprocessing or during storage in a cabinet. In keeping with international guidelines and the Italian position paper, the micro-organisms were classified as high-concern organisms (HCOs) and low-concern organisms (LCOs). FINDINGS In total, 144 samples were collected from 51 duodenoscopes. Of these, 36.81% were contaminated: 22.92% were contaminated with HCOs and 13.89% were contaminated with LCOs [2.08% with an LCO load of 11-100 colony-forming units (CFU)/device and 0.69% with an LCO load of >100 CFU/device]. The contamination rate was 27.5% in samples collected after reprocessing, 40% in samples collected during storage in a cabinet that was compliant with EN 16442:2015 (C-I), and 100% in samples collected during storage in a cabinet that was not compliant with EN 16442:2015 (NC-I). The respective HCO rates were 15.00%, 27.27% and 66.67%. Correlation between LCO contamination and storage time was demonstrated (Spearman's rho=0.3701; P=0.0026). The Olympus duodenoscope TJFQ180V demonstrated the lowest rate of contamination (29.82%), although the contamination rate was 100% for duodenoscopes stored in an NC-I cabinet. CONCLUSION Microbiological surveillance, along with strict adherence to reprocessing protocols, may help to detect endoscope contamination at an early stage, and reduce the risk of duodenoscope-associated infections.
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Affiliation(s)
- B Casini
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A M Spagnolo
- Department of Health Sciences, University of Genova, Genova, Italy; Operating Unit Hospital Hygiene, Galliera Hospital, Genoa, Italy.
| | - M Sartini
- Department of Health Sciences, University of Genova, Genova, Italy; Operating Unit Hospital Hygiene, Galliera Hospital, Genoa, Italy.
| | - B Tuvo
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - M Scarpaci
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - M Barchitta
- Department of Medical, Surgical and Advanced Technology Sciences "G.F. Ingrassia", University of Catania, Catania, Italy
| | - A Pan
- Operating Unit of Infectious Diseases, ASST Cremona, Cremona, Italy
| | - A Agodi
- Department of Medical, Surgical and Advanced Technology Sciences "G.F. Ingrassia", University of Catania, Catania, Italy
| | - M L Cristina
- Department of Health Sciences, University of Genova, Genova, Italy; Operating Unit Hospital Hygiene, Galliera Hospital, Genoa, Italy
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2
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Carletti R, Galvani M, Gardini E, De Vita M, Dallaserra C, Vizzuso A, Ottani F, Campacci F, Grosseto D, Di Gianuario G, Rinaldi G, Vecchio S, Mantero F, Mellini L, Albini A, Mughetti M, Gardelli G, Piciucchi S. P397 PROGNOSTIC VALUE OF CORONARY CALCIUM IN PATIENTS WITH COVID–19 AND SUSPECTED INTERSTITIAL PNEUMONIA: A CASE–CONTROL STUDY. Eur Heart J Suppl 2022. [PMCID: PMC9384032 DOI: 10.1093/eurheartj/suac012.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Short–term prognosis of SARS–CoV2 infection is mainly conditioned by the extent and severity of COVID–19 interstitial pneumonia. Coexistence of cardiac disease is however important and independently associated with an adverse outcome. Coronary calcium (CAC), detected at the time of chest computed tomography, can be a useful prognostic tool, as suggested by some cohort studies. Material and Methods We performed a retrospective, multi–centre, case–control (1:2) study in 195 COVID–19 patients admitted from 01–03–2020 to 30–04–2020. Cases were consecutive patients died within 30 days or admitted to the Intensive Care Units for invasive ventilation during the hospitalization (primary outcome measure). Controls were age– and sex–matched patients surviving until 30 days without need for invasive ventilation. For each case, we selected two controls, matched by age and sex dividing cases in age strata of 10 years, assuring within each age stratum twice the number of controls with an identical gender proportion. CAC estimation was performed with a with a semi–quantitative score (0 to 30) based on 10 segments and 4 degrees of severity of the calcification. Estimation of interstitial pneumonia, was similarly performed with a semi–quantitative score (from 0 to 20), based on 5 lobes and 5 degrees of severity of interstitial involvement. CT scans were acquired according to a standard protocol for non–cardio–synchronized chest CT, always on a multi–detector scanner with at least 16 layers. Results The mean CAC value in cases was significantly higher (p = 0.001) compared to controls: 5,52±1,38 vs 3,28±0,54 (mean value ± 95% CI). The percentage of cases with moderate–severe CAC was significantly higher (p = 0.013) compared to controls (41.5% vs 22.8%, OR 2.27 95% CI 1.20–4.29; primary end–point of the study). In multivariate analysis, independent predictors of outcome were (in descending order): interstitial pneumonia severity score (Wald 8.143, p = 0.004), CC score (Wald 5.569, p = 0.018), and the LDH value on admission (Wald 3.335, p = 0.034). Conclusions In our case–control study, the severity and extent of CAC is the main prognostic factor for the occurrence of adverse clinical outcome, beside the severity of interstitial pneumonia. These data suggest that a semi–quantitative estimation of CAC, feasible on any CT detector without the need of dedicated software, is clinically useful for the prognostic assessment of patients with COVID–19 interstitial pneumonia.
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Affiliation(s)
- R Carletti
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - M Galvani
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - E Gardini
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - M De Vita
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - C Dallaserra
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - A Vizzuso
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - F Ottani
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - F Campacci
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - D Grosseto
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - G Di Gianuario
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - G Rinaldi
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - S Vecchio
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - F Mantero
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - L Mellini
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - A Albini
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - M Mughetti
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - G Gardelli
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - S Piciucchi
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
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Toffanin T, Nifosì F, Follador H, Passamani A, Zonta F, Ferri G, Scanarini M, Amistà P, Pigato G, Scaroni C, Mantero F, Carollo C, Perini G. Volumetric MRI analysis of hippocampal subregions in Cushing's disease: A model for glucocorticoid neural modulation. Eur Psychiatry 2020; 26:64-7. [DOI: 10.1016/j.eurpsy.2010.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/14/2010] [Accepted: 09/18/2010] [Indexed: 10/18/2022] Open
Abstract
AbstractSeveral preclinical studies have demonstrated neuronal effects of glucocorticoids on the hippocampus (HC), a limbic structure with anterior–posterior anatomical and functional segmentation. We propose a volumetric magnetic resonance imaging analysis of hippocampus head (HH), body (HB) and tail (HT) using Cushing's disease (CD) as model, to investigate whether there is a differential sensitivity to glucocorticoid neuronal damage in these segments. We found a significant difference in the HH bilaterally after 12 months from trans-sphenoidal surgical selective resection of the adrenocorticotropic hormone (ACTH)-secreting pituitary micro-adenomas. This pre–post surgery difference could contribute to better understand the pathopysiology of CD as an in vivo model for stress-related hypercortisolemic neuropsychiatric disorders.
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Abstract
Essential hypertension is a highly prevalent disease in the general population. Secondary hypertension is characterized by a specific and potentially reversible cause of increased blood pressure levels. Some secondary endocrine forms of hypertension are common (caused by uncontrolled cortisol, aldosterone, or catecholamines production). This article describes rare monogenic forms of hypertension, characterized by electrolyte disorders and suppressed renin-aldosterone axis. They represent simple models for the physiology of renal control of sodium levels and plasma volume, thus reaching a high scientific interest. Furthermore, they could explain some features closer to the essential phenotype of hypertension, suggesting a mechanistically driven personalized treatment.
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MESH Headings
- Adrenal Hyperplasia, Congenital/complications
- Adrenal Hyperplasia, Congenital/metabolism
- Adrenal Hyperplasia, Congenital/therapy
- Arthrogryposis/complications
- Arthrogryposis/metabolism
- Arthrogryposis/therapy
- Cleft Palate/complications
- Cleft Palate/metabolism
- Cleft Palate/therapy
- Clubfoot/complications
- Clubfoot/metabolism
- Clubfoot/therapy
- Hand Deformities, Congenital/complications
- Hand Deformities, Congenital/metabolism
- Hand Deformities, Congenital/therapy
- Humans
- Hypertension/drug therapy
- Hypertension/etiology
- Hypertension/metabolism
- Hypertension/physiopathology
- Liddle Syndrome/complications
- Liddle Syndrome/metabolism
- Liddle Syndrome/therapy
- Mineralocorticoid Excess Syndrome, Apparent/complications
- Mineralocorticoid Excess Syndrome, Apparent/metabolism
- Mineralocorticoid Excess Syndrome, Apparent/therapy
- Mineralocorticoid Excess Syndrome, Apparent
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Affiliation(s)
- Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, Padova 35128, Italy.
| | - Franco Mantero
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, Padova 35128, Italy
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5
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Marini F, Giusti F, Fossi C, Cioppi F, Cianferotti L, Masi L, Boaretto F, Zovato S, Cetani F, Colao A, Davì MV, Faggiano A, Fanciulli G, Ferolla P, Ferone D, Loli P, Mantero F, Marcocci C, Opocher G, Beck-Peccoz P, Persani L, Scillitani A, Guizzardi F, Spada A, Tomassetti P, Tonelli F, Brandi ML. Multiple endocrine neoplasia type 1: analysis of germline MEN1 mutations in the Italian multicenter MEN1 patient database. Endocrine 2018; 62:215-233. [PMID: 29497973 DOI: 10.1007/s12020-018-1566-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/08/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Multiple endocrine neoplasia type 1 (MEN1) is caused by germline inactivating mutations of the MEN1 gene. Currently, no direct genotype-phenotype correlation is identified. We aim to analyze MEN1 mutation site and features, and possible correlations between the mutation type and/or the affected menin functional domain and clinical presentation in patients from the Italian multicenter MEN1 database, one of the largest worldwide MEN1 mutation series published to date. METHODS The study included the analysis of MEN1 mutation profile in 410 MEN1 patients [370 familial cases from 123 different pedigrees (48 still asymptomatic at the time of this study) and 40 single cases]. RESULTS We identified 99 different mutations: 41 frameshift [small intra-exon deletions (28) or insertions (13)], 13 nonsense, 26 missense and 11 splicing site mutations, 4 in-frame small deletions, and 4 intragenic large deletions spanning more than one exon. One family had two different inactivating MEN1 mutations on the same allele. Gastro-entero-pancreatic tumors resulted more frequent in patients with a nonsense mutation, and thoracic neuroendocrine tumors in individuals bearing a splicing-site mutation. CONCLUSIONS Our data regarding mutation type frequency and distribution are in accordance with previously published data: MEN1 mutations are scattered through the entire coding region, and truncating mutations are the most common in MEN1 syndrome. A specific direct correlation between MEN1 genotype and clinical phenotype was not found in all our families, and wide intra-familial clinical variability and variable disease penetrance were both confirmed, suggesting a role for modifying, still undetermined, factors, explaining the variable MEN1 tumorigenesis.
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Affiliation(s)
- Francesca Marini
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesca Giusti
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Caterina Fossi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Federica Cioppi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Laura Masi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesca Boaretto
- Familial Cancer Clinic, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Stefania Zovato
- Familial Cancer Clinic, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Vittoria Davì
- Internal Medicine, Section of Endocrinology, Department of Medicine, University of Verona, Verona, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Fanciulli
- NET Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Piero Ferolla
- Multidisciplinar NET Center, Umbria Regional Cancer Network, Azienda Ospedaliera di Perugia and University of Perugia, Perugia, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Paola Loli
- Department of Endocrinology, Hospital Niguarda Ca' Granda, Milan, Italy
| | - Franco Mantero
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Giuseppe Opocher
- Familial Cancer Clinic, Veneto Institute of Oncology IRCCS, Padua, Italy
| | | | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology 'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Fabiana Guizzardi
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Anna Spada
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Tomassetti
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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Marini F, Giusti F, Fossi C, Cioppi F, Cianferotti L, Masi L, Boaretto F, Zovato S, Cetani F, Colao A, Davì MV, Faggiano A, Fanciulli G, Ferolla P, Ferone D, Loli P, Mantero F, Marcocci C, Opocher G, Beck-Peccoz P, Persani L, Scillitani A, Guizzardi F, Spada A, Tomassetti P, Tonelli F, Brandi ML. Correction to: Multiple endocrine neoplasia type 1: analysis of germline MEN1 mutations in the Italian multicenter MEN1 patient database. Endocrine 2018; 62:234-241. [PMID: 30032405 DOI: 10.1007/s12020-018-1668-3] [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: 11/30/2022]
Abstract
The original version of this article unfortunately contained a mistake in Table 2. The table 2 was truncated in the original publication. The full table 2 is given below.
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Affiliation(s)
- Francesca Marini
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesca Giusti
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Caterina Fossi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Federica Cioppi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Laura Masi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesca Boaretto
- Familial Cancer Clinic, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Stefania Zovato
- Familial Cancer Clinic, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Vittoria Davì
- Internal Medicine, Section of Endocrinology, Department of Medicine, University of Verona, Verona, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Fanciulli
- NET Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Piero Ferolla
- Multidisciplinar NET Center, Umbria Regional Cancer Network, Azienda Ospedaliera di Perugia and University of Perugia, Perugia, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Paola Loli
- Department of Endocrinology, Hospital Niguarda Ca' Granda, Milan, Italy
| | - Franco Mantero
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Giuseppe Opocher
- Familial Cancer Clinic, Veneto Institute of Oncology IRCCS, Padua, Italy
| | | | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology 'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Fabiana Guizzardi
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Anna Spada
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Tomassetti
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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7
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Ceccato F, Barbot M, Albiger N, Antonelli G, Zilio M, Todeschini M, Regazzo D, Plebani M, Lacognata C, Iacobone M, Mantero F, Boscaro M, Scaroni C. Daily salivary cortisol and cortisone rhythm in patients with adrenal incidentaloma. Endocrine 2018; 59:510-519. [PMID: 28956262 DOI: 10.1007/s12020-017-1421-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 08/03/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIM Impaired cortisol rhythm is a characteristic feature of Cushing's Syndrome, nevertheless late night salivary cortisol (LNSC) is not suitable to detect subclinical hypercortisolism in patients with adrenal incidentaloma (AI). We studied daily salivary cortisol (F) and cortisone (E) rhythm in patients with AI. MATERIALS AND METHODS Six saliva samples were collected from awakening to night in 106 patients with AI and 40 controls. F and E were measured with LC-MS/MS and daily F exposure was calculated with the area under the curve (AUC). RESULTS Patients with serum cortisol after dexamethasone suppression test (DST) > 50 nmol/L showed higher morning F (15.5 ± 14.5 vs. 8.6 ± 5.5 nmol/L, p = 0.001), suppressed corticotropin levels (76 vs. 35%, p < 0.001) and increased daily F exposure (3795 ± 1716 vs. 2898 ± 1478, p = 0.012), especially in the morning (2035 ± 1267 vs. 1365 ± 777, p = 0.003), otherwise LNSC levels were similar. Salivary E and AUC levels were higher in patients with DST > 50 nmol/L. AUC was not correlated with urinary cortisol levels or adenoma size. F and E levels were similar among patients with unilateral or bilateral adenoma, or considering the presence of hypertension, dyslipidemia, diabetes, or cardiovascular events. CONCLUSION Daily cortisol exposure, evaluated with AUC from multiple saliva collections, is increased in AI patients with serum cortisol > 50 nmol/L after DST, especially in the morning, leading to reduced corticotropin levels. Cortisol rhythm is preserved in patients with AI, remarking that LNSC is not a screening test for subclinical hypercortisolism.
