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Vidali M, Giacchetti F, Sangiorgio A, Vantaggiato C, Rodari G, Orsenigo C, Di Modugno A, Napolitano F, Morniroli D, Colombo L, Profka E, Vizzari G, Mosca F, Ceriotti F, Mantovani G, Arosio M, Giannì ML, Giavoli C. Estimation of the reference values and decision limits for growth hormone in newborns using dried blood spots. Clin Chem Lab Med 2024; 62:939-945. [PMID: 37999718 DOI: 10.1515/cclm-2023-0972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Severe deficiency of growth hormone (GHD) of the newborn is a rare but potentially life-threatening disease. GH measured during the first week of life, using dried blood spots (DBS), may offer several advantages. Aim of the study was to estimate the reference values for GH in newborns by a new analytical method using DBS. METHODS Using a new developed analytical method, GH was estimated from DBS of 1,036 healthy newborns attending the Neonatology Unit of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan in the period July-October 2021. Reference values for GH deficiency were estimated by the Harrell-Davis bootstrap method, with 90 %CI calculated by the bias-corrected and accelerated bootstrap method. RESULTS All GH measurements required 33 analytical sessions (8 months) with a CV% for calibration curve slopes equal to 6.9 %. Intermediate precision evaluated by measurement of low (3 μg/L) and high (10 μg/L) quality controls was, respectively, 14 and 6.5 %. GH reference values, estimated at percentiles 1.0st, 2.5th and 5.0th, and their 90 %CI, were, respectively, 4.5 μg/L (90 %CI 3.8-5.1), 5.9 μg/L (90 %CI 5.4-6.4) and 7.0 μg/L (90 %CI 6.7-7.3). GH levels were not associated with sex, standard deviation scores, birth weight, gestational age, type of delivery or mother's variables (age, smoking habit, gestational diabetes). CONCLUSIONS Validation data suggest that this method can be used to measured GH in newborns using DBS. The reference values estimated in this study are in accordance with previous published works using ELISA and may help confirming the clinical suspicion of neonatal GHD.
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Affiliation(s)
- Matteo Vidali
- Clinical Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Giacchetti
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Chiara Vantaggiato
- Clinical Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Rodari
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Orsenigo
- Clinical Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Adriana Di Modugno
- Clinical Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filomena Napolitano
- Clinical Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Morniroli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Eriselda Profka
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Vizzari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ferruccio Ceriotti
- Clinical Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Arosio
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maria L Giannì
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudia Giavoli
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Rodari G, Federici S, Todisco T, Ubertini G, Cattoni A, Pagano M, Giacchetti F, Profka E, Citterio V, Messetti D, Collini V, Soranna D, Carbone E, Arosio M, Mantovani G, Persani L, Cappa M, Bonomi M, Giavoli C. Towards an individualized management of pubertal induction in girls with hypogonadism: insight into the best replacement outcomes from a large multicentre registry. Eur J Endocrinol 2023:7180093. [PMID: 37232247 DOI: 10.1093/ejendo/lvad056] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE An evidence-based pubertal induction scheme in hypogonadal girls is still to be established. Interestingly, literature data reports suboptimal uterine longitudinal diameter (ULD) in >50% of treated hypogonadal women, negatively influencing their pregnancy outcomes. This study aims to investigate auxological and uterine outcomes of pubertal induction in girls in the light of underlying diagnosis and therapeutic schemes used. DESIGN Retrospective analysis of longitudinal data from a multicentric registry. METHODS Auxological, biochemical and radiological data were collected at baseline and during follow-up in 95 hypogonadal girls (chronological age>10.9 years, Tanner stage≤2) treated with transdermal 17β-oestradiol patches for at least one year. Induction was started at a median dose of 0.14 mcg/kg/day with a six-monthly increase and was considered completed for 49/95 patients who started progesterone with concomitant oestrogen adult dose. RESULTS At the end of induction, the achievement of the complete breast maturation was associated with 17β-oestradiol dose at progesterone introduction. ULD showed a significant correlation with 17β-oestradiol dosage. Final ULD was>65 mm in only 17/45 girls. At multiple regression analysis, pelvic irradiation represented the major determinant of reduced final ULD. After correction for uterine irradiation, ULD was associated with the 17β-oestradiol dose at progesterone introduction. Final ULD was not significantly different from the one assessed after progesterone introduction. CONCLUSIONS Our results provide evidence that progestins, hampering further changes in uterine volume and breast development, should be introduced only in the presence of a concomitant adequate 17β-oestradiol dose and an appropriate clinical response.
