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Paja M, Merlo I, Rodríguez-Soto J, Cruz-Iglesias E, Moure MD, Elías C, Oleaga A, Egaña N. White blood cell count: a valuable tool for suspecting Cushing's syndrome. J Endocrinol Invest 2023; 46:141-149. [PMID: 35943722 DOI: 10.1007/s40618-022-01892-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/31/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Simple screening tests to determine whether Cushing's syndrome (CS) should be ruled out are lacking. Tools that enable early diagnosis could reduce morbidity and associated sequelae. The potential of glucocorticoid-induced changes in the white blood cell (WBC) count for raising suspicion of CS is assessed. METHODS This was a retrospective case‒control study. The WBC counts of 73 cases with CS and 146 matched controls were compared. The number of leukocytes (Leu), the number and percentage of neutrophils (N, Np), the number and percentage of lymphocytes (L, Lp), neutrophil-to-lymphocyte differences in the number and percentage (N-L, Np-Lp), neutrophil-to-lymphocyte ratio in the number and percentage (NLR, NLRp), and leukocyte-to-lymphocyte differences (Leu-L) were evaluated. The area under the ROC curve (AUC) was calculated for each of these parameters. Reference values were estimated that could help disclose occult CS. RESULTS All ten parameters showed significant differences between cases and controls. The AUC was greater than 0.7 for all ten parameters, and was the best for the NLRp and Lp (AUC: 0.89). An Lp of 23.9% showed a diagnostic accuracy of 84.9% for the diagnosis of CS. The concordance of an Lp below 24% and more than 8000 leucocytes had a PPV of 78.2% for CS, while the pairing of an Lp over 24% and a Leu below 8000 cells had an NPV of 97.3% for CS. CONCLUSION WBC count assessment can be an effective tool to raise suspicion of CS, prompting diagnostic testing. This simple and universally available test may allow earlier diagnosis of CS before highly evolved phenotypes develop.
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Affiliation(s)
- M Paja
- Basurto University Hospital, Bilbao, Spain.
- Basque Country University, Leioa, Spain.
- Endocrinology Department, Basurto University Hospital. Avda de Montevideo, 18. 48013, Bilbao, Spain.
| | - I Merlo
- Basurto University Hospital, Bilbao, Spain
| | | | | | - M D Moure
- Cruces University Hospital, Barakaldo, Spain
| | - C Elías
- Donostia University Hospital, Donostia, Spain
| | - A Oleaga
- Basurto University Hospital, Bilbao, Spain
- Basque Country University, Leioa, Spain
| | - N Egaña
- Donostia University Hospital, Donostia, Spain
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Martínez de LaPiscina I, Portillo Najera N, Rica I, Gaztambide S, Webb SM, Santos A, Moure MD, Paja Fano M, Hernandez MI, Chueca-Guindelain MJ, Hernández-Ramírez LC, Soto A, Valdés N, Castaño L. Clinical and genetic characteristics in patients under 30 years with sporadic pituitary adenomas. Eur J Endocrinol 2021; 185:485-496. [PMID: 34313605 DOI: 10.1530/eje-21-0075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/27/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pituitary adenomas (PA) are rare in young patients, and additional studies are needed to fully understand their pathogenesis in this population. We describe the clinical and genetic characteristics of apparently sporadic PA in a cohort of young patients. DESIGN Clinical and molecular analysis of 235 patients (age ≤ 30 years) with PA. Clinicians from several Spanish and Chilean hospitals provided data. METHODS Genetic screening was performed via next-generation sequencing and comparative genomic hybridization array. Clinical variables were compared among paediatric, adolescent (<19 years) and young adults' (≥19-30 years) cohorts and types of adenomas. Phenotype-genotype associations were examined. RESULTS Among the total cohort, mean age was 17.3 years. Local mass effect symptoms were present in 22.0%, and prolactinomas were the most frequent (44.7%). Disease-causing germline variants were identified in 22 individuals (9.3%), more exactly in 13.1 and 4.7% of the populations aged between 0-19 and 19-30 years, respectively; genetically positive patients were younger at diagnosis and had larger tumour size. Healthy family carriers were also identified. CONCLUSIONS Variants in genes associated with syndromic forms of PAs were detected in a large cohort of apparently sporadic pituitary tumours. We have identified novel variants in well-known genes and set the possibility of incomplete disease penetrance in carriers of MEN1 alterations or a limited clinical expression of the syndrome. Despite the low penetrance observed, screening of AIP and MEN1 variants in young patients and relatives is of clinical value.
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Affiliation(s)
- Idoia Martínez de LaPiscina
- Biocruces Bizkaia Health Research Institute, University of the Basque Country (UPV-EHU), Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), European Reference Network on Rare Endocrine Conditions (Endo-ERN), Barakaldo, Spain
| | - Nancy Portillo Najera
- Pediatric Department, Biocruces Bizkaia Health Research Institute, Alto Deba Hospital, UPV-EHU, Barakaldo, Spain
| | - Itxaso Rica
- Pediatric Endocrinology Department, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, CIBERER, CIBERDEM, Endo-ERN, Barakaldo, Spain
| | - Sonia Gaztambide
- Endocrinology Department, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, CIBERER, CIBERDEM, Endo-ERN, Barakaldo, Spain
| | - Susan M Webb
- Department of Endocrinology/Medicine, CIBERER U747, ISCIII, Research Center for Pituitary Diseases, Sant Pau Hospital, IIB-SPau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Santos
- Department of Endocrinology/Medicine, CIBERER U747, ISCIII, Research Center for Pituitary Diseases, Sant Pau Hospital, IIB-SPau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Dolores Moure
- Endocrinology Department, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Endo-ERN, Barakaldo, Spain
| | - Miguel Paja Fano
- Endocrinology Service, Basurto University Hospital, Bilbo, Spain
| | - Maria Isabel Hernandez
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, IDIMI, Casilla, Santiago, Chile
| | - Maria Jesús Chueca-Guindelain
- Pediatric Endocrinology Unit, Navarra Complex Hospital, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Laura Cristina Hernández-Ramírez
- Laboratory of Genomics, Research Support Network, National Autonomous University of Mexico, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Alfonso Soto
- Endocrinology and Nutrition Department, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Sevilla, Spain
| | - Nuria Valdés
- Endocrinology and Nutrition Department, Cabueñes University Hospital, Gijón, Spain
| | - Luis Castaño
- Pediatric Endocrinology Department, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, CIBERER, CIBERDEM, Endo-ERN, Barakaldo, Spain
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