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Affiliation(s)
- Filippo Ceccato
- Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy.
| | - Mattia Barbot
- Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy
| | - Nora Albiger
- Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy
| | - Giorgia Antonelli
- Department of Medicine DIMED, Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - Marialuisa Zilio
- Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy
| | - Marco Todeschini
- Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy
| | - Daniela Regazzo
- Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine DIMED, Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - Carmelo Lacognata
- Department of Medicine DIMED, Radiology Section, University-Hospital of Padova, Padova, Italy
| | - Maurizio Iacobone
- Department of Surgery, Minimally-Invasive Endocrine Surgery Unit, Oncology and Gastroenterology, University-Hospital of Padova, Padova, Italy
| | - Franco Mantero
- Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy
| | - Marco Boscaro
- Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy
| | - Carla Scaroni
- Department of Medicine DIMED, Endocrinology Unit, University-Hospital of Padova, Padova, Italy
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8
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Rossi GP, Maiolino G, Flego A, Belfiore A, Bernini G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Muiesan ML, Mannelli M, Negro A, Palumbo G, Parenti G, Rossi E, Mantero F. Adrenalectomy Lowers Incident Atrial Fibrillation in Primary Aldosteronism Patients at Long Term. Hypertension 2018; 71:585-591. [PMID: 29483224 DOI: 10.1161/hypertensionaha.117.10596] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/20/2017] [Accepted: 12/28/2017] [Indexed: 01/30/2023]
Abstract
Primary aldosteronism (PA) causes cardiovascular damage in excess to the blood pressure elevation, but there are no prospective studies proving a worse long-term prognosis in adrenalectomized and medically treated patients. We have, therefore, assessed the outcome of PA patients according to treatment mode in the PAPY study (Primary Aldosteronism Prevalence in Hypertension) patients, 88.8% of whom were optimally treated patients with primary (essential) hypertension (PH), and the rest had PA and were assigned to medical therapy (6.4%) or adrenalectomy (4.8%). Total mortality was the primary end point; secondary end points were cardiovascular death, major adverse cardiovascular events, including atrial fibrillation, and total cardiovascular events. Kaplan-Meier and Cox analysis were used to compare survival between PA and its subtypes and PH patients. After a median of 11.8 years, complete follow-up data were obtained in 89% of the 1125 patients in the original cohort. Only a trend (P=0.07) toward a worse death-free survival in PA than in PH patients was observed. However, at both univariate (90.0% versus 97.8%; P=0.002) and multivariate analyses (hazard ratio, 1.82; 95% confidence interval, 1.08-3.08; P=0.025), medically treated PA patients showed a lower atrial fibrillation-free survival than PH patients. By showing that during a long-term follow-up adrenalectomized aldosterone-producing adenoma patients have a similar long-term outcome of optimally treated PH patients, whereas, at variance, medically treated PA patients remain at a higher risk of atrial fibrillation, this large prospective study emphasizes the importance of an early identification of PA patients who need adrenalectomy as a key measure to prevent incident atrial fibrillation.
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Affiliation(s)
- Gian Paolo Rossi
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy.
| | - Giuseppe Maiolino
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Alberto Flego
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Anna Belfiore
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Giampaolo Bernini
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Bruno Fabris
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Claudio Ferri
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Gilberta Giacchetti
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Claudio Letizia
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Mauro Maccario
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Francesca Mallamaci
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Maria Lorenza Muiesan
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Massimo Mannelli
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Aurelio Negro
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Gaetana Palumbo
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Gabriele Parenti
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Ermanno Rossi
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Franco Mantero
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
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9
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Pagani L, Diekmann Y, Sazzini M, De Fanti S, Rondinelli M, Farnetti E, Casali B, Caretto A, Novara F, Zuffardi O, Garagnani P, Mantero F, Thomas MG, Luiselli D, Rossi E. Three Reportedly Unrelated Families With Liddle Syndrome Inherited From a Common Ancestor. Hypertension 2017; 71:273-279. [PMID: 29229744 DOI: 10.1161/hypertensionaha.117.10491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 10/31/2017] [Accepted: 11/14/2017] [Indexed: 12/31/2022]
Abstract
Liddle syndrome is considered a rare Mendelian hypertension. We have previously described 3 reportedly unrelated families, native of an Italian area around the Strait of Messina, carrying the same mutation (βP617L) of the epithelial sodium channel. The aims of our study were (1) to evaluate whether a close genomic relationship exists between the 3 families through the analysis of mitochondrial DNA and Y chromosome; and (2) to quantify the genomic relatedness between the patients with Liddle syndrome belonging to the 3 families and assess the hypothesis of a mutation shared through identity by descent. HVRI (the hypervariable region I) of the mitochondrial DNA genome and the Y chromosome short tandem repeats profiles were analyzed in individuals of the 3 families. Genotyping 542 585 genome-wide single nucleotide polymorphisms was performed in all the patients with Liddle syndrome of the 3 families and some of their relatives. A panel of 780 healthy Italian adult samples typed for the same set of markers was used as controls. espite different lineages between the 3 families based on the analysis of mitochondrial DNA and Y chromosome, the 3 probands and their 6 affected relatives share the same ≈5 Mbp long haplotype which encompasses the mutant allele. Using an approach based on coalescent theory, we estimate that the 3 families inherited the mutant allele from a common ancestor ≈13 generations ago and that such an ancestor may have left ≈20 carriers alive today. The prevalence of Liddle syndrome in the region of origin of the 3 families may be much higher than that estimated worldwide.
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Affiliation(s)
- Luca Pagani
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Yoan Diekmann
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Marco Sazzini
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Sara De Fanti
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Maurizio Rondinelli
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Enrico Farnetti
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Bruno Casali
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Amelia Caretto
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Francesca Novara
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Orsetta Zuffardi
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Paolo Garagnani
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Franco Mantero
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Mark G Thomas
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Donata Luiselli
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.)
| | - Ermanno Rossi
- From the Department of Biology (L.P.) and Endocrinology Unit, Department of Medicine (F.M.), University of Padova, Italy; Estonian Biocentre, Tartu (L.P.); Research Department of Genetics, Evolution and Environment, University College London, United Kingdom (Y.D., M.G.T.); Department of Biological Geological and Environmental Sciences (M.S., S.D.F., D.L.) and Department of Experimental, Diagnostic and Specialty Medicine (P.G.), University of Bologna, Italy; IRCCS Centro Cardiologico Monzino, Milano, Italy (M.R.); Department of Oncology and Advanced Technologies, Laboratory of Molecular Biology (E.F., B.C.) and Department of Internal Medicine (E.R.), IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy; Department of Endocrinology and Metabolic Diseases, San Raffaele Scientific Institute, Milano, Italy (A.C.); and Department of Molecular Medicine, University of Pavia, Italy (F.N., O.Z.).
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10
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Giusti F, Cianferotti L, Boaretto F, Cetani F, Cioppi F, Colao A, Davì MV, Faggiano A, Fanciulli G, Ferolla P, Ferone D, Fossi C, Giudici F, Gronchi G, Loli P, Mantero F, Marcocci C, Marini F, Masi L, Opocher G, Beck-Peccoz P, Persani L, Scillitani A, Sciortino G, Spada A, Tomassetti P, Tonelli F, Brandi ML. Multiple endocrine neoplasia syndrome type 1: institution, management, and data analysis of a nationwide multicenter patient database. Endocrine 2017; 58:349-359. [PMID: 28132167 DOI: 10.1007/s12020-017-1234-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [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: 09/12/2016] [Accepted: 01/13/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to integrate European epidemiological data on patients with multiple endocrine neoplasia type 1 by creating an Italian registry of this syndrome, including clinical and genetic characteristics and therapeutic management. METHODS Clinical, familial and genetic data of patients with multiple endocrine neoplasia type 1, diagnosed, treated, and followed-up for a mean time of 11.3 years, in 14 Italian referral endocrinological centers, were collected, over a 3-year course (2011-2013), to build a national electronic database. RESULTS The Italian multiple endocrine neoplasia type 1 database includes 475 patients (271 women and 204 men), of whom 383 patients (80.6%) were classified as familial cases (from 136 different pedigrees), and 92 (19.4%) patients were sporadic cases. A MEN1 mutation was identified in 92.6% of familial cases and in 48.9% of sporadic cases. Four hundred thirty-six patients were symptomatic, presenting primary hyperparathyroidism, gastroenteropancreatic neuroendocrine tumors and pituitary tumors in 93, 53, and 41% of cases, respectively. Thirty-nine subjects, belonging to affected pedigrees positive for a MEN1 mutation, were asymptomatic at clinical and biochemical screening. Age at diagnosis of multiple endocrine neoplasia type 1 probands was similar for both familial and simplex cases (mean age 47.2 ± 15.3 years). In familial cases, diagnosis of multiple endocrine neoplasia type 1 in relatives of affected probands was made more than 10 years in advance (mean age at diagnosis 36.5 ± 17.6 years). CONCLUSIONS The analysis of Italian registry of multiple endocrine neoplasia type 1 patients revealed that clinical features of Italian multiple endocrine neoplasia type 1 patients are similar to those of other western countries, and confirmed that the genetic test allowed multiple endocrine neoplasia type 1 diagnosis 10 years earlier than biochemical or clinical diagnosis.
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Affiliation(s)
- Francesca Giusti
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Francesca Boaretto
- Familial Tumor Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Federica Cioppi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Vittoria Davì
- Internal Medicine, Section of Endocrinology, Department of Medicine, University of Verona, Verona, Italy
| | - Antongiulio Faggiano
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Giuseppe Fanciulli
- NET Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Piero Ferolla
- Department of Internal Medicine and Endocrine Sciences, University of Perugia, Perugia, Italy
| | - Diego Ferone
- Endocrinology Units, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Caterina Fossi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Francesco Giudici
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Giorgio Gronchi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Paola Loli
- Department of Endocrinology, Hospital Niguarda Ca' Granda, Milan, Italy
| | - Franco Mantero
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Francesca Marini
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Laura Masi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Giuseppe Opocher
- Familial Tumor Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology 'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Giovanna Sciortino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Anna Spada
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paola Tomassetti
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy.
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11
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Jouinot A, Assie G, Libe R, Fassnacht M, Papathomas T, Barreau O, de la Villeon B, Faillot S, Hamzaoui N, Neou M, Perlemoine K, Rene-Corail F, Rodriguez S, Sibony M, Tissier F, Dousset B, Sbiera S, Ronchi C, Kroiss M, Korpershoek E, de Krijger R, Waldmann J, K D, Bartsch, Quinkler M, Haissaguerre M, Tabarin A, Chabre O, Sturm N, Luconi M, Mantero F, Mannelli M, Cohen R, Kerlan V, Touraine P, Barrande G, Groussin L, Bertagna X, Baudin E, Amar L, Beuschlein F, Clauser E, Coste J, Bertherat J. DNA Methylation Is an Independent Prognostic Marker of Survival in Adrenocortical Cancer. J Clin Endocrinol Metab 2017; 102:923-932. [PMID: 27967600 DOI: 10.1210/jc.2016-3205] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/08/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenocortical cancer (ACC) is an aggressive tumor with a heterogeneous outcome. Prognostic stratification is difficult even based on tumor stage and Ki67. Recently integrated genomics studies have demonstrated that CpG islands hypermethylation is correlated with poor survival. OBJECTIVE The goal of this study was to confirm the prognostic value of CpG islands methylation on an independent cohort. DESIGN Methylation was measured by methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA). SETTING MS-MLPA was performed in a training cohort of 50 patients with ACC to identify the best set of probes correlating with disease-free survival (DFS) and overall survival (OS). These outcomes were validated in an independent cohort from 21 ENSAT centers. PATIENTS The validation cohort included 203 patients (64% women, median age 50 years, 80% localized tumors). MAIN OUTCOME MEASURES DFS and OS. RESULTS In the training cohort, mean methylation of 4 genes (PAX5, GSTP1, PYCARD, PAX6) was the strongest methylation marker. In the validation cohort, methylation was a significant prognostic factor of DFS (P < 0.0001) and OS (P < 0.0001). Methylation, Ki67, and ENSAT stage were combined in multivariate models. For DFS, methylation (P = 0.0005) and stage (P < 0.0001) but not Ki67 (P = 0.19) remained highly significant. For OS, methylation (P = 0.0006), stage (P < 0.0001), and Ki67 (P = 0.024) were independent prognostic factors. CONCLUSIONS Tumor DNA methylation emerges as an independent prognostic factor in ACC. MS-MLPA is readily compatible with clinical routine and should enhance our ability for prognostication and precision medicine.