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Affiliation(s)
- Giulia Rodari
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Silvia Federici
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy
| | - Tommaso Todisco
- Endocrinology Unit, University-Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Graziamaria Ubertini
- Endocrinology Unit, University-Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Cattoni
- Pediatric Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, Milano-Bicocca University, Italy
| | - Marta Pagano
- Pediatric Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, Milano-Bicocca University, Italy
| | - Federico Giacchetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Eriselda Profka
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Valeria Citterio
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
| | - Dario Messetti
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
| | - Valentina Collini
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Erika Carbone
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy
| | - Maura Arosio
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Giovanna Mantovani
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Luca Persani
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy
| | - Marco Cappa
- Research Unit for Innovative Therapies in Endocrinopathies, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Bonomi
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy
| | - Claudia Giavoli
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
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Rodari G, Villa R, Porro M, Gangi S, Iascone M, Elli F, Giacchetti F, Profka E, Collini V, Dall'Antonia A, Arosio M, Mantovani G, Bedeschi MF, Giavoli C. Short stature in PRMT7 Mutations: first evidence of response to growth hormone treatment. Eur J Hum Genet 2023; 31:195-201. [PMID: 36348013 PMCID: PMC9905056 DOI: 10.1038/s41431-022-01220-9] [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] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/19/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Abstract
Protein arginine methyltransferase 7 (PRMT7) pathogenetic variants have been associated with the human disorder of Short Stature, Brachydactyly, Intellectual Developmental Disability and Seizures syndrome (SBIDDS). Only 15 cases have been described in the literature. Here we report two female dizygotic twins with novel compound heterozygous deleterious variants of PRMT7 and describe the associated endocrine manifestations and short-term response to recombinant growth hormone (rGH) treatment. They were born at 36 + 3 weeks from a dichorionic diamniotic twin pregnancy. Twin A was appropriate for gestational age while Twin B was small for gestational age. Whole exome sequencing analyses showed the same novel compound heterozygous genetic defects in the PRMT7 gene (c.1220 G > A of maternal origin; c.1323 + 2 T > G of paternal origin, Fig. 1). Due to severe short stature and growth impairment, at six years of age, endocrine investigations were performed to rule out growth hormone (GH) deficiency, and revealed GH deficiency (GHD) in Twin A and an appropriate GH response in Twin B. Therefore, both started rGH, albeit at different dosages according to the underlying diagnosis. Both showed a satisfactory short-term response to treatment with height gain (∆HT) of +0.52 SDS (Twin A) and +0.88 SDS (Twin B) during the first year. In conclusion, our findings expand the knowledge about the endocrine manifestations associated with PRMT7 pathogenetic variants, including GH deficiency and rGH response. Further studies are needed to investigate long-term outcomes and establish whether PRMT7 genetic defects can be included among syndromic short stature treatable with rGH.
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Affiliation(s)
- Giulia Rodari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberta Villa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Medical Genetic Unit, Milan, Italy
| | - Matteo Porro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine & Rehabilitation Unit, Milan, Italy
| | - Silvana Gangi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit (NICU), Milan, Italy67University of Milan, Milan, Italy
| | - Maria Iascone
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Elli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Federico Giacchetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Eriselda Profka
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | | | | | - Maura Arosio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanna Mantovani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Claudia Giavoli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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Rodari G, Guez S, Salera S, Ulivieri FM, Tadini G, Brena M, Profka E, Giacchetti F, Arosio M, Giavoli C. A single-centre study on predictors and determinants of pubertal delay and growth impairment in Epidermolysis Bullosa. PLoS One 2022; 17:e0274072. [PMID: 36067143 PMCID: PMC9447886 DOI: 10.1371/journal.pone.0274072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Delayed puberty is a possible complication of Epidermolysis Bullosa (EB), though the actual incidence is still unknown. In chronic illnesses delayed puberty should be correctly managed since, if untreated, can have detrimental effects on adult height attainment, peak bone mass achievement and psychological health.
Aims and methods
This is a single-centre study on pubertal development, growth and bone status in EB. Auxological, densitometric (areal Bone Mineral Density-aBMD Z-score, Bone Mineral Apparent Density-BMAD Z-score, Trabecular Bone Score-TBS and Bone Strain Index-BSI at Lumbar spine) and body composition data (Total Body DXA scans) were collected. Disease severity was defined according to Birmingham Epidermolysis Bullosa Severity (BEBS) score.
Results
Twenty-one patients (12 Recessive Dystrophic EB-RDEB, 3 Dominant Dystrophic EB, 3 Junctional EB-JEB, 2 EB Simplex and one Kindler EB) aged 13 years (females) or 14 years (males) and above were enrolled (age 16.2±2.5 years, M/F 11/10). Short stature was highly prevalent (57%, mean height -2.12±2.05 SDS) with 55% patients with height <-2SD their mid-parental height. 7/21 patients (33%, 6 RDEB and 1 JEB) had delayed puberty with a median BEBS of 50 (range 29 to 63), a height SDS of -2.59 SDS (range -5.95 to -2.22) and a median lumbar BMAD Z-score of -4.0 SDS (range -5.42 to -0.63 SDS). Pubertal status was negatively associated with BEBS, skin involvement, inflammatory state and positively with height SDS and BMI SDS.
Conclusions
Pubertal delay is highly prevalent in EB, especially in patients with RDEB and JEB, high severity score and inflammatory state. Moreover, pubertal delay worsens growth impairment and bone health. A study on pubertal induction is ongoing to enlighten possible beneficial effects on adult height attainment and peak bone mass accrual.
