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Cherenko M, Appelman-Dijkstra NM, Priego Zurita AL, Biermasz NR, Dekkers OM, Klok FA, Reisch N, Aulinas A, Biagetti B, Cannavo S, Canu L, Detomas M, Devuyst F, Falhammar H, Feelders RA, Ferrau F, Gatto F, Grasselli C, van Houten P, Hoybye C, Isidori AM, Kyrilli A, Loli P, Maiter D, Nowak E, Pivonello R, Ragnarsson O, Steenaard RV, Unger N, van de Ven A, Webb SM, Yeste D, Ahmed SF, Pereira AM. Venous thromboembolism in Cushing syndrome: results from an EuRRECa and Endo-ERN survey. Endocr Connect 2024; 13:e240046. [PMID: 38614126 PMCID: PMC11103746 DOI: 10.1530/ec-24-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/11/2024] [Indexed: 04/15/2024]
Abstract
Background Patients with Cushing syndrome (CS) are at increased risk of venous thromboembolism (VTE). Objective The aim was to evaluate the current management of new cases of CS with a focus on VTE and thromboprophylaxis. Design and methods A survey was conducted within those that report in the electronic reporting tool (e-REC) of the European Registries for Rare Endocrine Conditions (EuRRECa) and the involved main thematic groups (MTG's) of the European Reference Networks for Rare Endocrine Disorders (Endo-ERN) on new patients with CS from January 2021 to July 2022. Results Of 222 patients (mean age 44 years, 165 females), 141 patients had Cushing disease (64%), 69 adrenal CS (31%), and 12 patients with ectopic CS (5.4%). The mean follow-up period post-CS diagnosis was 15 months (range 3-30). Cortisol-lowering medications were initiated in 38% of patients. One hundred fifty-four patients (69%) received thromboprophylaxis (including patients on chronic anticoagulant treatment), of which low-molecular-weight heparins were used in 96% of cases. VTE was reported in six patients (2.7%), of which one was fatal: two long before CS diagnosis, two between diagnosis and surgery, and two postoperatively. Three patients were using thromboprophylaxis at time of the VTE diagnosis. The incidence rate of VTE in patients after Cushing syndrome diagnosis in our study cohort was 14.6 (95% CI 5.5; 38.6) per 1000 person-years. Conclusion Thirty percent of patients with CS did not receive preoperative thromboprophylaxis during their active disease stage, and half of the VTE cases even occurred during this stage despite thromboprophylaxis. Prospective trials to establish the optimal thromboprophylaxis strategy in CS patients are highly needed. Significance statement The incidence rate of venous thromboembolism in our study cohort was 14.6 (95% CI 5.5; 38.6) per 1000 person-years. Notably, this survey showed that there is great heterogeneity regarding time of initiation and duration of thromboprophylaxis in expert centers throughout Europe.
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Affiliation(s)
- M Cherenko
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, Netherlands
| | - N M Appelman-Dijkstra
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, Netherlands
| | - A L Priego Zurita
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, Netherlands
| | - N R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, Netherlands
| | - O M Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, Netherlands
| | - F A Klok
- Department of Medicine, Division of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, Netherlands
| | - N Reisch
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - A Aulinas
- Department of Endocrinology, Fundacio de Gestio Sanitaria Hospital de la Santa Creu i Sant Pau, IR-SantPau and CIBERER Unit 747 (ISCIII), Barcelona, Spain
| | - B Biagetti
- Department of Endocrinology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - S Cannavo
- Endocrine Unit, University Hospital AOU Policlinico G. Martino, Messina, Italy
| | - L Canu
- University Hospital Florence Careggi, Florence, Italy
| | - M Detomas
- Department of Internal Medicine, University Hospital Würzburg, Wuerzburg, Germany
| | - F Devuyst
- Department of Endocrinology, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - H Falhammar
- Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - R A Feelders
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, Rotterdam, Netherlands
| | - F Ferrau
- Endocrine Unit, University Hospital AOU Policlinico G. Martino, Messina, Italy
| | - F Gatto
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - C Grasselli
- Cardiovascular Medicine Unit, AUSL-IRCCS, Reggio Emilia, Italy
| | - P van Houten
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - C Hoybye
- Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Kyrilli
- Department of Endocrinology, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - P Loli
- Division of Endocrinology, San Raffaele Vita-Salute University, IRCCS San Raffaele Hospital Milan, Italy
| | - D Maiter
- Department of Endocrinology, Cliniques universitaires Saint-Luc – UCLouvain, Brussels, Belgium
| | - E Nowak
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università “Federico II” di Napoli, Naples, Italy
| | - O Ragnarsson
- Sahlgrenska Academy, Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine (O.R.), University of Gothenburg, Sweden
| | - R V Steenaard
- Department of Internal Medicine, Máxima MC, Veldhoven, Netherlands
| | - N Unger
- University Hospital Essen, Department of Endocrinology, Diabetes and Metabolism, Essen, Germany
| | - A van de Ven
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - S M Webb
- Department of Endocrinology, Fundacio de Gestio Sanitaria Hospital de la Santa Creu i Sant Pau, IR-SantPau and CIBERER Unit 747 (ISCIII), Barcelona, Spain
| | - D Yeste
- Pediatric Endocrinology Service, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. CIBER Enfermedades Raras, Instituto Carlos III, Madrid, Spain
| | - S F Ahmed
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, Netherlands
- University of Glasgow, Office for Rare Conditions, Glasgow, UK
- University of Glasgow, Developmental Endocrinology Research Group, Royal Hospital for Children, Glasgow, UK
| | - A M Pereira
- Department of Endocrinology & Metabolism, Amsterdam University Medical Centre, Amsterdam, Noord-Holland, Netherlands
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2