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Affiliation(s)
- Anne Jouinot
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
- Medical Oncology
| | - Guillaume Assie
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
- Department of Endocrinology
| | - Rossella Libe
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
- Department of Endocrinology
| | - Martin Fassnacht
- Endocrinology and Diabetes Unit, University Hospital, and
- Comprehensive Cancer Center Mainfranken, University of Würzburg, 97070 Würzburg, Germany
| | - Thomas Papathomas
- Department of Pathology, Erasmus MC University Medical Center, 3062 PA Rotterdam, The Netherlands
| | - Olivia Barreau
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
- Department of Endocrinology
| | - Bruno de la Villeon
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
| | - Simon Faillot
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
| | | | - Mario Neou
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
| | - Karine Perlemoine
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
| | - Fernande Rene-Corail
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
| | - Stéphanie Rodriguez
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
| | - Mathilde Sibony
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
- Department of Pathology, and
| | - Frédérique Tissier
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
- Department of Pathology, and
| | - Bertrand Dousset
- Department of Digestive and Endocrine Surgery, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Silviu Sbiera
- Endocrinology and Diabetes Unit, University Hospital, and
| | | | - Matthias Kroiss
- Comprehensive Cancer Center Mainfranken, University of Würzburg, 97070 Würzburg, Germany
| | - Esther Korpershoek
- Department of Pathology, Erasmus MC University Medical Center, 3062 PA Rotterdam, The Netherlands
| | - Ronald de Krijger
- Department of Pathology, Erasmus MC University Medical Center, 3062 PA Rotterdam, The Netherlands
- Department of Pathology, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands
| | - Jens Waldmann
- Department of Surgery, University Hospital Giessen and Marburg, 35043 Marburg, Germany
| | | | - Bartsch
- Department of Surgery, University Hospital Giessen and Marburg, 35043 Marburg, Germany
| | - Marcus Quinkler
- Department of Medicine, Charite University, 10117 Berlin, Germany
| | - Magalie Haissaguerre
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Antoine Tabarin
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Bordeaux, 33000 Bordeaux, France
| | | | - Nathalie Sturm
- Department of Biology and Pathology, University Hospital of Grenoble, 38700 La Tronche, France
| | - Michaela Luconi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy
| | - Franco Mantero
- Department of Medicine, Endocrinology Unit, University of Padova, 35122 Padova, Italy
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy
| | - Regis Cohen
- Department of Endocrinology, Saint Denis Hospital, 93200 Saint Denis, France
| | - Véronique Kerlan
- Department of Endocrinology, Brest University Hospital, 29200 Brest, France
| | | | - Gaelle Barrande
- Department of Endocrinology, Regional Hospital of Orléans, 45770 Saran, France
| | - Lionel Groussin
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
- Department of Endocrinology
| | - Xavier Bertagna
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
- Department of Endocrinology
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, 94800 Villejuif, France; and
| | - Laurence Amar
- Hypertension Unit, Hôpital Européen Georges Pompidou and
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, 80539 München, Germany
| | | | - Joel Coste
- Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, 75000 Paris, France
| | - Jérôme Bertherat
- Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, 75014 Paris, France
- Department of Endocrinology
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12
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Ronchi CL, Di Dalmazi G, Faillot S, Sbiera S, Assié G, Weigand I, Calebiro D, Schwarzmayr T, Appenzeller S, Rubin B, Waldmann J, Scaroni C, Bartsch DK, Mantero F, Mannelli M, Kastelan D, Chiodini I, Bertherat J, Reincke M, Strom TM, Fassnacht M, Beuschlein F. Genetic Landscape of Sporadic Unilateral Adrenocortical Adenomas Without PRKACA p.Leu206Arg Mutation. J Clin Endocrinol Metab 2016; 101:3526-38. [PMID: 27389594 DOI: 10.1210/jc.2016-1586] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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 Adrenocortical adenomas (ACAs) are among the most frequent human neoplasias. Genetic alterations affecting the cAMP/protein kinase A signaling pathway are common in cortisol-producing ACAs, whereas activating mutations in the gene encoding β-catenin (CTNNB1) have been reported in a subset of both benign and malignant adrenocortical tumors. However, the molecular pathogenesis of most ACAs is still largely unclear. OBJECTIVE The aim of the study was to define the genetic landscape of sporadic unilateral ACAs. DESIGN AND SETTING Next-generation whole-exome sequencing was performed on fresh-frozen tumor samples and corresponding normal tissue samples. PATIENTS Ninety-nine patients with ACAs (74 cortisol-producing and 25 endocrine inactive) negative for p.Leu206Arg PRKACA mutation. MAIN OUTCOME MEASURES Identification of known and/or new genetic alterations potentially involved in adrenocortical tumorigenesis and autonomous hormone secretion, genotype-phenotype correlation. RESULTS A total of 706 somatic protein-altering mutations were detected in 88 of 99 tumors (median, six per tumor). We identified several mutations in genes of the cAMP/protein kinase A pathway, including three novel mutations in PRKACA, associated with female sex and Cushing's syndrome. We also found genetic alterations in different genes involved in the Wnt/β-catenin pathway, associated with larger tumors and endocrine inactivity, and notably, in many genes of the Ca(2+)-signaling pathway. Finally, by comparison of our genetic data with those available in the literature, we describe a comprehensive genetic landscape of unilateral ACAs. CONCLUSIONS This study provides the largest sequencing effort on ACAs to date. We thereby identified somatic alterations affecting known and novel pathways potentially involved in adrenal tumorigenesis.
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Affiliation(s)
- Cristina L Ronchi
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Guido Di Dalmazi
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Simon Faillot
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Silviu Sbiera
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Guillaume Assié
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Isabel Weigand
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Davide Calebiro
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Thomas Schwarzmayr
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Silke Appenzeller
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Beatrice Rubin
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Jens Waldmann
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Carla Scaroni
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Detlef K Bartsch
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Franco Mantero
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Massimo Mannelli
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Darko Kastelan
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Iacopo Chiodini
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Jerome Bertherat
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Martin Reincke
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Tim M Strom
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Felix Beuschlein
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
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Rubin B, Regazzo D, Redaelli M, Mucignat C, Citton M, Iacobone M, Scaroni C, Betterle C, Mantero F, Fassina A, Pezzani R, Boscaro M. Investigation of N-cadherin/β-catenin expression in adrenocortical tumors. Tumour Biol 2016; 37:13545-13555. [PMID: 27468715 DOI: 10.1007/s13277-016-5257-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023] Open
Abstract
β-catenin is a multifunctional protein; it is a key component of the Wnt signaling, and it plays a central role in cadherin-based adhesions. Cadherin loss promotes tumorigenesis by releasing membrane-bound β-catenin, hence stimulating Wnt signaling. Cadherins seem to be involved in tumor development, but these findings are limited in adrenocortical tumors (ACTs). The objective of this study was to evaluate alterations in key components of cadherin/catenin adhesion system and of Wnt pathway. This study included eight normal adrenal samples (NA) and 95 ACT: 24 adrenocortical carcinomas (ACCs) and 71 adrenocortical adenomas (ACAs). β-catenin mutations were evaluated by sequencing, and β-catenin and cadherin (E-cadherin and N-cadherin) expression was analyzed by quantitative reverse transcription PCR (qRT-PCR) and by immunohistochemistry (IHC). We identified 18 genetic alterations in β-catenin gene. qRT-PCR showed overexpression of β-catenin in 50 % of ACC (12/24) and in 48 % of ACA (21/44). IHC data were in accordance with qRT-PCR results: 47 % of ACC (7/15) and 33 % of ACA (11/33) showed increased cytoplasmic or nuclear β-catenin accumulation. N-cadherin downregulation has been found in 83 % of ACC (20/24) and in 59 % of ACA (26/44). Similar results were obtained by IHC: N-cadherin downregulation was observed in 100 % (15/15) of ACC and in 55 % (18/33) of ACA. β-catenin overexpression together with the aberrant expression of N-cadherin may play important role in ACT tumorigenesis. The study of differentially expressed genes (such as N-cadherin and β-catenin) may enhance our understanding of the biology of ACT and may contribute to the discovery of new diagnostic and prognostic tools.
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Affiliation(s)
- Beatrice Rubin
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, via Ospedale Civile, 105, 35128, Padua, Italy.
| | - Daniela Regazzo
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, via Ospedale Civile, 105, 35128, Padua, Italy
| | - Marco Redaelli
- Department of Molecular Medicine, University of Padova, via Marzolo 3, 35131, Padova, Italy
| | - Carla Mucignat
- Department of Molecular Medicine, University of Padova, via Marzolo 3, 35131, Padova, Italy
| | - Marilisa Citton
- Division of Minimally Invasive Endocrine Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Maurizio Iacobone
- Division of Minimally Invasive Endocrine Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carla Scaroni
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, via Ospedale Civile, 105, 35128, Padua, Italy
| | - Corrado Betterle
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, via Ospedale Civile, 105, 35128, Padua, Italy
| | - Franco Mantero
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, via Ospedale Civile, 105, 35128, Padua, Italy
| | - Ambrogio Fassina
- Division of Pathology and Cytopathology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Raffaele Pezzani
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, via Ospedale Civile, 105, 35128, Padua, Italy
| | - Marco Boscaro
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, via Ospedale Civile, 105, 35128, Padua, Italy
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Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101:1889-916. [PMID: 26934393 DOI: 10.1210/jc.2015-4061] [Citation(s) in RCA: 1529] [Impact Index Per Article: 191.1] [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: 12/13/2022]
Abstract
OBJECTIVE To develop clinical practice guidelines for the management of patients with primary aldosteronism. PARTICIPANTS The Task Force included a chair, selected by the Clinical Guidelines Subcommittee of the Endocrine Society, six additional experts, a methodologist, and a medical writer. The guideline was cosponsored by American Heart Association, American Association of Endocrine Surgeons, European Society of Endocrinology, European Society of Hypertension, International Association of Endocrine Surgeons, International Society of Endocrinology, International Society of Hypertension, Japan Endocrine Society, and The Japanese Society of Hypertension. The Task Force received no corporate funding or remuneration. EVIDENCE We searched for systematic reviews and primary studies to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation group criteria to describe both the quality of evidence and the strength of recommendations. We used "recommend" for strong recommendations and "suggest" for weak recommendations. CONSENSUS PROCESS We achieved consensus by collecting the best available evidence and conducting one group meeting, several conference calls, and multiple e-mail communications. With the help of a medical writer, the Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and Council successfully reviewed the drafts prepared by the Task Force. We placed the version approved by the Clinical Guidelines Subcommittee and Clinical Affairs Core Committee on the Endocrine Society's website for comments by members. At each stage of review, the Task Force received written comments and incorporated necessary changes. CONCLUSIONS For high-risk groups of hypertensive patients and those with hypokalemia, we recommend case detection of primary aldosteronism by determining the aldosterone-renin ratio under standard conditions and recommend that a commonly used confirmatory test should confirm/exclude the condition. We recommend that all patients with primary aldosteronism undergo adrenal computed tomography as the initial study in subtype testing and to exclude adrenocortical carcinoma. We recommend that an experienced radiologist should establish/exclude unilateral primary aldosteronism using bilateral adrenal venous sampling, and if confirmed, this should optimally be treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia or those unsuitable for surgery should be treated primarily with a mineralocorticoid receptor antagonist.
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Affiliation(s)
- John W Funder
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Robert M Carey
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Franco Mantero
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - M Hassan Murad
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Martin Reincke
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Hirotaka Shibata
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Michael Stowasser
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - William F Young
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
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Stigliano A, Chiodini I, Giordano R, Faggiano A, Canu L, Della Casa S, Loli P, Luconi M, Mantero F, Terzolo M. Management of adrenocortical carcinoma: a consensus statement of the Italian Society of Endocrinology (SIE). J Endocrinol Invest 2016; 39:103-21. [PMID: 26165270 DOI: 10.1007/s40618-015-0349-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/23/2015] [Indexed: 01/10/2023]
Affiliation(s)
- A Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - I Chiodini
- Endocrinology and Metabolic Disease Unit, IRCCS Foundation Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - R Giordano
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - A Faggiano
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - L Canu
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - S Della Casa
- Endocrinology, Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | - P Loli
- Endocrine Unit, Niguarda Cà Granda Hospital, Milan, Italy
| | - M Luconi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - F Mantero
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - M Terzolo
- Internal Medicine I, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Rubin B, Monticelli H, Redaelli M, Mucignat C, Barollo S, Bertazza L, Mian C, Betterle C, Iacobone M, Fassina A, Boscaro M, Pezzani R, Mantero F. Mitogen-Activated Protein Kinase Pathway: Genetic Analysis of 95 Adrenocortical Tumors. Cancer Invest 2015; 33:526-31. [DOI: 10.3109/07357907.2015.1080832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ceccato F, Barbot M, Zilio M, Frigo AC, Albiger N, Camozzi V, Antonelli G, Plebani M, Mantero F, Boscaro M, Scaroni C. Screening Tests for Cushing's Syndrome: Urinary Free Cortisol Role Measured by LC-MS/MS. J Clin Endocrinol Metab 2015; 100:3856-61. [PMID: 26274344 DOI: 10.1210/jc.2015-2507] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 02/03/2023]
Abstract
INTRODUCTION AND AIM As initial screening for Cushing's syndrome (CS), The Endocrine Society guidelines recommend one of the following: the 1-mg dexamethasone suppression test (DST) or late-night salivary cortisol (LNSC) or urinary free cortisol (UFC) measurement. We examined the diagnostic performance of the above-mentioned tests in a series of patients. MATERIALS AND METHODS We retrospectively analyzed 137 patients with clinical conditions suggestive of hypercortisolism: 38 with confirmed CS diagnosis and 99 without (termed non-CS). UFC was measured by liquid chromatography tandem-mass spectrometry, whereas LNSC by the radioimmunometric method and serum cortisol were measured by a chemiluminescence immunoassay. RESULTS Comparing CS vs non-CS, a cutoff of 138 nmol/L after 1-mg DST revealed the best specificity (SP; 97%), whereas the 50-nmol/L cutoff confirmed the best sensitivity (SE; 100%); the SE and SP for LNSC greater than 14.46 nmol/L were, respectively, 84% and 89%, whereas the SE and SP for UFC greater than 170 nmol per 24 hours, they were 97% and 91%. Overall, UFC revealed both a combined higher positive and a lower negative likelihood ratio among first-line tests (respectively 10.7 and 0.03). Computing a receiver-operating curve -contrast analysis to compare the power of each single test with that of the others, alone or combined (DST+LNSC, DST+UFC, and LNSC+UFC) or with that of all the tests together (DST+LNSC+UFC), the UFC assay was at least as good as all the other possible combinations. CONCLUSIONS Measuring UFC by liquid chromatography tandem-mass spectrometry achieves the best accuracy in diagnosing CS among patients presenting with suspected hypercortisolism.