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Affiliation(s)
- Giulia Rodari
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- * E-mail: ,
| | - Sophie Guez
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milano, Italy
| | - Simona Salera
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milano, Italy
| | - Fabio Massimo Ulivieri
- Centre for Diagnosis and Treatment of Osteoporosis, Casa di Cura La Madonnina, Milan, Italy
| | - Gianluca Tadini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Dermatology, Pediatric Highly Intensive Care Unit, Milano, Italy
| | - Michela Brena
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Dermatology, Pediatric Highly Intensive Care Unit, Milano, Italy
| | - Eriselda Profka
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Federico Giacchetti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Maura Arosio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Claudia Giavoli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
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Carosi G, Morelli V, Del Sindaco G, Serban AL, Cremaschi A, Frigerio S, Rodari G, Profka E, Indirli R, Mungari R, Resi V, Orsi E, Ferrante E, Dolci A, Giavoli C, Arosio M, Mantovani G. Adrenal Insufficiency at the Time of COVID-19: A Retrospective Study in Patients Referring to a Tertiary Center. J Clin Endocrinol Metab 2021; 106:e1354-e1361. [PMID: 33107576 PMCID: PMC7665569 DOI: 10.1210/clinem/dgaa793] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Coronavirus disease 2019 (COVID-19) represents a global health emergency, and infected patients with chronic diseases often present with a severe impairment. Adrenal insufficiency (AI) is supposed to be associated with an increased infection risk, which could trigger an adrenal crisis. OBJECTIVE Our primary aim was to evaluate the incidence of COVID-19 symptoms and complications in AI patients. DESIGN AND SETTING We conducted a retrospective case-control study. All patients were on active follow-up and lived in Lombardy, Italy, one of the most affected areas. PATIENTS We enrolled 279 patients with primary and secondary AI and 112 controls (patients with benign pituitary lesions without hormonal alterations). All AI patients had been previously trained to modify their replacement therapy on stress doses. INTERVENTION By administering a standardized questionnaire by phone, we collected data on COVID-19 suggestive symptoms and consequences. RESULTS In February through April 2020, the prevalence of symptomatic patients (complaining at least 1 symptom of viral infection) was similar between the 2 groups (24% in AI and 22.3% in controls, P = 0.79). Highly suggestive COVID-19 symptoms (at least 2 including fever and/or cough) also occurred equally in AI and controls (12.5% in both groups). No patient required hospitalization and no adrenal crisis was reported. Few nasopharyngeal swabs were performed (n = 12), as indicated by sanitary regulations, limiting conclusions on the exact infection rate (2 positive results in AI and none in controls, P = 0.52). CONCLUSIONS AI patients who are adequately treated and trained seem to display the same incidence of COVID-19-suggestive symptoms and disease severity as controls.
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Affiliation(s)
- Giulia Carosi
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Morelli
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Correspondence and Reprint Requests: Valentina Morelli, Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy. E-mail:
| | - Giulia Del Sindaco
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Andreea Liliana Serban
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Arianna Cremaschi
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Sofia Frigerio
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Giulia Rodari
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Eriselda Profka
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Rita Indirli
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Roberta Mungari
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Resi
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Orsi
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Dolci
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Giavoli
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Maura Arosio
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Italy
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Profka E, Rodari G, Giacchetti F, Giavoli C. GH Deficiency and Replacement Therapy in Hypopituitarism: Insight Into the Relationships With Other Hypothalamic-Pituitary Axes. Front Endocrinol (Lausanne) 2021; 12:678778. [PMID: 34737721 PMCID: PMC8560895 DOI: 10.3389/fendo.2021.678778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022] Open
Abstract
GH deficiency (GHD) in adult patients is a complex condition, mainly due to organic lesion of hypothalamic-pituitary region and often associated with multiple pituitary hormone deficiencies (MPHD). The relationships between the GH/IGF-I system and other hypothalamic-pituitary axes are complicated and not yet fully clarified. Many reports have shown a bidirectional interplay both at a central and at a peripheral level. Signs and symptoms of other pituitary deficiencies often overlap and confuse with those due to GH deficiency. Furthermore, a condition of untreated GHD may mask concomitant pituitary deficiencies, mainly central hypothyroidism and hypoadrenalism. In this setting, the diagnosis could be delayed and possible only after recombinant human Growth Hormone (rhGH) replacement. Since inappropriate replacement of other pituitary hormones may exacerbate many manifestations of GHD, a correct diagnosis is crucial. This paper will focus on the main studies aimed to clarify the effects of GHD and rhGH replacement on other pituitary axes. Elucidating the possible contexts in which GHD may develop and examining the proposed mechanisms at the basis of interactions between the GH/IGF-I system and other axes, we will focus on the importance of a correct diagnosis to avoid possible pitfalls.
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Affiliation(s)
- Eriselda Profka
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Rodari
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- *Correspondence: Giulia Rodari, ,
| | - Federico Giacchetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudia Giavoli
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Giavoli C, Profka E, Giancola N, Rodari G, Giacchetti F, Ferrante E, Arosio M, Mantovani G. Growth hormone therapy at the time of Covid-19 pandemic: adherence and drug supply issues. Eur J Endocrinol 2020; 183:L13-L15. [PMID: 32688337 PMCID: PMC9494317 DOI: 10.1530/eje-20-0481] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Claudia Giavoli
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Correspondence should be addressed to C Giavoli;
| | - Eriselda Profka
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Noemi Giancola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Rodari
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federico Giacchetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Arosio
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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8
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Profka E, Rodari G, Giacchetti F, Berrettini A, Manzoni G, Daccò V, Arosio M, Giavoli C, Colombo C. A case of testicular atrophy associated with cystic fibrosis. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200095. [PMID: 33434179 PMCID: PMC7576656 DOI: 10.1530/edm-20-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 07/30/2020] [Accepted: 08/25/2020] [Indexed: 11/08/2022] Open
Abstract
SUMMARY An 8-year-old boy with cystic fibrosis came to our attention for an empty scrotum. General physical examination showed a normal penis and hypoplastic scrotum with non-palpable testes bilaterally. Routine blood investigations showed low levels of LH, testosterone, inhibin B and antiMullerian hormone and elevated levels of FSH. Karyotype was normal. An abdominal ultrasound confirmed the absence of the testes into the scrotum, in the inguinal region and abdomen. At laparoscopy were noted bilaterally hypotrophic spermatic vessels, absence of the vas deferens and a closed inner ring. Inguinal exploration found out a small residual testis and histological examination showed fibrotic tissue. This is the first case of testicular atrophy associated to CFTR mutation described. The process that led to bilateral testicular and vas deferens atrophy remains unexplained, a possible influence of CFTR dysfunction cannot be ruled out, although it is possible that these conditions are independently associated. LEARNING POINTS Cystic fibrosis produces a multisystemic disease which can affect also the reproductive tract. Nearly 97-98% of male patients are infertile because of congenital bilateral absence of vas deferens. A correlation between cystic fibrosis and bilateral testicular atrophy could be possible.