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Schock L, Chmielewski WX, Siegel S, Detomas M, Deutschbein T, Giese S, Honegger J, Unger N, Kreitschmann-Andermahr I. The effect of coping strategies on health-related quality of life in acromegaly patients. Endocrine 2024:10.1007/s12020-024-03813-4. [PMID: 38613640 DOI: 10.1007/s12020-024-03813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/29/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Patients with acromegaly oftentimes exhibit a reduced physical and psychological health-related quality of life (HRQoL). Maladaptive coping styles are associated with poor HRQoL in a number of diseases and patients with pituitary adenomas in general exhibit less effective coping styles than healthy controls. This study aimed to assess coping strategies in acromegaly patients in order to explore leverage points for the improvement of HRQoL. METHODS In this cross-sectional study, we administered self-report surveys for coping strategies and HRQoL (Short Form SF-36, Freiburg questionnaire on coping with illness, FKV-LIS) in patients with acromegaly. These were set into relation with a variety of health variables. RESULTS About half of the 106 patients (44.3% female) with a mean age of 56.4 ± 1.3 years showed impaired physical and psychological HRQoL on average 11.2 years after the initial diagnosis. Body mass index, age at survey date and concomitant radiotherapy explained 27.8% of the variance of physical HRQoL, while depressive coping added an additional 9.2%. Depressive coping style and trivialization and wishful thinking were pivotal predictors of an impaired psychological HRQoL with a total explained variance of 51.6%, whereas patient health variables did not affect psychological HRQoL. CONCLUSION Our results show that maladaptive coping styles have a substantial negative impact on psychological HRQoL in patients with acromegaly, whereas physical HRQoL is influenced to a lesser extent. Specialized training programs aimed at improving coping strategies could reduce long-term disease burden and increase HRQoL in the affected patients.
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Affiliation(s)
- Lisa Schock
- Department of Neurosurgery and Spine Surgery, Member of ENDO-ERN, University Hospital Essen, Essen, Germany.
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany.
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany.
| | - Witold X Chmielewski
- Department of Neurosurgery and Spine Surgery, Member of ENDO-ERN, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Sonja Siegel
- Department of Neurosurgery and Spine Surgery, Member of ENDO-ERN, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Mario Detomas
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
- Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Sabrina Giese
- Department of Neurosurgery, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Jürgen Honegger
- Department of Neurosurgery, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Nicole Unger
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany
- Department of Endocrinology, Diabetes and Metabolism, Member of ENDO-ERN, University Hospital Essen, Essen, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, Member of ENDO-ERN, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
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3
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Mathew A, Bertram S, Rawitzer J, Nottrott M, Farzaliyev F, Unger N, Weber F, Dralle H, Führer D, Lahner H. Hormonal Hypersecretion and Pain - Rare But Not To Be Forgotten. Am J Med 2024; 137:311-314. [PMID: 38104643 DOI: 10.1016/j.amjmed.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Annie Mathew
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Stefanie Bertram
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Josefine Rawitzer
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Nottrott
- Department of Tumororthopedics, University Hospital Essen and Sarcoma Center at the West German Cancer Center, University of Essen-Duisburg, Essen, Germany
| | - Farhad Farzaliyev
- Department of Tumororthopedics, University Hospital Essen and Sarcoma Center at the West German Cancer Center, University of Essen-Duisburg, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Harald Lahner
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Kiewert C, Jedanowski J, Hauffa BP, Petersenn S, Mann K, Führer D, Unger N. Transition from Paediatric to Adult Care in CAH: 20 Years of Experience at a Tertiary Referral Center. Horm Metab Res 2024; 56:45-50. [PMID: 38171370 DOI: 10.1055/a-2201-6548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Transition medicine aims at the coordinated transfer of young patients with a chronic disease from paediatric to adult care. The present study reflects 20 years of experience in transitioning patients with congenital adrenal hyperplasia (CAH) in a single center setting. Our endocrine transition-clinic was established in 2002 and offers joint paediatric and adult consultations. Data were evaluated retrospectively from 2002 to 2005 and 2008 to present. Fifty-nine patients (29 males) were transferred. Median age was 18.4 years (17.6-23.6). Ninety percent of the patients presented with 21-hydroxlase-deficiency (21-OHD), 38 patients (23 m) with salt-wasting (sw), 7 (1 m) with simple-virilising (sv) and 8 (3 m) with the non-classic (nc) form. Rarer enzyme deficiencies were found in 6 cases: 17α-OHD (2 sisters), P450-oxidoreductase-deficiency (2 siblings), 3β-hydroxysteroid-dehydrogenase-deficiency (1 m) and 11β-OHD (1 female). Thirty-four patients (57.6%, 20 m) are presently still attending the adult clinic, 1 patient (1.7%, m) moved away and 24 (40.7%, 8 m) were lost to follow-up (13 sw-21-OHD, 6 sv-21-OHD, 5 nc-21-OHD). Thirty-seven patients (62.7%) attended the adult clinic for >2 years after transfer, 17 (28.8%) for >10 years. In the lost to follow-up group, median time of attendance was 16.3 months (0-195.2). Defining a successful transfer as two or more visits in the adult department after initial consultation in the transition clinic, transfer was efficient in 84.7% of the cases. A seamless transfer to adult care is essential for adolescents with CAH. It requires a continuous joint support during the transition period, remains challenging, and necessitates adequate funding.