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Affiliation(s)
- Filippo Ceccato
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Mattia Barbot
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Marialuisa Zilio
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Anna Chiara Frigo
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Nora Albiger
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Valentina Camozzi
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Giorgia Antonelli
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Mario Plebani
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Franco Mantero
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Marco Boscaro
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
| | - Carla Scaroni
- Endocrinology Unit (F.C., M.Ba., M.Z., N.A., V.C., F.M., M.Bo., C.S.) and Laboratory Medicine Unit (G.A., M.P.), Department of Medicine, and Unit of Biostatistics, Epidemiology, and Public Health (A.C.F.), Department of Cardiac, Thoracic, and Vascular Sciences, University-Hospital of Padova, 35128 Padova, Italy
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Albiger NM, Ceccato F, Zilio M, Barbot M, Occhi G, Rizzati S, Fassina A, Mantero F, Boscaro M, Iacobone M, Scaroni C. An analysis of different therapeutic options in patients with Cushing's syndrome due to bilateral macronodular adrenal hyperplasia: a single-centre experience. Clin Endocrinol (Oxf) 2015; 82:808-15. [PMID: 25727927 DOI: 10.1111/cen.12763] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 07/22/2014] [Revised: 11/09/2014] [Accepted: 02/24/2015] [Indexed: 12/30/2022]
Abstract
CONTEXT Bilateral macronodular adrenal hyperplasia (BMAH) is a rare form of Cushing's syndrome (CS). A variety of in vivo tests to identify aberrant receptor expression have been proposed to guide medical treatment. Unilateral adrenalectomy (UA) may be effective in selected patients, but little is known about recurrence during follow-up. OBJECTIVE To describe a series of patients with BMAH and CS treated by different approaches, with a particular focus on the benefit of UA. DESIGN AND PATIENTS We retrospectively assessed 16 patients with BMAH and CS (11 females, five males), analysing the in vivo cortisol response to different provocative tests. Twelve of the 16 patients underwent UA and were monitored over the long term. RESULTS Based on in vivo test results, octreotide LAR or propranolol was administered in one case of food-dependent CS and two patients with a positive postural test. A significant improvement in biochemical values was seen in all patients but with limited clinical response. UA was performed in 12 patients, producing long-term remission in three (106 ± 28 months; range: 80-135), recurrence in eight (after 54 ± 56 months; range 12-180) and persistence in one other. Four patients subsequently underwent contralateral adrenalectomy for overt CS, one received ketoconazole, and four other patients remain under observation for subclinical CS. CONCLUSIONS Medical treatment based on cortisol response to provocative tests had a limited role in our patients, whereas UA was useful in some of them. Although recurrence is likely, the timing of onset is variable and close follow-up is mandatory to identify it.
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Affiliation(s)
- N M Albiger
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - F Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - M Zilio
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - M Barbot
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - G Occhi
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - S Rizzati
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - A Fassina
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - F Mantero
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - M Boscaro
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - M Iacobone
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - C Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
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Giraldi FP, Cavallo LM, Tortora F, Pivonello R, Colao A, Cappabianca P, Mantero F. The role of inferior petrosal sinus sampling in ACTH-dependent Cushing's syndrome: review and joint opinion statement by members of the Italian Society for Endocrinology, Italian Society for Neurosurgery, and Italian Society for Neuroradiology. Neurosurg Focus 2015; 38:E5. [DOI: 10.3171/2014.11.focus14766] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the management of adrenocorticotropic hormone (ACTH)–dependent Cushing's syndrome, inferior petrosal sinus sampling (IPSS) provides information for the endocrinologist, the neurosurgeon, and the neuroradiologist. To the endocrinologist who performs the etiological diagnosis, results of IPSS confirm or exclude the diagnosis of Cushing's disease with 80%–100% sensitivity and over 95% specificity. Baseline central-peripheral gradients have suboptimal accuracy, and stimulation with corticotropin-releasing hormone (CRH), possibly desmopressin, has to be performed. The rationale for the use of IPSS in this context depends on other diagnostic means, taking availability of CRH and reliability of dynamic testing and pituitary imaging into account. As regards the other specialists, the neuroradiologist may collate results of IPSS with findings at imaging, while IPSS may prove useful to the neurosurgeon to chart a surgical course. The present review illustrates the current standpoint of these 3 specialists on the role of IPSS.
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Affiliation(s)
- Francesca Pecori Giraldi
- 1Department of Clinical Sciences and Community Health, University of Milan
- 2Neuroendocrine Research Laboratory, Istituto Auxologico Italiano, Milan
| | - Luigi Maria Cavallo
- 3Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, and
| | - Fabio Tortora
- 4Department of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Naples; and
| | - Rosario Pivonello
- 6Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Annamaria Colao
- 6Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Paolo Cappabianca
- 3Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, and
| | - Franco Mantero
- 5Endocrinology Unit, Department of Medicine, University of Padua, Italy
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Di Dalmazi G, Kisker C, Calebiro D, Mannelli M, Canu L, Arnaldi G, Quinkler M, Rayes N, Tabarin A, Laure Jullié M, Mantero F, Rubin B, Waldmann J, Bartsch DK, Pasquali R, Lohse M, Allolio B, Fassnacht M, Beuschlein F, Reincke M. Novel somatic mutations in the catalytic subunit of the protein kinase A as a cause of adrenal Cushing's syndrome: a European multicentric study. J Clin Endocrinol Metab 2014; 99:E2093-100. [PMID: 25057884 DOI: 10.1210/jc.2014-2152] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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 Somatic mutations in PRKACA gene, encoding the catalytic subunit of protein kinase A (PKA), have been recently found in a high proportion of sporadic adenomas associated with Cushing's syndrome. The aim was to analyze the PRKACA mutation in a large cohort of patients with adrenocortical masses. METHODS Samples from nine European centers were included (Germany, n = 4; Italy, n = 4; France, n = 1). Samples were drawn from 149 patients with nonsecreting adenomas (n = 32 + 2 peritumoral), subclinical hypercortisolism (n = 36), Cushing's syndrome (n = 64 + 2 peritumoral), androgen-producing tumors (n = 4), adrenocortical carcinomas (n = 5 + 2 peritumoral), and primary bilateral macronodular adrenal hyperplasias (n = 8). Blood samples were available from patients with nonsecreting adenomas (n = 15), subclinical hypercortisolism (n = 10), and Cushing's syndrome (n = 35). Clinical and hormonal data were collected. DNA amplification by PCR of exons 6 and 7 of the PRKACA gene and direct sequencing were performed. RESULTS PRKACA heterozygous mutations were found in 22/64 samples of Cushing's syndrome patients (34%). No mutations were found in peritumoral tissue and blood samples or in other tumors examined. The c.617A>C (p.Leu206Arg) occurred in 18/22 patients. Furthermore, two novel mutations were identified: c.600_601insGTG/p.Cys200_Gly201insVal in three patients and c.639C>G+c.638_640insATTATCCTGAGG/p.Ser213Arg+p.Leu212_Lys214insIle-Ile-Leu-Arg) in one. All the mutations involved a region implicated in interaction between PKA regulatory and catalytic subunits. Patients with somatic PRKACA mutations showed higher levels of cortisol after dexamethasone test and a smaller adenoma size, compared with nonmutated subjects. CONCLUSIONS These data confirm and extend previous observations that somatic PRKACA mutations are specific for adrenocortical adenomas causing Cushing's syndrome.
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Affiliation(s)
- Guido Di Dalmazi
- Medizinische Klinik und Poliklinik IV (G.D.D., M.F., F.B., M.R.), Klinikum der Universität München, München, Germany; Rudolf Virchow Center for Experimental Biomedicine (C.K., D.C., M.L.), University of Würzburg, Würzburg, Germany; Institute of Pharmacology and Toxicology (D.C., M.L.), University of Würzburg, 97080 Würzburg, Germany; Department of Experimental and Clinical Biomedical Sciences (M.M., L.C.), Florence, Italy; Endocrinology Division, Department of Clinical and Molecular Sciences (G.A.), University Hospital, Ancona, Italy; Bereich Klinische Endokrinologie, Charité Campus Mitte (M.Q.), Charité Universitätsmedizin, Berlin, Germany; Department of General, Visceral, and Transplant Surgery (N.R.), Charité Campus Virchow Clinic, Berlin, Germany; Department of Endocrinology (A.T.), Centre Hospitalier Universitaire Bordeaux and University of Bordeaux, Bordeaux, France; Service d'Anatomopathologie (L.J.), Centre Hospitalier Universitaire Bordeaux and University of Bordeaux, Bordeaux, France; Endocrinology Unit, Department of Medicine (F.M., B.R.), University of Padua, Padua, Italy; Klinik für Visceral, Thorax, und Gefäßchirurgie (J.W., D.K.B.), Marburg, Germany; Endocrinology Unit, Department of Medical and Surgical Sciences (R.P.), Alma Mater University of Bologna, Bologna, Italy; Endocrine and Diabetes Unit, Department of Internal Medicine I (B.A.), University Hospital, University of Würzburg, Würzburg, Germany; and Comprehensive Cancer Center Mainfranken (M.F.), University of Würzburg, Germany
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Ceccato F, Antonelli G, Barbot M, Zilio M, Mazzai L, Gatti R, Zaninotto M, Mantero F, Boscaro M, Plebani M, Scaroni C. The diagnostic performance of urinary free cortisol is better than the cortisol:cortisone ratio in detecting de novo Cushing's syndrome: the use of a LC-MS/MS method in routine clinical practice. Eur J Endocrinol 2014; 171:1-7. [PMID: 24743401 DOI: 10.1530/eje-14-0061] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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 The Endocrine Society Clinical Guidelines recommend measuring 24-h urinary free cortisol (UFF) levels using a highly accurate method as one of the first-line screening tests for the diagnosis of Cushing's Syndrome (CS). We evaluated the performance of UFF, urinary free cortisone (UFE), and the UFF:UFE ratio, measured using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. SUBJECTS AND METHODS The LC-MS/MS was used to analyze UFF and UFE levels in 43 surgically confirmed CS patients: 26 with Cushing's disease (CD, 16 de novo and ten recurrences), 11 with adrenal CS and six with ectopic CS; 22 CD patients in remission; 14 eu-cortisolemic CD patients receiving medical therapy; 60 non-CS patients; and 70 healthy controls. Sensitivity and specificity were determined in the combined groups of non-CS patients, healthy controls, and CD in remission. RESULTS UFF>170 nmol/24 h showed 98.7% specificity and 100% sensitivity for de novo CS, while sensitivity was 80% for recurrent CD patients, who were characterized by lower UFF levels. The UFF:UFE and UFF+UFE showed lower sensitivity and specificity than UFF. Ectopic CS patients had the highest UFF and UFF:UFE levels, which were normal in the CD remission patients and in those receiving medical therapy. CONCLUSIONS Our data suggest high diagnostic performance of UFF excretion measured using LC-MS/MS, in detecting de novo CS. UFF:UFE and UFF+UFE assessments are not useful in the first step of CS diagnosis, although high levels were found to be indicative of ectopic CS.
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Affiliation(s)
- Filippo Ceccato
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Giorgia Antonelli
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Mattia Barbot
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Marialuisa Zilio
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Linda Mazzai
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Rosalba Gatti
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Martina Zaninotto
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Franco Mantero
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Marco Boscaro
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Mario Plebani
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, ItalyEndocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
| | - Carla Scaroni
- Endocrinology UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyLaboratory Medicine UnitDepartment of Medicine DIMED, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, ItalyEndocrinology UnitUniversity-Hospital of Padova, via Ospedale Civile 105, 35128 Padova, ItalyDepartment of Laboratory Medicine,University-Hospital of Padovavia Giustiniani 2, 35128 Padova, Italy
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Rossi GP, Cesari M, Letizia C, Seccia TM, Cicala MV, Zinnamosca L, Kuppusamy M, Mareso S, Sciomer S, Iacobone M, Mantero F, Pessina AC. KCNJ5 gene somatic mutations affect cardiac remodelling but do not preclude cure of high blood pressure and regression of left ventricular hypertrophy in primary aldosteronism. J Hypertens 2014; 32:1514-21; discussion 1522. [DOI: 10.1097/hjh.0000000000000186] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fernandes-Rosa FL, Williams TA, Riester A, Steichen O, Beuschlein F, Boulkroun S, Strom TM, Monticone S, Amar L, Meatchi T, Mantero F, Cicala MV, Quinkler M, Fallo F, Allolio B, Bernini G, Maccario M, Giacchetti G, Jeunemaitre X, Mulatero P, Reincke M, Zennaro MC. Genetic spectrum and clinical correlates of somatic mutations in aldosterone-producing adenoma. Hypertension 2014; 64:354-61. [PMID: 24866132 DOI: 10.1161/hypertensionaha.114.03419] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary aldosteronism is the most common form of secondary hypertension. Somatic mutations in KCNJ5, ATP1A1, ATP2B3, and CACNA1D have been described in aldosterone-producing adenomas (APAs). Our aim was to investigate the prevalence of somatic mutations in these genes in unselected patients with APA (n=474), collected through the European Network for the Study of Adrenal Tumors. Correlations with clinical and biochemical parameters were first analyzed in a subset of 199 patients from a single center and then replicated in 2 additional centers. Somatic heterozygous KCNJ5 mutations were present in 38% (180/474) of APAs, whereas ATP1A1 mutations were found in 5.3% (25/474) and ATP2B3 mutations in 1.7% (8/474) of APAs. Previously reported somatic CACNA1D mutations as well as 10 novel CACNA1D mutations were identified in 44 of 474 (9.3%) APAs. There was no difference in the cellular composition of APAs or in CYP11B2, CYP11B1, KCNJ5, CACNA1D, or ATP1A1 gene expression in APAs across genotypes. Patients with KCNJ5 mutations were more frequently female, diagnosed younger, and with higher minimal plasma potassium concentrations compared with CACNA1D mutation carriers or noncarriers. CACNA1D mutations were associated with smaller adenomas. These associations were largely dependent on the population structure of the different centers. In conclusion, recurrent somatic mutations were identified in 54% of APAs. Young women with APAs are more likely to be KCNJ5 mutation carriers; identification of specific characteristics or surrogate biomarkers of mutation status may lead to targeted treatment options.
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Affiliation(s)
- Fabio Luiz Fernandes-Rosa
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Tracy Ann Williams
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Anna Riester
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Olivier Steichen
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Felix Beuschlein
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Sheerazed Boulkroun
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Tim M Strom
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Silvia Monticone
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Laurence Amar
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Tchao Meatchi
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Franco Mantero
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Maria-Verena Cicala
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Marcus Quinkler
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Francesco Fallo
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Bruno Allolio
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Giampaolo Bernini
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Mauro Maccario
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Gilberta Giacchetti
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Xavier Jeunemaitre
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Paolo Mulatero
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Martin Reincke
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Maria-Christina Zennaro
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.).