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Affiliation(s)
- Eriselda Profka
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Rodari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Giacchetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Berrettini
- Pediatric Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianantonio Manzoni
- Pediatric Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Daccò
- Cystic Fibrosis Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Giavoli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carla Colombo
- Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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9
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Serban AL, Del Sindaco G, Sala E, Carosi G, Indirli R, Rodari G, Giavoli C, Locatelli M, Carrabba G, Bertani G, Marfia G, Mantovani G, Arosio M, Ferrante E. Determinants of outcome of transsphenoidal surgery for Cushing disease in a single-centre series. J Endocrinol Invest 2020; 43:631-639. [PMID: 31773581 DOI: 10.1007/s40618-019-01151-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND First-line therapy of Cushing disease (CD) is transsphenoidal surgery (TSS) aimed to obtain a complete removal of the pituitary adenoma and remission of disease. PURPOSE To analyse the surgical outcome of patients with CD who underwent TSS in our Centre. METHODS Retrospective analysis on patients with CD who underwent TSS between 1990 and 2016. RESULTS We analysed 102 TSS that included: 84 first TSS and 18 second and third TSS. The overall remission rate after surgery was 76.5%, with a significant higher percentage of remitted patients after the first TSS compared to the subsequent TSS (82% vs 50%, p = 0.014). The remission after the first TSS was significantly higher when performed by a dedicated surgical team (DST) (89.8% vs 71% p = 0.04) and when the immunohistochemical examination confirmed the adrenocorticotropic adenoma (87% vs 55%, p = 0.04). Neuroradiological findings influenced the surgical outcome in a non-significant manner. Post-TSS complications were reported in 32 patients, with no significant variation when TSS was performed by DST. In case of reintervention, remission of disease was obtained in 72.7% of microadenoma, while no remitted patients were observed in case of macroadenomas. The DST did not significantly improve the outcome. CONCLUSION Cushing disease is characterized by a broad spectrum of neuroradiological presentation. Despite the availability of a DST make the TSS a safe and effective first-line treatment among all these patients, a precise pre-treatment evaluation is needed in order to define the aim of neurosurgery and to schedule the management of recurrent disease.
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Affiliation(s)
- A L Serban
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Del Sindaco
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Sala
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy
| | - G Carosi
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - R Indirli
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Rodari
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Giavoli
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Locatelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurosurgery Division, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - G Carrabba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurosurgery Division, Milan, Italy
| | - G Bertani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurosurgery Division, Milan, Italy
| | - G Marfia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurosurgery Division, Milan, Italy
| | - G Mantovani
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - M Arosio
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Ferrante
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology Unit, Via Francesco Sforza, 35, Milan, 20143, Italy
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10
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Rodari G, Cattoni A, Albanese A. Final height in growth hormone-deficient childhood cancer survivors after growth hormone therapy. J Endocrinol Invest 2020; 43:209-217. [PMID: 31452114 DOI: 10.1007/s40618-019-01102-w] [Citation(s) in RCA: 4] [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: 06/12/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Growth hormone deficiency (GHD) is the most prevalent hypothalamic-pituitary (HP) disorder found in childhood cancer survivors (CCS). The published studies assessing GHD in CCS concluded that recombinant human GH (rhGH) does not restore final height (FH) to that predicted from mid-parental height (MPH). Thus, wider analyses on final height outcomes after rhGH in CCS are needed. METHODS Retrospective study on final height (FH) in 87 CCS treated with rhGH. Patients were divided into: Group A (n =48) who underwent cranial radiotherapy or had non-irradiated tumours of HP area, and B (n =39) who were treated with craniospinal or total body irradiation (TBI). 19/87 patients with central precocious/early puberty also received GnRH analogues. RESULTS Height (HT) gain after 1 and 2 years of rhGH was 0.38 ± 0.35 SDS and 0.18 ± 0.30 SDS, respectively (P < 0.0001); mean FH was in the normal range (- 0.85 ± 1.34 SDS), though not significantly different from HT SDS at baseline. 67% overall failed to reach MPH especially in Group B (P < 0.0001). However, height loss (HT SDS-MPH SDS) at FH improved or remained stable compared to baseline in 26/45 patients (58%). On stepwise regression analysis, major determinants of FH were HT at baseline (P < 0.0001) and delay before start of rhGH (P = 0.012). There was no significant difference in FH when GnRHa was added to rhGH. CONCLUSION rhGH and GnRH analogues therapy, when indicated, though failing to induce catch-up growth, prevented further height loss leading to a FH within the normal range but still below MPH, this latter being statistically significant in children who received craniospinal and TBI.