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Barollo S, Pezzani R, Cristiani A, Redaelli M, Zambonin L, Rubin B, Bertazza L, Zane M, Mucignat-Caretta C, Bulfone A, Pennelli G, Casal Ide E, Pelizzo MR, Mantero F, Moro S, Mian C. Prevalence, tumorigenic role, and biochemical implications of rare BRAF alterations. Thyroid 2014; 24:809-19. [PMID: 24295088 DOI: 10.1089/thy.2013.0403] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most common malignant tumor of the thyroid gland, accounting for 74-80% of all thyroid cancers. The 1799T>A transversion is an activating mutation of the BRAF oncogene that is common in and specific to conventional PTC. We studied the prevalence, tumorigenic role, and biochemical implications of rare BRAF variants in a large cohort of patients. METHODS A total of 2131 fine-needle aspiration biopsy samples were collected and subjected to BRAF mutation analysis. BRAF genetic variants were analyzed by Western blot, immunofluorescence, and in silico analysis. RESULTS BRAF mutations were found in 50% (347/700) of thyroid cancers (644 PTCs, 22 anaplastic thyroid carcinomas, 34 follicular thyroid carcinomas). They were the classic (c.1799T>A, p.V600E) mutation in 96.8% (336/347) and rare genetic variants in 3.2% (11/347). In all, five infrequent BRAF alterations were detected: (i) c.1795_1797dupACA (p.T599dup); (ii) c.1801A>G (p.K601E); (iii) c.1799_1801delTGA (p.V600_K601>E); (iv) c.1799_1814>A (p.V600_S605>D); and (v) c.1798_1810delinsA (p.V600_W604>R). The last BRAF variant has never been described in the literature. Western blot analysis and immunofluorescence both revealed a variegated reactivity pattern, again emphasizing the peculiar role of every specific BRAF genetic alteration. In silico analysis of the samples studied revealed a stabilization of the "active" geometrical conformation of the B-raf enzyme associated with the activated and productive state of the kinase domain. CONCLUSIONS Rare BRAF variants were found in 1.6% of all thyroid malignancies, all clustered around the codon V600, in the binding pocket named A-loop, confirming its crucial role in the enzymatic activation of the B-Raf protein. These mutations were associated mainly with the activation of key effectors in the mitogen-activated protein kinase pathway, but a simultaneous stimulation of the PI3k/Akt cascade was demonstrated in some cases. The rare BRAF variants were not generally associated with an aggressive behavior of the PTC. To our knowledge, this is the largest series of thyroid cancers analyzed to identify and functionally characterize rare BRAF variants.
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Affiliation(s)
- Susi Barollo
- 1 Endocrinology Unit, Department of Medicine, University of Padua , Padua, Italy
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Assié G, Letouzé E, Fassnacht M, Jouinot A, Luscap W, Barreau O, Omeiri H, Rodriguez S, Perlemoine K, René-Corail F, Elarouci N, Sbiera S, Kroiss M, Allolio B, Waldmann J, Quinkler M, Mannelli M, Mantero F, Papathomas T, De Krijger R, Tabarin A, Kerlan V, Baudin E, Tissier F, Dousset B, Groussin L, Amar L, Clauser E, Bertagna X, Ragazzon B, Beuschlein F, Libé R, de Reyniès A, Bertherat J. Integrated genomic characterization of adrenocortical carcinoma. Nat Genet 2014; 46:607-12. [PMID: 24747642 DOI: 10.1038/ng.2953] [Citation(s) in RCA: 456] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/17/2014] [Indexed: 12/15/2022]
Abstract
Adrenocortical carcinomas (ACCs) are aggressive cancers originating in the cortex of the adrenal gland. Despite overall poor prognosis, ACC outcome is heterogeneous. We performed exome sequencing and SNP array analysis of 45 ACCs and identified recurrent alterations in known driver genes (CTNNB1, TP53, CDKN2A, RB1 and MEN1) and in genes not previously reported in ACC (ZNRF3, DAXX, TERT and MED12), which we validated in an independent cohort of 77 ACCs. ZNRF3, encoding a cell surface E3 ubiquitin ligase, was the most frequently altered gene (21%) and is a potential new tumor suppressor gene related to the β-catenin pathway. Our integrated genomic analyses further identified two distinct molecular subgroups with opposite outcome. The C1A group of ACCs with poor outcome displayed numerous mutations and DNA methylation alterations, whereas the C1B group of ACCs with good prognosis displayed specific deregulation of two microRNA clusters. Thus, aggressive and indolent ACCs correspond to two distinct molecular entities driven by different oncogenic alterations.
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Affiliation(s)
- Guillaume Assié
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [4] Center for Rare Adrenal Diseases, Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France. [5]
| | - Eric Letouzé
- 1] Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France. [2]
| | - Martin Fassnacht
- 1] Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, University of Munich, Munich, Germany. [2] Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany. [3] Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Anne Jouinot
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Windy Luscap
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Olivia Barreau
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [4] Center for Rare Adrenal Diseases, Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Hanin Omeiri
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Stéphanie Rodriguez
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Karine Perlemoine
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Fernande René-Corail
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Nabila Elarouci
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France
| | - Silviu Sbiera
- 1] Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, University of Munich, Munich, Germany. [2] Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Matthias Kroiss
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Bruno Allolio
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Jens Waldmann
- Visceral, Thoracic and Vascular Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Marcus Quinkler
- Department of Clinical Endocrinology, Charité Campus Mitte, Charité University Medicine, Berlin, Germany
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Franco Mantero
- Endocrinology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Thomas Papathomas
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ronald De Krijger
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Antoine Tabarin
- 1] Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Bordeaux, Bordeaux, France. [2] Rare Adrenal Cancer Network COMETE, Paris, France
| | - Véronique Kerlan
- 1] Rare Adrenal Cancer Network COMETE, Paris, France. [2] Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Brest, Brest, France
| | - Eric Baudin
- 1] Rare Adrenal Cancer Network COMETE, Paris, France. [2] Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - Frédérique Tissier
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [4] Department of Pathology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, France
| | - Bertrand Dousset
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [4] Center for Rare Adrenal Diseases, Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France. [5] Department of Digestive and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Lionel Groussin
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [4] Center for Rare Adrenal Diseases, Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Laurence Amar
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Eric Clauser
- Oncogenetic Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Xavier Bertagna
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [4] Center for Rare Adrenal Diseases, Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France. [5] Rare Adrenal Cancer Network COMETE, Paris, France
| | - Bruno Ragazzon
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, University of Munich, Munich, Germany
| | - Rossella Libé
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [4] Center for Rare Adrenal Diseases, Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France. [5] Rare Adrenal Cancer Network COMETE, Paris, France
| | - Aurélien de Reyniès
- 1] Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France. [2]
| | - Jérôme Bertherat
- 1] INSERM U1016, Institut Cochin, Paris, France. [2] CNRS UMR 8104, Paris, France. [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [4] Center for Rare Adrenal Diseases, Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France. [5] Rare Adrenal Cancer Network COMETE, Paris, France. [6]
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Barbot M, Albiger N, Ceccato F, Zilio M, Frigo AC, Denaro L, Mantero F, Scaroni C. Combination therapy for Cushing's disease: effectiveness of two schedules of treatment: should we start with cabergoline or ketoconazole? Pituitary 2014; 17:109-17. [PMID: 23468128 DOI: 10.1007/s11102-013-0475-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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: 11/29/2022]
Abstract
Cushing's disease (CD) is associated with increased morbidity and mortality. Until now, no medical treatment has been shown to be totally satisfactory when administrated alone. This study aimed to assess the effectiveness of cabergoline with added ketoconazole and of the same combination in reverse, using urinary free cortisol (UFC) and late night salivary cortisol (LNSC) levels as biochemical markers of the treatments' efficacy in CD patients. A prospective analysis conducted on 14 patients (f/m = 12/2; median age 52, range 33-70 years) divided into two groups: 6 patients initially treated with cabergoline for 4-6 months (rising from 0.5-1 mg/week up to 3.0 mg/week), after which ketoconazole was added (group A); and 8 patients first took ketoconazole alone for 4-6 months (rising from 200 mg/day to 600 mg/day), then cabergoline was added (group B). Patients were compared with 14 age-matched patients in prolonged remission after effective neurosurgery for CD. The combination therapy led to UFC normalization in 79 % of patients with no differences between the groups; only one patient failed to respond at all. Neither drug succeeded in controlling the disease when taken alone. LNSC dropped when compared to baseline levels, but not to a significant degree (p = 0.06), and it remained significantly higher than in controls (p = 0.0006). Associating cabergoline with ketoconazole may represent an effective second-line treatment, achieving a satisfactory reduction in UFC levels and clinical improvement. Although the combined treatment lowered patients' LNSC levels, they remained higher than normal, indicating a persistent subclinical hypercortisolism; the implications of this condition need to be considered. No differences emerged between the two treatment schedules.
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Affiliation(s)
- M Barbot
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy,
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28
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Zilio M, Barbot M, Ceccato F, Camozzi V, Bilora F, Casonato A, Frigo AC, Albiger N, Daidone V, Mazzai L, Mantero F, Scaroni C. Diagnosis and complications of Cushing's disease: gender-related differences. Clin Endocrinol (Oxf) 2014; 80:403-10. [PMID: 23889360 DOI: 10.1111/cen.12299] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 04/25/2013] [Revised: 05/10/2013] [Accepted: 07/22/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cushing's disease (CD) presents a remarkable preponderance in female gender, with a female-to-male ratio of 3-8:1. The aim of this study was to evaluate gender-related differences in the presentation of CD, as regards: biochemical indices of hypercortisolism; sensitivity of diagnostic tests; clinical features and complications of disease. METHODS We retrospectively studied 84 adult patients with CD, 67 women and 17 men, evaluated at diagnosis. We compared the features of the disease between the sexes and analysed the effect of gender on CD complications, adjusted for potential confounders (age, gonadal status, BMI, urinary free cortisol values). RESULTS We observed no differences between males and females as regards age at diagnosis, disease duration and BMI. Men, compared with women, presented higher urinary free cortisol values (P < 0·001) and ACTH values (P < 0·05). As regards diagnostic tests, men presented a lower ACTH response to DDAVP stimulation (P < 0·05). The pituitary tumour itself was less easily visualized by pituitary MRI in males compared with females (P < 0·05). Furthermore, some complications of disease were more frequent or more severe in men, in particular hypokalaemia (P < 0·05), hypercoagulable state and osteoporosis at lumbar spine (P < 0·01), with consequent higher risk of vertebral fractures. Male gender was found to be an independent risk factor for dyslipidaemia, severity of hypertension, lumbar osteoporosis and fractures. CONCLUSIONS Although CD is less frequent in male patients, in this gender, it presents with more florid clinical manifestations and may imply more diagnostic difficulties.
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Affiliation(s)
- Marialuisa Zilio
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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Antonelli G, Artusi C, Marinova M, Brugnolo L, Zaninotto M, Scaroni C, Gatti R, Mantero F, Plebani M. Cortisol and cortisone ratio in urine: LC-MS/MS method validation and preliminary clinical application. Clin Chem Lab Med 2014; 52:213-20. [PMID: 24391193 DOI: 10.1515/cclm-2013-0471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/03/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND The determination of urinary cortisol/cortisone ratio is of clinical utility in cases of Cushing's syndrome, apparent mineralocorticoid excess, and also provides information on 11β-hydroxysteroid dehydrogenase (11β-HSD) type 2 activity. It is therefore of utmost importance to ensure accurate cortisol and cortisone measurement and establish appropriate reference ranges. METHODS After the isotopic dilution of urine, sample cleanups were obtained with on-line solid-phase extraction and cortisol and cortisone, separated using a Zorbax Eclipse XDB-C18 HPLC analytical column, were analyzed by tandem mass spectrometry with an electrospray ionization source in positive ion mode operation. RESULTS The method was linear, with concentrations of up to 625 and 1125 nmol/L and lower limit of quantitation (LLOQ) of 5 and 6 nmol/L, for cortisol and cortisone, respectively. Within-run and between-run coefficients of variation were <5% and 6% for cortisol and 6% and 8% for cortisone, respectively. No ion suppression was observed. The non-parametric reference range for the cortisol/cortisone ratio was 0.14-1.09. CONCLUSIONS A simple and sensitive liquid chromatography tandem mass spectrometry method was developed and validated for the measurement of cortisol and cortisone in urine. Our findings indicate that the proposed analytical method is suitable for routine purposes and useful in many pathological conditions.
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Koutroumpi S, Spiezia L, Albiger N, Barbot M, Bon M, Maggiolo S, Gavasso S, Simioni P, Frigo A, Mantero F, Scaroni C. Thrombin generation in Cushing's Syndrome: do the conventional clotting indices tell the whole truth? Pituitary 2014; 17:68-75. [PMID: 23408210 DOI: 10.1007/s11102-013-0467-3] [Citation(s) in RCA: 21] [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: 10/27/2022]
Abstract
Cushing's Syndrome (CS) is associated with an increased mortality, where hypercoagulability seems to have a crucial role in both arterial and venous thrombosis. Parameters of in vitro thrombin generation (TG) such as lag time, peak thrombin and endogenous thrombin potential (ETP), that describe the time until thrombin burst, the peak amount of TG and the total amount of thrombin generated, respectively as well as classical clotting markers were evaluated in 33 CS patients compared to both a group of 28 patients matched for the features of Metabolic Syndrome (MetS) and 31 healthy individuals. CS and MetS patients had shorter lag time (p < 0.0001), higher peak and ETP (p < 0.0001) than healthy controls, though lag time was less shortened in CS (p < 0.0001) respect to MetS group. Prothrombin time (PT) was increased (p < 0.0001) in both CS and MetS patients, while partial thromboplastin time (PTT) was shorter (p < 0.0001) in CS compared to both MetS and healthy group (p < 0.0001). Factor VIII (FVIII), Antithrombin (AT), protein C and S were increased only in CS patients (p < 0.0001). lag time, AT and FVIII correlated to night salivary cortisol (r = + 0.59; p = 0.0005, r = + 0.40; p = 0.003, r = + 0.40; p = 0.04, respectively); PTT correlated inversely to urinary free cortisol (r = -0.45; p = 0.009). BMI correlated negatively to lag time (r = -0.40; p = 0.0001) and positively to peak and ETP (r = + 0.34; p = 0.001, r = + 0.28; p = 0.008, respectively). Obese and diabetic patients had shorter lag time (p = 0.0005; p = 0.0002, respectively), higher ETP (p = 0.0006; p = 0.007, respectively) and peak (p = 0.0003; p = 0.0005, respectively) as well as a more prolonged PT (p = 0.04; p = 0.009, respectively). Hypertensive individuals had higher ETP (p = 0.004), peak (p = 0.0008) and FVIII (p = 0.001). Our findings confirm a prothrombotic state in both CS and MetS patients, though lag time was less shortened in CS. The high levels of endogenous physiological anticoagulants, could possibly represent a protective mechanism against hypercoagulability seen in CS patients.
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Affiliation(s)
- S Koutroumpi
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale, 105, 35128, Padua, Italy
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Ceccato F, Occhi G, Regazzo D, Randi ML, Cecchin D, Gardiman MP, Manara R, Lombardi G, Denaro L, Mantero F, Scaroni C. Gonadotropin secreting pituitary adenoma associated with erythrocytosis: case report and literature review. Hormones (Athens) 2014; 13:131-9. [PMID: 24722134 DOI: 10.1007/bf03401328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Most pituitary adenomas with FSH- or LH-positive immunohistochemistry are endocrinologically silent, and neurological symptoms due to their large volume are the first clinical signs; they are rarely reported to be secreting gonadotropins, this usually occurring in cases with clinical endocrine findings. Gonadotropinomas are often treated surgically because they are unresponsive to conventional medical therapies. Temozolomide was recently recommended for non-responder aggressive pituitary adenoma management. CASE REPORT A 43-year-old male with a history of 5 years of erythrocytosis presented with severe headache, orthostatic dizziness, and difficulty walking. MRI documented a giant pituitary adenoma and high uptake of 111In-pentetreotide indicated somatostatin receptor (SSR) expression. Biochemical tests revealed a secreting gonadotropinoma. Therapy with somatostatin analogs and dopamine agonists improved the patient's headache, achieved partial hormone control, slightly reduced the size of the adenoma, and controlled erythrocytosis. Six months after the diagnosis, hormone escape occurred despite therapy, thus neurosurgery was performed. After the procedure the patient died of untreatable intracranial hypertension. The surgical specimen revealed SSR 2 and 3 expression, and temozolomide did not induce apoptosis in primary cell culture. REVIEW OF LITERATURE Among gonadotropinomas, female gender (77%), macroadenoma (84%), young age at diagnosis (28 ± 12 years), delay from first symptoms to diagnosis (up to 15 years), and ovarian cysts/menstrual disorders in females or macro-orchidism in males were the foremost clinical and neuroimaging features. CONCLUSIONS Male gonadotropin-secreting pituitary adenomas may have a variable clinical expression secondary to testosterone excess. Somatostatin analogs, dopamine agonists or temozolomide may have a role that needs to be assessed case by case.
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Affiliation(s)
- Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED; University of Padua Medical School, Padua, Italy
| | - Gianluca Occhi
- Endocrinology Unit, Department of Medicine DIMED; University of Padua Medical School, Padua, Italy
| | - Daniela Regazzo
- Endocrinology Unit, Department of Medicine DIMED; University of Padua Medical School, Padua, Italy
| | - Maria Luigia Randi
- Internal Medicine, Department of Medicine DIMED; University of Padua Medical School, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED; University of Padua Medical School, Padua, Italy
| | - Marina Paola Gardiman
- Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED; University of Padua Medical School, Padua, Italy
| | - Renzo Manara
- Neuroradiologic Unit, University Hospital of Padua, Padua, Italy
| | - Giuseppe Lombardi
- Medical Oncology 1, Venetian Oncology Institute - IRCCS, Padua, Italy
| | - Luca Denaro
- Neurosurgery Division, University Hospital of Padua; Padua, Italy
| | - Franco Mantero
- Endocrinology Unit, Department of Medicine DIMED; University of Padua Medical School, Padua, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED; University of Padua Medical School, Padua, Italy
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Pezzani R, Rubin B, Redaelli M, Radu C, Barollo S, Cicala MV, Salvà M, Mian C, Mucignat-Caretta C, Simioni P, Iacobone M, Mantero F. The antiproliferative effects of ouabain and everolimus on adrenocortical tumor cells. Endocr J 2014; 61:41-53. [PMID: 24153038 DOI: 10.1507/endocrj.ej13-0225] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 11/23/2022] Open
Abstract
Ouabain is a cardiotonic steroid obtained from Strophanthus. Recently its role as antiproliferative agent has been investigated in tumor cells. Everolimus is a derivative of rapamycin and acts as a signal transduction inhibitor. Adrenocortical carcinoma is a rare cancer, with poor prognosis. This research focuses on antineoplastic properties of ouabain and its association with everolimus. We analyzed the effects of drugs on cells by MTT assay, by [(3)H] thymidine assay, by Wright's staining, by homogeneous caspases assay, by flow cytometry analysis and by Western blot analysis on H295R and SW13 cells and on primary adrenocortical tumor cells. Ouabain induced cell viability reduction in SW13, H295R and 5 primary adrenocortical tumor cells. Combination of ouabain with everolimus produced a stronger cytotoxic effect on cell proliferation and viability. Marked morphological changes were observed in both SW13 and H295R cell lines after ouabain treatment, with an increase in necrosis. Cell cycle distribution was altered by ouabain in SW13. Analysis of apoptosis demonstrated an increase in caspase activity, clearly evident for SW13 at 72h. FACS analysis by Annexin V-FITC kit and propidium iodide confirmed an increased level of necrosis at higher concentrations. Western blot analysis showed that PI3k/Akt signaling pathway was modified after ouabain treatments in SW13. Ouabain exerts antiproliferative effects on SW13 and H295R cell lines and on primary adrenocortical tumor cells. These data suggest that ouabain or ouabain derivatives may be potential anticancer agents.
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Affiliation(s)
- Raffaele Pezzani
- Endocrinology Unit, Department of Medicine, University of Padova, Padova 35128, Italy
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Ryu OH, Lee S, Yu J, Choi MG, Yoo HJ, Mantero F. A prospective randomized controlled trial of the effects of vitamin D supplementation on long-term glycemic control in type 2 diabetes mellitus of Korea. Endocr J 2014; 61:167-76. [PMID: 24240575 DOI: 10.1507/endocrj.ej13-0356] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 11/23/2022] Open
Abstract
Epidemiologic studies have shown that low vitamin D levels are associated with reduced insulin sensitivity and increased risk of developing type 2 diabetes mellitus (T2DM). However, there is little evidence that vitamin D supplementation improves glucose intolerance. We evaluated the glucose-lowering effect of vitamin D in Korean T2DM subjects. We enrolled 158 T2DM patients who had stable glycemic control [hemoglobin A1c (HbA1c) <8.5%] and vitamin D levels less than 20 ng/mL. The participants were randomized into two groups: Placebo (100 mg daily of elemental calcium administered twice a day) or Vitamin D (1000 IU daily of cholecalciferol combined with 100 mg of elemental calcium administered twice a day). We compared outdoor physical activity, glycemic control, homeostasis model of assessment - insulin resistance (HOMA-IR), and parathyroid hormone (PTH), during the 24-week intervention. We analyzed the data of 129 participants (placebo =65, vitamin D =64) who completely followed the protocol. Outdoor physical activity and oral anti-diabetic drugs did not differ between the groups. While there were significant differences in the vitamin D levels (15.6 ± 7.1 ng/mL vs 30.2 ± 10.8 ng/mL, P<0.001) and change in PTH levels (1.4 ± 15.3 pg/mL vs -5.5 ± 9.8 pg/mL, P=0.003) between the placebo and vitamin D groups, there were no differences in HbA1c (7.27 ± 0.87% vs 7.40 ± 0.90%) (P=0.415) and HOMA-IR. Serum calcium and kidney function results showed that the vitamin D supplementation was safe. While vitamin D supplementation is safe and effective in the attainment of vitamin D sufficiency, it had no effect on long-term glycemic control for T2DM in our study.
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Affiliation(s)
- Ohk-Hyun Ryu
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
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Betterle C, Scarpa R, Garelli S, Morlin L, Lazzarotto F, Presotto F, Coco G, Masiero S, Parolo A, Albergoni MP, Favero R, Barollo S, Salvà M, Basso D, Chen S, Rees Smith B, Furmaniak J, Mantero F. Addison's disease: a survey on 633 patients in Padova. Eur J Endocrinol 2013; 169:773-84. [PMID: 24014553 DOI: 10.1530/eje-13-0528] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [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: 11/08/2022]
Abstract
OBJECTIVE Addison's disease (AD) is a rare endocrine condition. DESIGN We aimed to evaluate clinical, immunologic, adrenal imaging, and genetic features in 633 Italian patients with AD followed up since 1967. METHODS Adrenal cortex autoantibodies, presence of other autoimmune and nonautoimmune diseases, nonadrenal autoantibodies, adrenal imaging, and genetic profile for HLA-DRB1 and AIRE were analyzed. RESULTS A total of 492 (77.7%) patients were found to be affected by autoimmune AD (A-AD), 57 (9%) tuberculous AD, 29 (4.6%) genetic-associated AD, 10 (1.6%) adrenal cancer, six (0.94%) post-surgical AD, four (0.6%) vascular disorder-related AD, three (0.5%) post-infectious AD, and 32 (5.1%) were defined as idiopathic. Adrenal cortex antibodies were detected in the vast majority (88100%) of patients with recent onset A-AD, but in none of those with nonautoimmune AD. Adrenal imaging revealed normal/atrophic glands in all A-AD patients: 88% of patients with A-AD had other clinical or subclinical autoimmune diseases or were positive for nonadrenal autoantibodies. Based on the coexistence of other autoimmune disorders, 65.6% of patients with A-AD were found to have type 2 autoimmune polyendocrine syndrome (APS2), 14.4% have APS1, and 8.5% have APS4. Class II HLA alleles DRB1*03 and DRB1*04 were increased, and DRB1*01, DRB1*07, DRB1*013 were reduced in APS2 patients when compared with controls. Of the patients with APS1, 96% were revealed to have AIRE gene mutations. CONCLUSIONS A-AD is the most prevalent form of adrenal insufficiency in Italy, and ∼90% of the patients are adrenal autoantibody-positive at the onset. Assessment of patients with A-AD for the presence of other autoimmune diseases should be helpful in monitoring and diagnosing APS types 1, 2, or 4 and improving patients' care.
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Affiliation(s)
- Corrado Betterle
- Endocrine Unit, Department of Medicine, University of Padova, Via Ospedale Civile, 105, 35128 Padova, Italy
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Kerkhofs TM, Baudin E, Terzolo M, Allolio B, Chadarevian R, Mueller HH, Skogseid B, Leboulleux S, Mantero F, Haak HR, Fassnacht M. Comparison of two mitotane starting dose regimens in patients with advanced adrenocortical carcinoma. J Clin Endocrinol Metab 2013; 98:4759-67. [PMID: 24057287 DOI: 10.1210/jc.2013-2281] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mitotane is the only approved drug for treatment of adrenocortical carcinoma. Its pharmacokinetic properties are not fully elucidated and different dosing regimens have never been compared head to head. OBJECTIVE The objective of the study was to investigate the relationship between mitotane dose and plasma concentration comparing two dosing regimens. DESIGN/SETTING This was a prospective, open-label, multicenter trial of a predefined duration of 12 weeks. PATIENTS/INTERVENTIONS Forty mitotane-naïve patients with metastatic adrenocortical carcinoma were assigned to a predefined low- or high-dose regimen by the local investigator. Thirty-two patients could be evaluated in detail. MAIN OUTCOME MEASURE The difference in median mitotane plasma levels between both treatment groups was measured. RESULTS Despite a difference in mean cumulative dose (440 ± 142 g vs 272 ± 121 g), median maximum plasma levels were not significantly different between the two groups [high dose 14.3 mg/L (range 6.3-29.7, n = 20) vs 11.3 mg/L (range 5.5-20.0, n = 12), P = .235]. Ten of 20 patients on the high-dose regimen reached plasma concentrations of 14 mg/L or greater after 46 days (range 18-81 d) compared with 4 of 12 patients on the low-dose regimen after 55 days (range 46-74 d, P = .286). All patients who reached 14 mg/L at 12 weeks displayed a level of 4.1 mg/L or greater on day 33 (100% sensitivity). There were no significant differences in frequency and severity of adverse events. Among patients not receiving concomitant chemotherapy mitotane exposure was higher in the high-dose group: 1013 ± 494 mg/L · d vs 555 ± 168 mg/L · d (P = .080). CONCLUSIONS The high-dose starting regimen resulted in neither significantly different mitotane levels nor a different rate of adverse events, but concomitant chemotherapy influenced these results. Thus, for mitotane monotherapy the high-dose approach is favorable, whereas for combination therapy a lower dose seems reasonable.
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Affiliation(s)
- T M Kerkhofs
- MD, Department of Internal Medicine, Máxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven, The Netherlands.
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Rossi GP, Cesari M, Cuspidi C, Maiolino G, Cicala MV, Bisogni V, Mantero F, Pessina AC. Response to Effectiveness of Adrenalectomy and Aldosterone Antagonists for Long-Term Treatment of Primary Aldosteronism. Hypertension 2013; 62:e14. [DOI: 10.1161/hypertensionaha.113.01755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gian Paolo Rossi
- Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Maurizio Cesari
- Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Cesare Cuspidi
- Department of Health Science, University of Milano-Bicocca, andIstituto Auxologico Italiano IRCCS Milan, Italy
| | | | | | - Valeria Bisogni
- Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Franco Mantero
- Department of Medicine-DIMED, University of Padova, Padua, Italy
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Barbot M, Albiger N, Koutroumpi S, Ceccato F, Frigo AC, Manara R, Fassina A, Gardiman MP, Scanarini M, Mantero F, Scaroni C. Predicting late recurrence in surgically treated patients with Cushing's disease. Clin Endocrinol (Oxf) 2013; 79:394-401. [PMID: 23278711 DOI: 10.1111/cen.12133] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 10/04/2012] [Revised: 11/06/2012] [Accepted: 12/17/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Cushing's disease (CD) has an uncertain prognosis because patients achieving remission after transsphenoidal pituitary neurosurgery (TSS) may relapse. We aimed to identify factors predicting relapse, focusing on desmopressin (DDAVP) and corticotropin-releasing hormone (CRH) tests after surgery. MATERIALS AND METHODS Fifty-seven patients with CD (mean age 36 years) after TSS experienced remission (24 cases), late relapse (LR) (15 cases), or persistent disease (18 cases). RESULTS The median time to relapse was 40 months. ACTH levels increased after both DDAVP and CRH stimulation, with a significantly higher response in the late recurrence group, showing this to be an indicator of increased risk of relapse. In the logistic regression model, a rise in ACTH >9 pg/ml after DDAVP and >36·7 pg/ml after CRH showed a sensitivity of 93% and 73%, respectively, a specificity of 82% and 76% in LR group. The area under the curve was 0·91 for DDAVP, 0·80 for CRH and 0·95 for DDAVP+CRH test, i.e. the combined tests performed better than each test alone, but not to a statistically significant degree. A response to both tests resulted in a positive predictive value (PPV) of 100%, while no response to either test in a negative predictive value (NPV) of 100%. CONCLUSIONS ACTH hyper-responsiveness to DDAVP stimulation proved a valuable indicator of relapsing patients with high sensitivity and specificity; in selected cases when a clear high increment of ACTH level is not evident, the CRH test might be used as additional tool to confirm the risk of future relapses.