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Affiliation(s)
- G Rodari
- Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK.
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 28, 20122, Milan, Italy.
| | - A Cattoni
- Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
- Paediatric Department, Azienda Ospedaliera San Gerardo, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | - A Albanese
- Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
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11
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Giavoli C, Iurlaro E, Morelli V, Rodari G, Ronchi A, Pietrasanta C, Pugni L, Tubiolo D, Properzi P, Pesenti A, Mantovani G, Ferrazzi E, Arosio M. Case Report: Late-Onset Congenital Adrenal Hyperplasia and Acute Covid-19 Infection in a Pregnant Woman: Multidisciplinary Management. Front Endocrinol (Lausanne) 2020; 11:602535. [PMID: 33519712 PMCID: PMC7845779 DOI: 10.3389/fendo.2020.602535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The impact of the Covid-19 infection on patients with chronic endocrine disease is not fully known. We describe here the first case of a pregnant woman with Covid-19 acute infection and non-classical congenital adrenal hyperplasia (NCAH). CASE DESCRIPTION A woman at 36 weeks of gestation was referred to our Maternity Hospital for premature rupture of membranes (PROM). Her medical history was positive for NCAH on chronic steroid replacement till the age of 17 years (cortisone acetate and dexamethasone, both in the morning). At admission, her naso-oro-pharyngeal swab resulted positive for SARS-CoV-2. Due to hyperpyrexia and late preterm PROM, cesarean section was planned, and she was started on a 100 mg-bolus of hydrocortisone, followed by continuous infusion of 200 mg/24 h. A female neonate in good clinical condition and with a negative nasopharyngeal Covid-19 swab was delivered. On second postpartum day, the mother was in good condition and was switched to oral steroid therapy. On third postpartum day she worsened, with radiological signs of acute pulmonary embolism. Oro-tracheal intubation and mechanical ventilation were started, and she was switched back to intravenous steroid therapy. On April 30, pulmonary embolism was resolved, and on May 13th she was discharged in good condition. CONCLUSIONS We report the first case of Covid-19 acute infection that occurred in late-pregnancy in a woman with NCAH on chronic steroid replacement. The management of the patient in a reference center with early involvement of a multidisciplinary team granted prompt care and adequate protection for all the involved sanitary operators.
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Affiliation(s)
- Claudia Giavoli
- Endocrinology Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- *Correspondence: Claudia Giavoli,
| | - Enrico Iurlaro
- Unit of Obstetrics and Gynecology, Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Morelli
- Endocrinology Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Rodari
- Endocrinology Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Ronchi
- Neonatology and Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Pietrasanta
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Neonatology and Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenza Pugni
- Neonatology and Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Tubiolo
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Properzi
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Enrico Ferrazzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Unit of Obstetrics and Gynecology, Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Arosio
- Endocrinology Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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12
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Salera S, Tadini G, Rossetti D, Grassi FS, Marchisio P, Agostoni C, Giavoli C, Rodari G, Guez S. A nutrition-based approach to epidermolysis bullosa: Causes, assessments, requirements and management. Clin Nutr 2019; 39:343-352. [PMID: 30857908 DOI: 10.1016/j.clnu.2019.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/23/2019] [Accepted: 02/15/2019] [Indexed: 12/15/2022]
Abstract
Inherited epidermolysis bullosa (EB) is a clinically and genetically heterogeneous group of rare diseases characterized by skin and mucous membrane fragility. EB primarily involves the skin and, in specific subtypes, the mucous membrane, resulting in complications which can strongly affect nutritional status (e.g. gastrointestinal complications, hand deformities, pain). The aims of nutritional support mainly include improving nutritional status, alleviating the stress of oral feeding and minimizing nutritional deficiencies, thus consequently improving growth, pubertal development, bowel function, immune status and wound healing. The aim of this review is to discuss knowledge of different aspects of the disease related to nutrition and growth.
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Affiliation(s)
- Simona Salera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy.
| | - Gianluca Tadini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy
| | - Donata Rossetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milano, Italy
| | - Francesca Sofia Grassi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milano, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milano, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Media Intensità di Cura, 20122, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122, Milano, Italy
| | - Claudia Giavoli
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinologia, 20122, Milano, Italy
| | - Giulia Rodari
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinologia, 20122, Milano, Italy
| | - Sophie Guez
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy
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13
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Filopanti M, Verga U, Ulivieri FM, Giavoli C, Rodari G, Arosio M, Natacci F, Spada A. Trabecular Bone Score (TBS) and Bone Metabolism in Patients Affected with Type 1 Neurofibromatosis (NF1). Calcif Tissue Int 2019; 104:207-213. [PMID: 30421324 DOI: 10.1007/s00223-018-0488-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022]
Abstract
In patients with neurofibromatosis type 1 (NF1), decreased bone mineral density (BMD) and low levels of 25-hydroxy vitamin D3 (25OHD) have been reported. Recently, the trabecular bone score (TBS) measurement has been proposed as index of bone microarchitecture and fracture risk. In 74 NF1 patients (48 females, 26 males, age 41 ± 12), we measured TBS and investigated clinical stage, lifestyle, vitamin D, serum bone turnover markers, vertebral and femoral BMD. A homogenous cohort of 61 healthy subjects was used as control group. TBS was lower in NF1 patients (1.266 ± 0.113 vs. 1.346 ± 0.105) without differences between sexes. No correlations with 25OHD, low exercise, low calcium intake, reduced sun exposure, and number of skin neurofibromas were observed. As expected, hypovitaminosis D was common (98.6%), as well as BMD reduction in hip and spine sites: In NF1 patients, bone texture evaluated by TBS was low in both sexes without any correlation with clinical or metabolic parameters, suggesting a direct role of the fibromin mutation.