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Affiliation(s)
- Mattia Barbot
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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Rossi GP, Seccia TM, Letizia C, Cicala MV, Zinnamosca L, Kuppusamy M, Cesari M, Sciomer S, Mantero F, Pessina AC. Abstract 358: Excess Cardio-renal Damage in Aldosterone-producing Adenoma Patients With Somatic Mutations in the KCNJ5 Gene. Hypertension 2013. [DOI: 10.1161/hyp.62.suppl_1.a358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aldosterone exerts detrimental cardiovascular (CV) effects, and aldosterone producing adenoma (APA) patients carrying somatic mutations in the KCNJ5 K+ channel (mutAPA) have higher plasma aldosterone concentration (PAC) than those wild-type (wtAPA).
We therefore investigated whether mutAPA patients develop a more prominent CV and renal damage than wtAPA patients.
From 250 consecutive PA patients, we identified 170 who had a diagnosis of APA by the 'four corners' criteria and high-quality echocardiographic data. Of them 106 with KCNJ5 sequencing information and long-term follow-up data could be compared for echocardiographic changes and eGFR (by CKD-EPI equation) according to presence (mutAPA, 18.8%) or absence (wtAPA, 81.2%) of the KCNJ5 mutations.
At baseline the mutAPA had lower eGFR (75±29 ml/min vs 84±20, p<0.05), and higher left ventricular mass index (LVMI, 61.9±21.4 mg/h2.7vs 49.5±11.3, p=0.001), PAC (48.9 [37.4-77.1] ng/dl vs 37.0 [24.9-48.5]), <0.0001), aldosterone-renin-ratio (ARR, 173.5 [92.2-229.6] ng/dl/ng/ml/h vs 144.3 [69.9-252.1], <0.0001), than the wtAPA patients. They were similar for blood pressure (BP) and need for antihypertensive medications. After adrenalectomy BP, PAC, ARR, and LVMI normalized in all groups, with no difference between mutAPA vs wtAPA.
Compared to the wild-type APA patients those with KCNJ5 mutations showed more prominent cardiovascular and renal damage, likely because of the higher PAC. However, the presence of these mutations did not compromise the chances of being cured from the hyperaldosteronism and the high blood pressure, or the regression of LVMI after adrenalectomy.
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Barollo S, Pezzani R, Cristiani A, Bertazza L, Rubin B, Bulfone A, Pelizzo MR, Torresan F, Mantero F, Pennelli G, Moro S, Mian C. Functional significance of the novel H-RAS gene mutation M72I in a patient with medullary thyroid cancer. Exp Clin Endocrinol Diabetes 2013; 121:546-50. [PMID: 23934677 DOI: 10.1055/s-0033-1351299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 10/26/2022]
Abstract
Medullary thyroid cancer (MTC) accounts for around 5-10% of all thyroid cancers. Though usually sporadic, 1 in 4 cases are of genetic origin, with germinal mutations in the RET proto-oncogene in familial forms and somatic mutations both in RET and in the RAS family genes in sporadic ones.This study aimed to characterize a rare H-RAS sequence variant -M72I- in a patient with sporadic MTC, focusing on its functional significance.Mutation analysis was performed for the RET, N-RAS, K-RAS and H-RAS genes by direct sequencing. Western blot analysis was done on 4 thyroid tissues from 1 patient carrying the M72I mutation in H-RAS, 1 with the Q61R mutation in H-RAS, 1 with no RET, H-RAS, K-RAS or N-RAS gene mutations, and 1 normal thyroid, using different antibodies against Erk1/2, phospho-Erk1/2 (Thr202/Tyr204), Akt and phospho-Akt (Ser473). Large-scale molecular dynamics simulations were completed for H-RAS wt and H-RAS M72I.Western blot analysis demonstrated that both MAPK and PI3K/Akt pathways were activated in the MTC patient carrying the M72I variant. In silico results showed conformational changes in H-RAS that could influence its activation by Sos and phosphate binding. Results of molecular dynamics were consistent with Western blot experiments.The M72I mutation may contribute effectively to proliferation and survival signaling throughout the MAPK and PI3K/Akt pathways. This work underscores the importance of studying genetic alterations that may lead to carcinogenesis.
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Affiliation(s)
- S Barollo
- Department of Medicine, Endocrinology Unit, University of Padua, Italy
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Ceccato F, Barbot M, Zilio M, Ferasin S, Occhi G, Daniele A, Mazzocut S, Iacobone M, Betterle C, Mantero F, Scaroni C. Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency. Eur J Endocrinol 2013; 169:31-6. [PMID: 23610124 DOI: 10.1530/eje-13-0159] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [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 Salivary cortisol has recently been suggested for studies on the hypothalamic-pituitary-adrenal (HPA) axis. The lack of circadian rhythm is a marker of Cushing's syndrome (CS), and some authors have reported that low salivary cortisol levels may be a marker of adrenal insufficiency. The aim of our study was to define the role of salivary cortisol in specific diagnostic settings of HPA axis disease. SUBJECTS AND METHODS We analyzed morning salivary cortisol (MSC) and late-night salivary CORTISOL (LNSC) levels in 406 SUBJECTS: 52 patients with Cushing's disease (CD), 13 with ectopic CS, 17 with adrenal CS, 27 with CD in remission (a mean follow-up of 66±39 months), 45 with adrenal incidentaloma, 73 assessed as having CS and then ruled out for endogenous hypercortisolism, 75 with adrenal insufficiency, and 104 healthy subjects. RESULTS A LNSC value above 5.24 ng/ml differentiated CS patients from controls with high sensitivity (96.3%) and specificity (97.1%); we found higher LNSC levels in ectopic CS patients than in CD patients. We found no difference in MSC and LNSC levels between patients with CD in remission and healthy subjects. Both MSC and LNSC levels were higher in patients with adrenal incidentaloma than in healthy controls. A MSC value below 2.65 ng/ml distinguished patients with adrenal insufficiency from controls with high sensitivity (97.1%) and specificity (93.3%). CONCLUSIONS Salivary cortisol is a useful tool to assess endogenous cortisol excess or adrenal insufficiency and to evaluate stable CD in remission.
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Affiliation(s)
- Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105, 35128 Padova, Italy
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Koutroumpi S, Daidone V, Sartori MT, Cattini MG, Albiger NM, Occhi G, Ferasin S, Frigo A, Mantero F, Casonato A, Scaroni C. Venous thromboembolism in patients with Cushing's syndrome: need of a careful investigation of the prothrombotic risk profile. Pituitary 2013; 16:175-81. [PMID: 22585010 DOI: 10.1007/s11102-012-0398-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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
A high incidence of venous thromboembolic (VTE) complications has been reported in Cushing's syndrome (CS), mostly post-operatively and attributable to hypercoagulability. The prevalence of symptomatic VTE was investigated retrospectively in 58 consecutive CS patients in relation to acquired and genetic thrombotic risk factors. Eight CS patients (14 %) developed VTE (group A), 3 of them related and 5 unrelated to surgery. These patients had higher urinary free cortisol (p = 0.01) and VWF levels (p = 0.02) than the 50 patients without VTE (group B), as well an increase in the hemostatically more efficient, high-molecular-weight VWF multimers (p = 0.002). Factor V Leiden and the prothrombin gene 20210A variants (the most common inherited thrombophilic defects) were more represented in group A than in group B, as was the genotype GCAG/GCAG of the VWF gene promoter, known to hyperinduce VWF upregulation under cortisol excess. All but one of the patients with VTE unrelated to surgery had at least four acquired and at least one inherited risk factor. Severe hypercortisolism and VWF levels with increased haemostatic activity are strongly associated with VTE in CS. VTE episodes unrelated to surgery are attributable to the synergistic action of acquired and inherited thrombotic risk factors. Based on these observations, we believe that severely affected CS patients should be screened for coagulation disorders and receive antithrombotic prophylaxis whenever they have concomitant prothrombotic risk factors.
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Affiliation(s)
- S Koutroumpi
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Padua Medical School, Via Ospedale 105, 35128 Padua, Italy.
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42
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Rossi GP, Cesari M, Cuspidi C, Maiolino G, Cicala MV, Bisogni V, Mantero F, Pessina AC. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension 2013; 62:62-9. [PMID: 23648698 DOI: 10.1161/hypertensionaha.113.01316] [Citation(s) in RCA: 235] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Primary aldosteronism (PA), a common cause of high blood pressure (BP), induces left ventricular (LV) hypertrophy and an excess rate of cardiovascular events. Whether its treatment provides long-term cure of hypertension and regression of cardiovascular damage remains uncertain. To the aim of assessing the effect of treatment of PA on BP and LV changes, we prospectively recruited 323 patients in a long-term follow-up study entailing serial echocardiography evaluations. Of them, 180 had PA and were assigned to either adrenalectomy (n=110) or medical therapy (n=70) on the basis of the adrenal vein sampling. The remaining 143 were consecutive optimally treated primary hypertensive patients. At baseline, the PA patients had more inappropriate LV mass than PH patients (27.1% versus 16.2%; P=0.020), despite similar BP values. At a median follow-up of 36 months (range, 6-225), BP was lowered (P<0.0001 versus baseline) to similar values in adrenalectomized (135±15/83±9 mm Hg), medically treated PA (133±11/83±7 mm Hg), and PH (139±15/86±9 mm Hg) patients. To this end, the adrenalectomized patients required significantly less drugs than the other groups. In PA patients, the LV mass index and the rate of LV hypertrophy fell through LV inward remodeling to the level of optimally treated PH patients, indicating that the LV work markedly decreased. Findings were similar when long-term (≥5 and ≥10 years) data were examined. Thus, an early diagnosis and a specific treatment of PA warrant normalization of BP and reversal of detrimental LV changes at long term.
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Affiliation(s)
- Gian Paolo Rossi
- Department of Health Science, University of Milan-Bicocca, Milan, Italy.
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43
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Occhi G, Regazzo D, Trivellin G, Boaretto F, Ciato D, Bobisse S, Ferasin S, Cetani F, Pardi E, Korbonits M, Pellegata NS, Sidarovich V, Quattrone A, Opocher G, Mantero F, Scaroni C. A novel mutation in the upstream open reading frame of the CDKN1B gene causes a MEN4 phenotype. PLoS Genet 2013; 9:e1003350. [PMID: 23555276 PMCID: PMC3605397 DOI: 10.1371/journal.pgen.1003350] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 01/16/2013] [Indexed: 11/19/2022] Open
Abstract
The CDKN1B gene encodes the cyclin-dependent kinase inhibitor p27KIP1, an atypical tumor suppressor playing a key role in cell cycle regulation, cell proliferation, and differentiation. Impaired p27KIP1 expression and/or localization are often observed in tumor cells, further confirming its central role in regulating the cell cycle. Recently, germline mutations in CDKN1B have been associated with the inherited multiple endocrine neoplasia syndrome type 4, an autosomal dominant syndrome characterized by varying combinations of tumors affecting at least two endocrine organs. In this study we identified a 4-bp deletion in a highly conserved regulatory upstream ORF (uORF) in the 5′UTR of the CDKN1B gene in a patient with a pituitary adenoma and a well-differentiated pancreatic neoplasm. This deletion causes the shift of the uORF termination codon with the consequent lengthening of the uORF–encoded peptide and the drastic shortening of the intercistronic space. Our data on the immunohistochemical analysis of the patient's pancreatic lesion, functional studies based on dual-luciferase assays, site-directed mutagenesis, and on polysome profiling show a negative influence of this deletion on the translation reinitiation at the CDKN1B starting site, with a consequent reduction in p27KIP1 expression. Our findings demonstrate that, in addition to the previously described mechanisms leading to reduced p27KIP1 activity, such as degradation via the ubiquitin/proteasome pathway or non-covalent sequestration, p27KIP1 activity can also be modulated by an uORF and mutations affecting uORF could change p27KIP1 expression. This study adds the CDKN1B gene to the short list of genes for which mutations that either create, delete, or severely modify their regulatory uORFs have been associated with human diseases. Gene expression can be modulated at different steps on the way from DNA to protein including control of transcription, translation, and post-translational modifications. An abnormality in the regulation of mRNA and protein expression is a hallmark of many human diseases, including cancer. In some eukaryotic genes translation can be influenced by small DNA sequences termed upstream open reading frames (uORFs). These elements located upstream to the gene start codon may either negatively influence the ability of the translational machinery to reinitiate translation of the main protein or, much less frequently, stimulate protein translation by enabling the ribosomes to bypass cis-acting inhibitory elements. CDKN1B, which encodes the cell cycle inhibitor p27KIP1, includes an uORF in its 5′UTR sequence. p27KIP1 expression is often reduced in cancer, and germline mutations have been identified in CDKN1B in patients affected with a syndrome (MEN4) characterized by varying combinations of tumors in endocrine glands. Here we show that a small deletion in the uORF upstream to CDKN1B reduces translation reinitiation efficiency, leading to underexpression of p27KIP1 and coinciding with tumorigenesis. This study describes a novel mechanism by which p27KIP1 could be underexpressed in human tumors. In addition, our data provide a new insight to the unique pathogenic potential of uORFs in human diseases.
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Affiliation(s)
- Gianluca Occhi
- Department of Medicine, Endocrinology Unit, University of Padova, Padova, Italy.
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Manara R, Bommarito G, Rizzati S, Briani C, Della Puppa A, Citton V, Zanchetta E, Zerbo F, Ermani M, Martini C, Mantero F, Sicolo N, Maffei P, Scaroni C. Herniation of cerebellar tonsils in acromegaly: prevalence, pathogenesis and clinical impact. Pituitary 2013; 16:122-30. [PMID: 22485017 DOI: 10.1007/s11102-012-0385-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 01/08/2023]
Abstract
Herniation of cerebellar tonsils (CTH) might occur in acromegaly patients and improve after acromegaly treatment. Our study investigated CTH prevalence in acromegaly, its relationship with clinical, laboratory and neuroimaging findings and its possible pathogenesis and clinical impact. 150 acromegaly patients (median-age 56 years, age-range 21-88, 83 females) underwent brain magnetic resonance imaging (MRI). Clinical data, laboratory and pituitary adenoma imaging findings were recorded. CTH, posterior cranial fossa area, tentorial angle, clivus, supraocciput and Twining's line length were measured in acromegaly patients and controls, who included MRI of 115 consecutive subjects with headache or transient neurological deficits (control group-1) and 24 symptomatic classic Chiari 1 malformation patients (control group-2). Acromegaly patients were interviewed for symptoms known to be related with CTH. 22/150 acromegaly patients (15 %) and 8/115 control group-1 subjects presented with CTH (p = 0.04). In acromegaly patients, CTH correlated positively with younger age and inversely with GH-receptor antagonist treatment. Control group-2 had a shorter clivus than CTH acromegaly patients (40.4 ± 3.2 mm vs 42.5 ± 3.3 mm, p < 0.05), while posterior fossa measures did not differ among acromegaly subgroups (with and without CTH) and control group-1. Headache and vision problems were more frequent in CTH acromegaly patients (p < 0.05); two acromegaly patients presented with imaging and neurological signs of syringomyelia. Despite no signs of posterior fossa underdevelopment or cranial constriction, CTH is more frequent in acromegaly patients and seems to contribute to some disabling neurological symptoms.
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Affiliation(s)
- Renzo Manara
- Neuroradiologic Unit, University Hospital of Padua, Via Giustiniani 5, 35138, Padua, Italy.
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Chortis V, Taylor AE, Schneider P, Tomlinson JW, Hughes BA, O'Neil DM, Libé R, Allolio B, Bertagna X, Bertherat J, Beuschlein F, Fassnacht M, Karavitaki N, Mannelli M, Mantero F, Opocher G, Porfiri E, Quinkler M, Sherlock M, Terzolo M, Nightingale P, Shackleton CHL, Stewart PM, Hahner S, Arlt W. Mitotane therapy in adrenocortical cancer induces CYP3A4 and inhibits 5α-reductase, explaining the need for personalized glucocorticoid and androgen replacement. J Clin Endocrinol Metab 2013; 98:161-71. [PMID: 23162091 DOI: 10.1210/jc.2012-2851] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mitotane [1-(2-chlorophenyl)-1-(4-chlorophenyl)-2,2-dichloroethane] is the first-line treatment for metastatic adrenocortical carcinoma (ACC) and is also regularly used in the adjuvant setting after presumed complete removal of the primary tumor. Mitotane is considered an adrenolytic substance, but there is limited information on distinct effects on steroidogenesis. However, adrenal insufficiency and male hypogonadism are widely recognized side effects of mitotane treatment. OBJECTIVE Our objective was to define the impact of mitotane treatment on in vivo steroidogenesis in patients with ACC. SETTING AND DESIGN At seven European specialist referral centers for adrenal tumors, we analyzed 24-h urine samples (n = 127) collected from patients with ACC before and during mitotane therapy in the adjuvant setting (n = 23) or for metastatic ACC (n = 104). Urinary steroid metabolite excretion was profiled by gas chromatography/mass spectrometry in comparison with healthy controls (n = 88). RESULTS We found a sharp increase in the excretion of 6β-hydroxycortisol over cortisol (P < 0.001), indicative of a strong induction of the major drug-metabolizing enzyme cytochrome P450 3A4. The contribution of 6β-hydroxycortisol to total glucocorticoid metabolites increased from 2% (median, interquartile range 1-4%) to 56% (39-71%) during mitotane treatment. Furthermore, we documented strong inhibition of systemic 5α-reductase activity, indicated by a significant decrease in 5α-reduced steroids, including 5α-tetrahydrocortisol, 5α-tetrahydrocorticosterone, and androsterone (all P < 0.001). The degree of inhibition was similar to that in patients with inactivating 5α-reductase type 2 mutations (n = 23) and patients receiving finasteride (n = 5), but cluster analysis of steroid data revealed a pattern of inhibition distinct from these two groups. Longitudinal data showed rapid onset and long-lasting duration of the observed effects. CONCLUSIONS Cytochrome P450 3A4 induction by mitotane results in rapid inactivation of more than 50% of administered hydrocortisone, explaining the need for doubling hydrocortisone replacement in mitotane-treated patients. Strong inhibition of 5α-reductase activity is in line with the clinical observation of relative inefficiency of testosterone replacement in mitotane-treated men, calling for replacement by 5α-reduced androgens.
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Affiliation(s)
- Vasileios Chortis
- Centre for Endocrinology, Diabetes and Metabolism, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, B15 2TT, United Kingdom
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46
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Ceccato F, Albiger N, Reimondo G, Frigo AC, Ferasin S, Occhi G, Mantero F, Terzolo M, Scaroni C. Assessment of glucocorticoid therapy with salivary cortisol in secondary adrenal insufficiency. Eur J Endocrinol 2012; 167:769-76. [PMID: 23034783 DOI: 10.1530/eje-12-0534] [Citation(s) in RCA: 26] [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] [Indexed: 11/08/2022]
Abstract
CONTEXT Appropriate glucocorticoid replacement therapy in adrenal insufficiency (AI) is crucial, given the risks of chronic under- or overtreatment, particularly in patients on multiple medications. Salivary sampling allows for non-invasive, stress-free cortisol measurement. OBJECTIVE To determine whether salivary cortisol measurement is helpful in assessing the adequacy of glucocorticoid therapy with cortisone acetate (CA) in patients with secondary AI. DESIGN A prospective cohort study at the Endocrinology Unit of Padua University Hospital. METHODS Six samples of salivary cortisol were collected from 28 patients with secondary AI on CA treatment and from 36 healthy volunteers at fixed times of the day, and used to calculate salivary cortisol levels at each time point and the area under the curve (AUC) across the different sampling times. RESULTS Salivary cortisol levels were lower in patients than in controls in the morning but no differences were found in the afternoon or at night before resting. Salivary cortisol levels were higher in patients immediately following CA administration. Ten patients showed an AUC above the 97.5th percentile of controls, without clinical signs of hypercortisolism, and salivary cortisol levels 90 min after each dose of CA predict the AUC. All patients had severe GH deficiency and there were no differences in salivary cortisol levels or AUC between patients treated or not with GH. CONCLUSIONS Two salivary cortisol determinations, able to predict the daily AUC, may allow for assessing the adequacy of glucocorticoid replacement therapy in secondary AI and for identifying cases of over- or undertreatment.
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Affiliation(s)
- Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128 Padova, Italy
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Seccia TM, Mantero F, Letizia C, Kuppusamy M, Caroccia B, Barisa M, Cicala MV, Miotto D, Rossi GP. Somatic mutations in the KCNJ5 gene raise the lateralization index: implications for the diagnosis of primary aldosteronism by adrenal vein sampling. J Clin Endocrinol Metab 2012; 97:E2307-13. [PMID: 23012392 DOI: 10.1210/jc.2012-2342] [Citation(s) in RCA: 26] [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] [Indexed: 02/12/2023]
Abstract
CONTEXT Somatic mutations in the selectivity filter of KCNJ5 K(+) channel were found to be associated with higher plasma aldosterone concentrations in the patients with an aldosterone-producing adenoma (APA). OBJECTIVE We investigated whether plasma aldosterone levels and the lateralization index are higher from the side with the APA with the mutation, as compared with those without the mutation. DESIGN From 170 consecutive APA patients with comprehensive clinical and KCNJ5 data and a conclusive diagnosis, we recruited 91 patients with adrenal vein sampling and follow-up data. We measured CYP11B1 and CYP11B2 mRNA in APA tissue and plasma aldosterone (PAC) and plasma cortisol concentrations (PCC) in adrenal vein blood. To determine whether KCNJ5 mutations affected aldosterone output from the APA, we calculated the lateralization index (defined as the ratio of PAC to PCC at the APA side over the PAC to PCC ratio at the contralateral side). We also calculated two indexes of the aldosterone production from the APA side and the contralateral suppression index. RESULTS The mRNA content of CYP11B2, but not of CYP11B1, and, accordingly, the lateralization index was higher (29.9 ± 7.4 vs. 10.3 ± 3.6, P < 0.02) in the APA with the mutation than in the APA without the mutation. CONCLUSIONS APA patients with the somatic KCNJ5 mutations showed a higher production of aldosterone than those without such mutations, which translates in a higher lateralization index. Thus, they are more likely to be identified at adrenal vein sampling and therefore to receive adrenalectomy.
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Affiliation(s)
- Teresa M Seccia
- Internal Medicine 4, Department of Medicine-DIMED, University of Padua, 35126 Padua, Italy
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48
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Nacamulli D, Nico L, Barollo S, Zambonin L, Pennelli G, Girelli ME, Casal Ide E, Pelizzo MR, Vianello F, Negro I, Watutantrige-Fernando S, Mantero F, Rugge M, Mian C. Comparison of the diagnostic accuracy of combined elastosonography and BRAF analysis vs cytology and ultrasonography for thyroid nodule suspected of malignancy. Clin Endocrinol (Oxf) 2012; 77:608-14. [PMID: 22540190 DOI: 10.1111/j.1365-2265.2012.04427.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 01/21/2023]
Abstract
OBJECTIVE Diagnosing thyroid nodules preoperatively using traditional diagnostic tools - ultrasonography (US) and cytology - still carries a considerable degree of uncertainty, and surgery is recommended for a far from negligible number of patients simply for diagnostic purposes. Thyroid elastosonography (USE) and BRAF analysis have recently proved useful in detecting thyroid malignancies. The aim of this study is to establish whether combining USE and BRAF testing ameliorates preoperative diagnosis of thyroid nodule candidates for intervention by conventional approaches, thereby avoiding the need for diagnostic surgical procedures. DESIGN AND PATIENTS We retrospectively analysed the files of 155 consecutive patients with 164 nodules, all assessed by ultrasonography, cytology, USE and BRAF testing, who underwent thyroid surgery. RESULTS Of the 164 nodules, 74 (45%) were benign and 90 (55%) were malignant at final histology. Combining ultrasonography and cytology identified 21 (13%) as benign, 93 (57%) as malignant or probably malignant and 50 (30%) as 'suspended' (when the combined test was not able to classify the node as benign or malignant) with a 99% sensitivity, 28% specificity, 63% PPV, 95% NPV and 67% accuracy. Combining USE and BRAF testing indicated that 59 (36%) were benign, 74 (45%) were malignant and 31 (19%) were in a 'suspended' category, with a 95% sensitivity, 74% specificity, 82% PPV, 93% NPV and 86% accuracy. CONCLUSIONS In assessing thyroid nodules suspected of malignancy, the combined analysis of USE and BRAF is equally sensitive and more specific than conventional procedures, achieving more accurate preoperative diagnoses than US and cytology combined. USE and BRAF analysis for thyroid nodule evaluation might reduce the number of unnecessary surgical procedures.
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Affiliation(s)
- Davide Nacamulli
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
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Seccia TM, Mantero F, Letizia C, Kuppusamy M, Barisa M, Miotto D, Rossi GP. Abstract 277: Mutations in the KCNJ5 Gene Imply a Higher Lateralization Index at Adrenal Vein Sampling for Primary Aldosteronism. Hypertension 2012. [DOI: 10.1161/hyp.60.suppl_1.a277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background.
The mutations that affect the selectivity filter of the KCNJ5 K+ channel can play a role in triggering and/or maintaining aldosterone oversecretion in primary aldosteronism (PA). We therefore hypothesized that these somatic mutations can be associated with an increased aldosterone secretion from the APA, thus translating in raised plasma aldosterone concentrations (PAC) in the ipsilateral adrenal vein.
Aim.
To investigate if the lateralization index (LI) at adrenal vein sampling (AVS) is higher in the patients with an APA carrying the mutation (KCNJ5mut), as compared to those without the mutation (KCNJ5wt).
Methods.
Ninety-two consecutive PA patients who underwent AVS and received diagnosis of APA based on the four corners criteria were recruited. Unequivocal information on the presence or absence of the KCNJ5 mutations was available for each patient. The selectivity index (SI) was calculated as ratio between the right or left adrenal vein PCC (PCCside) and the infrarenal IVC PCC and a cutoff of 2.00 was used. The lateralization index (LI) was calculated in the bilaterally selective AVS as the ratio of PAC/PCC at the APA side to PAC/PCC at the contralateral side. We sequenced the KCNJ5 coding region spanning aminoacids 122 to 199, which include the selectivity filer.
Results.
The overall prevalence rate of KCNJ5 somatic mutations was 34%; G151R, L168R and T158A mutations were found in 19, 10 and 1 APA respectively. The G151E mutation was not found. The KCNJ5mut and KCNJ5wt groups were similar for gender, age, sK+ levels, while PAC and ARR were higher, and PRA lower (all p<0.05) in the KCNJ5 mut group. In the latter group the LI was higher than in the KCNJ5wt group (29.3± 6.7 vs 16.7±3.9, p< 0.02). This was due to a PAC/PCC ratio which was higher in the adrenal vein ipsilateral to the APA side and lower contralaterally in the KCNJ5mut group.
Conclusions.
These results provide direct in vivo evidence for a higher aldosterone secretion from APA carrying the KCNJ5 mutations, which translates into higher values of the LI, compared to the tumors without such mutations. Hence, the presence of these KCNJ5 mutations can affect the accuracy of the AVS-based diagnosis of the subtype of PA.
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Mariniello B, Rosato A, Zuccolotto G, Rubin B, Cicala MV, Finco I, Iacobone M, Frigo AC, Fassina A, Pezzani R, Mantero F. Combination of sorafenib and everolimus impacts therapeutically on adrenocortical tumor models. Endocr Relat Cancer 2012; 19:527-39. [PMID: 22673336 DOI: 10.1530/erc-11-0337] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Treatment options are insufficient in patients with adrenocortical carcinoma (ACC). Based on the efficacy of sorafenib, a tyrosine kinase inhibitor, and everolimus, an inhibitor of the mammalian target of rapamycin in tumors of different histotype, we aimed at testing these drugs in adrenocortical cancer models. The expression of vascular endothelial growth factor and its receptors (VEGFR1-2) was studied in 18 ACCs, 33 aldosterone-producing adenomas, 12 cortisol-producing adenomas, and six normal adrenal cortex by real-time PCR and immunohistochemistry and by immunoblotting in SW13 and H295R cancer cell lines. The effects of sorafenib and everolimus, alone or in combination, were tested on primary adrenocortical cultures and SW13 and H295R cells by evaluating cell viability and apoptosis in vitro and tumor growth inhibition of tumor cell line xenografts in immunodeficient mice in vivo. VEGF and VEGFR1-2 were detected in all samples and appeared over-expressed in two-thirds of ACC specimens. Dose-dependent inhibition of cell viability was observed particularly in SW13 cells after 24 h treatment with either drug; drug combination produced markedly synergistic growth inhibition. Increasing apoptosis was observed in tumor cells treated with the drugs, particularly with sorafenib. Finally, a significant mass reduction and increased survival were observed in SW13 xenograft model undergoing treatment with the drugs in combination. Our data suggest that an autocrine VEGF loop may exist within ACC. Furthermore, a combination of molecularly targeted agents may have both antiangiogenic and direct antitumor effects and thus could represent a new therapeutic tool for the treatment of ACC.
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Affiliation(s)
- Barbara Mariniello
- Endocrinology Unit, Department of Medicine, University of Padua, Via Ospedale Civile 105, 35128 Padua, Italy
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