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Affiliation(s)
- Marcello Filopanti
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Uberta Verga
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- U.O. Endocrinologia Ospedale Policlinico IRCCS, Via F.Sforza 35, 20121, Milan, Italy.
| | - Fabio Massimo Ulivieri
- Bone Metabolic Unit, Division of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Giavoli
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Rodari
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Arosio
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Natacci
- Medical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Spada
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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14
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Messina C, Lastella G, Sorce S, Piodi LP, Rodari G, Giavoli C, Marchelli D, Guglielmi G, Ulivieri FM. Pediatric dual-energy X-ray absorptiometry in clinical practice: What the clinicians need to know. Eur J Radiol 2018; 105:153-161. [PMID: 30017273 DOI: 10.1016/j.ejrad.2018.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/12/2017] [Revised: 05/23/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
The importance of childhood and adolescence for bone development and mineral accrual is increasingly accepted, leading to a need of suitable methods for monitoring bone health even in pediatric setting. Among the several different imaging methods available for clinical measurement of bone mineral density (BMD) in children, dual-energy X-ray absorptiometry (DXA) is the most widely available and commonly used due to its reproducibility, negligible radiation dose and reliable pediatric reference data. Nevertheless, DXA in children has some technical specific features that should be known by those physicians who interpret and report this examination. We provide recommendations for optimal DXA scan reporting in pediatric setting, including indications, skeletal sites to be examined, parameters to be measured, timing of follow-up BMD measurements. Adequate report and analysis of DXA examinations are essential to prevent over- and underdiagnosis of bone mineral impairment in pediatric patients. In conclusion, a complete and exhaustive DXA report in children and adolescents is mandatory for an accurate diagnosis and a precise monitoring of pediatric bone status.
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Affiliation(s)
- Carmelo Messina
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20166, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20135, Milan, Italy.
| | - Giulia Lastella
- Postgraduate School of Radiodiagnostic, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Salvatore Sorce
- Postgraduate School of Physical Medicine and Rehabilitation, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Luca Petruccio Piodi
- Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology Unit, Via F.Sforza 35, 20122, Milan, Italy(1)
| | - Giulia Rodari
- Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Via F. Sforza 35, 20122, Milan, Italy
| | - Claudia Giavoli
- Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Via F. Sforza 35, 20122, Milan, Italy.
| | - Daniele Marchelli
- Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Nuclear Medicine Unit, Via F.Sforza 35, 20122, Milan, Italy.
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale L. Pinto 1, 71100, Foggia, Italy.
| | - Fabio Massimo Ulivieri
- Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Nuclear Medicine Unit, Bone Metabolic Unit, Via F.Sforza 35, 20122, Milan, Italy.
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15
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Abstract
Central hypothyroidism is a rare and heterogeneous disorder that is characterized by a defect in thyroid hormone secretion in an otherwise normal thyroid gland due to insufficient stimulation by TSH. The disease results from the abnormal function of the pituitary gland, the hypothalamus, or both. Moreover, central hypothyroidism can be isolated or combined with other pituitary hormone deficiencies, which are mostly acquired and are rarely congenital. The clinical manifestations of central hypothyroidism are usually milder than those observed in primary hypothyroidism. Obtaining a positive diagnosis for central hypothyroidism can be difficult from both a clinical and a biochemical perspective. The diagnosis of central hypothyroidism is based on low circulating levels of free T4 in the presence of low to normal TSH concentrations. The correct diagnosis of both acquired (also termed sporadic) and congenital (also termed genetic) central hypothyroidism can be hindered by methodological interference in free T4 or TSH measurements; routine utilization of total T4 or T3 measurements; concurrent systemic illness that is characterized by low levels of free T4 and normal TSH concentrations; the use of the sole TSH-reflex strategy, which is the measurement of the sole level of TSH, without free T4, if levels of TSH are in the normal range; and the diagnosis of congenital hypothyroidism based on TSH analysis without the concomitant measurement of serum levels of T4. In this Review, we discuss current knowledge of the causes of central hypothyroidism, emphasizing possible pitfalls in the diagnosis and treatment of this disorder.
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Affiliation(s)
| | - Giulia Rodari
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza 35, Milan 20122, Italy
| | - Claudia Giavoli
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza 35, Milan 20122, Italy
| | - Andrea Lania
- Department of Biomedical Sciences, Humanitas University and Endocrinology Unit, Humanitas Research Hospital, Via Manzoni 56, Rozzano 20086, Italy
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16
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Rodari G, Guez S, Manzoni F, Chalouhi KK, Profka E, Bergamaschi S, Salera S, Tadini G, Ulivieri FM, Spada A, Giavoli C, Esposito S. Birmingham epidermolysis severity score and vitamin D status are associated with low BMD in children with epidermolysis bullosa. Osteoporos Int 2017; 28:1385-1392. [PMID: 28012019 DOI: 10.1007/s00198-016-3883-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/02/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED Bone status impairment represents a complication of generalized forms of epidermolysis bullosa (EB); however, the prevalence and the main determinants of this event in localized forms remain poorly defined. Birmingham epidermolysis bullosa severity (BEBS) score and 25-hydroxyvitamin D levels are strongly associated with low bone mass, suggesting that vitamin D may play a potential beneficial role in bone health. Further longitudinal studies are needed in order to confirm this hypothesis. INTRODUCTION Bone status impairment represents a complication of generalized forms of EB; thus, we aimed to estimate the prevalence of low bone mass, to examine mineralization differences in various EB subtypes and to identify the most important determinants of bone impairment in children with either generalized or localized EB. METHODS An observational study of 20 children (11 males; mean age ± standard deviation, 11.7 ± 3.9 years) with EB was performed. Clinical history, physical examination, laboratory studies, X-ray of the left hand and wrist for bone age, and dual energy X-ray absorptiometry scans of the lumbar spine were obtained. Areal bone mineral density (aBMD Z-scores) and bone mineral apparent density were related to the BEBS score. RESULTS Areal BMD Z-score (mean -1.82 ± 2.33, range, -7.6-1.7) was reduced (<-2 SD) in 8 patients (40%), whereas aBMD Z-score adjusted for bone age was low in 7 patients (35%). BEBS score and 25-hydroxyvitamin D serum levels were the most important elements associated with aBMD (P = 0.0001 and P = 0.016, respectively). A significant correlation between the aBMD Z-score and area of skin damage, insulin-like growth factor-1, C-reactive protein, and sodium serum levels was also found. CONCLUSIONS Low aBMD can be considered a systemic complication of EB, primarily associated with BEBS score and 25-hydroxyvitamin D levels. Therefore, longitudinal evaluation of bone status is ongoing in these patients to define whether vitamin D supplementation would prevent, or at least reduce, bone status impairment.
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Affiliation(s)
- G Rodari
- Endocrinology and Metabolic Diseases Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Guez
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Manzoni
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - K K Chalouhi
- Department of Radiology, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, Italy
| | - E Profka
- Endocrinology and Metabolic Diseases Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Bergamaschi
- Endocrinology and Metabolic Diseases Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Salera
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Tadini
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F M Ulivieri
- Bone Metabolic Unit, Division of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Spada
- Endocrinology and Metabolic Diseases Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Giavoli
- Endocrinology and Metabolic Diseases Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - S Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
The relationships between GH system and hypothalamic-pituitary-thyroid axis are complex and not yet fully understood. The reported effects of GH administration on thyroid status of GHD patients have been remarkably divergent. This review will focus on the main studies aimed to clarify the effects of GH on thyroid function, firstly going through the diagnosis of central hypothyroidism and its possible pitfalls, then elucidating the possible contexts in which GHD may develop and examining the proposed mechanisms at the basis of interactions between the GH-IGF-I system and the hypothalamic-pituitary-thyroid axis.
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Affiliation(s)
- Claudia Giavoli
- Endocrinology and Diabetology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Eriselda Profka
- Endocrinology and Diabetology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Rodari
- Endocrinology and Diabetology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Lania
- Endocrine Unit, IRCCS Humanitas Research Hospital, Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
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Sala E, Bellaviti Buttoni P, Malchiodi E, Verrua E, Carosi G, Profka E, Rodari G, Filopanti M, Ferrante E, Spada A, Mantovani G. Recurrence of hyperprolactinemia following dopamine agonist withdrawal and possible predictive factors of recurrence in prolactinomas. J Endocrinol Invest 2016; 39:1377-1382. [PMID: 27245604 DOI: 10.1007/s40618-016-0483-z] [Citation(s) in RCA: 24] [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: 01/13/2016] [Accepted: 05/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal duration of cabergoline (CAB) treatment of prolactinomas that minimizes recurrences is not well established. 2011 Endocrine Society Guidelines suggested that withdrawal may be safely undertaken after 2 years in patients achieving normoprolactinemia and tumor reduction. MATERIALS We analyzed 74 patients (mean age = 46.9 ± 14.4, M/F = 19/55, macro/micro = 18/56) bearing a prolactinoma divided in 3 groups: group A (23) treated for 3 years, group B (23) for a period between 3 and 5 years, and group C (28) for a period >5 years. CAB therapy was interrupted according to Endocrine Society Guidelines. Prolactin (PRL) levels were measured 3, 6, 12 and 24 months after withdrawal. Recurrence was defined with PRL levels ≥30 ng/ml. RESULTS Groups did not differ in pretreatment PRL levels (123.2 ± 112.1, 120.9 ± 123.8, 176.6 ± 154.0), pituitary deficit (4, 17, 17 %), mean CAB weekly dose (0.7 ± 0.4, 0.6 ± 0.3, 0.7 ± 0.4) and PRL levels before withdrawal (17.1 ± 19.6, 11.4 ± 8.8, 13.8 ± 13.5). Recurrence occurred within 12 months in 34 patients (45.9 %), without significant differences among groups. Neuroradiological evaluation showed a significantly higher presence of macroadenoma in group C (13, 17 and 39 %, respectively). Recurrence rate of hyperprolactinemia did not depend on sex, tumor size or CAB dose but it was significantly correlated with PRL levels at diagnosis and before withdrawal (p = 0.03). Finally, patients with pituitary deficit at diagnosis showed a significantly higher recurrence rate (p = 0.03). CONCLUSIONS The study provides additional evidence that prolonging therapy for more than 3 years does not reduce recurrence rate. In particular, recurrence risk was similar in micro- and macroadenomas, and higher in patients with pituitary deficits at diagnosis.
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Affiliation(s)
- E Sala
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy.
| | - P Bellaviti Buttoni
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
| | - E Malchiodi
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
| | - E Verrua
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
| | - G Carosi
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
| | - E Profka
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
| | - G Rodari
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
| | - M Filopanti
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
| | - E Ferrante
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
- Unit of Endocrinology, San Carlo Borromeo Hospital, Milan, Italy
| | - A Spada
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
| | - G Mantovani
- Unit of Endocrinology and Diabetology - Pad. Granelli, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35, 20122, Milan, Italy
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Profka E, Giavoli C, Bergamaschi S, Ferrante E, Malchiodi E, Sala E, Verrua E, Rodari G, Filopanti M, Beck-Peccoz P, Spada A. Analysis of short- and long-term metabolic effects of growth hormone replacement therapy in adult patients with craniopharyngioma and non-functioning pituitary adenoma. J Endocrinol Invest 2015; 38:413-20. [PMID: 25330765 DOI: 10.1007/s40618-014-0196-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/10/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Adult patients operated for craniopharyngioma develop more frequently GH deficiency (GHD) than patients operated for non-functioning pituitary adenoma (NFPA). The aim of the study was to compare both short- (1 year) and long-term (5 years) effects of rhGH in 38 GHD adult patients (19 operated for Craniopharyngioma (CP) and 19 for NFPA). METHODS IGF-I levels, body composition (BF%), BMI, lipid profile and glucose homeostasis were evaluated in all patients. Pituitary MRI was performed at baseline and during follow-up, as needed. RESULTS At baseline no difference between the two groups was observed, apart from a higher prevalence of diabetes insipidus in CP patients (79 vs 21%). After 12 months, IGF-I SDS normalized and BF% significantly decreased only in the NFPA group. During long-term treatment, decrease in BF% and improvement in lipid profile shown by reduction in total- and LDL-cholesterol were present in NFPA group only, while increase in insulin levels and HbA1c and decrease of QUICKI were observed in CP patients only. Accordingly, after long-term therapy, the prevalence of metabolic syndrome (MS) was significantly higher in CP than in NFPA group (37% in CP and in 5% in NFPA group; p < 0.05). CONCLUSION The present data suggest that CP patients are less sensitive to the positive rhGH effects on lipid profile and BF% and more prone to insulin sensitivity worsening than NFPA patients, resulting in increased prevalence of MS in CP only.
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Affiliation(s)
- E Profka
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy.
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.
| | - C Giavoli
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - S Bergamaschi
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Ferrante
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Malchiodi
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Sala
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Verrua
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Rodari
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - M Filopanti
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Beck-Peccoz
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - A Spada
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Endocrinology and Metabolic Diseases Unit, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
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20
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Giavoli C, Tagliabue C, Profka E, Senatore L, Bergamaschi S, Rodari G, Spada A, Beck-Peccoz P, Esposito S. Evaluation of pituitary function after infectious meningitis in childhood. BMC Endocr Disord 2014; 14:80. [PMID: 25287789 PMCID: PMC4196011 DOI: 10.1186/1472-6823-14-80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of studies of adults have shown that pituitary deficiencies can develop in a considerable proportion of subjects during the acute phase of meningitis or years after the infection has disappeared. The results of the very few studies of the impact of pediatric meningitis on hypothalamic-pituitary function are conflicting. METHODS In order to determine the incidence of pituitary dysfunction in children with central nervous system infection, we evaluated pituitary function and anthropometric parameters in 19 children with meningitis of different etiologies (15 males; mean age ± standard deviation [SD] at pituitary evaluation, 5.9 ± 4.0 years; mean time from the acute event ± SD, 18 ± 10 months). RESULTS All of the subjects had a normal stature and growth velocity for their age and gender, and none of them was obese. On the basis of Tanner's reference charts, 17 subjects (13 boys and all four girls) were pre-pubertal; two boys were in Tanner stage 2. None of the subjects had central hypothyroidism. All of the patients had normal serum of insulin growth factor (IGF)-I and prolactin. Their sex steroid and gonadotropin levels were concordant with their age and pubertal status. Early morning urine osmolality and serum electrolyte levels showed no signs of diabetes insipidus. All of the patients had normal plasma adrenocorticotropic hormone (ACTH) levels. Peak cortisol responses to the standard dose Synacthen test (SDST) were normal in all cases. CONCLUSIONS The results showed that hypopituitarism following infectious meningitis appears to be infrequent in childhood and children's pituitary glands seem to be less vulnerable to damage than those of adults.
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Affiliation(s)
- Claudia Giavoli
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Tagliabue
- />Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | - Eriselda Profka
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Senatore
- />Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | - Silvia Bergamaschi
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Rodari
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Spada
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Beck-Peccoz
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Esposito
- />Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
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