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Affiliation(s)
- Cordula Kiewert
- Division of Paediatric Endocrinology and Diabetes, Member of ENDO-ERN, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Julia Jedanowski
- Department of Endocrinology, Diabetes and Metabolism, Member of ENDO-ERN, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Berthold P Hauffa
- Division of Paediatric Endocrinology and Diabetes, Member of ENDO-ERN, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg, Germany, and University of Duisburg-Essen, Germany
| | - Klaus Mann
- Department of Endocrinology, Diabetes and Metabolism, Member of ENDO-ERN, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, Member of ENDO-ERN, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, Member of ENDO-ERN, University Hospital Essen, University of Duisburg-Essen, Germany
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Miralles AJ, Unger N, Kannaiyan N, Rossner MJ, Dimou L. Analysis of the GPR17 receptor in NG2-glia under physiological conditions unravels a new subset of oligodendrocyte progenitor cells with distinct functions. Glia 2023; 71:1536-1552. [PMID: 36815579 DOI: 10.1002/glia.24356] [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: 10/10/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
NG2-glia comprise a heterogeneous population of cycling cells that give rise to mature, myelinating oligodendrocytes. The mechanisms that regulate the process of differentiation from NG2-glia into oligodendrocytes are still not fully understood but over the last years the G Protein-coupled Receptor 17 (GPR17) has been on the spotlight as a possible key regulator. Interestingly, GPR17-expressing NG2-glia show under physiological conditions a slower and lower level of differentiation compared to NG2-glia without GPR17. In contrast, after a CNS insult these react with proliferation and differentiation in a high rate, pointing towards a role in repair processes. However, the role of GPR17+ NG2-glia under healthy conditions in adulthood has not been addressed yet. Therefore, we aimed here to characterize the GPR17-expressing NG2-glia. Using transgenic mouse models, we showed restricted GPR17 expression in only some NG2-glia. Furthermore, we found that these cells constitute a distinct subset within the NG2-glia population, which shows a different gene expression profile and behavior when compared to the total NG2-glia population. Genetic depletion of GPR17+ cells showed that these are not contributing to the dynamic and continuous generation of new oligodendrocytes in the adult brain. Taken together, GPR17+ NG2-glia seem to play a distinct role under physiological conditions that goes beyond their classic differentiation control, that needs to be further elucidated. These results open new avenues for using the GPR17 receptor as a target to change oligodendrogenesis under physiological and pathological conditions, highlighting the importance of further characterization of this protein for future pharmacological studies.
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Affiliation(s)
- Antonio J Miralles
- Molecular and Translational Neuroscience, Department of Neurology, Ulm University, Ulm, Germany
| | - Nicole Unger
- Molecular and Translational Neuroscience, Department of Neurology, Ulm University, Ulm, Germany
| | - Nirmal Kannaiyan
- Molecular and Behavioral Neurobiology, Department of Psychiatry and Psychotherapy, LMU Klinikum, Munich, Germany
| | - Moritz J Rossner
- Molecular and Behavioral Neurobiology, Department of Psychiatry and Psychotherapy, LMU Klinikum, Munich, Germany
| | - Leda Dimou
- Molecular and Translational Neuroscience, Department of Neurology, Ulm University, Ulm, Germany
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Maric I, Weber M, Prochnow A, Schmitz J, Unger N, Schaarschmidt BM, Poeppel TD, Rischpler C, Bockisch A, Herrmann K, Jentzen W, Fendler WP. Efficacy and safety of 124I-mIBG dosimetry-guided high activity 131I-mIBG therapy of advanced pheochromocytoma or neuroblastoma. J Nucl Med 2023:jnumed.122.264775. [PMID: 36732054 DOI: 10.2967/jnumed.122.264775] [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: 08/15/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction: We aim to evaluate the efficacy and safety of 124I-mIBG dosimetry guided high-activity 131I-mIBG therapy of advanced pheochromocytoma or neuroblastoma. Methods: Fourteen patients with advanced pheochromocytoma or neuroblastoma, age 9 to 69 years, underwent 124I-mIBG PET scans and whole-body retention measurements to assess the whole-body dose as a surrogate of bone marrow toxicity and tumor (absorbed) dose per unit of administered activity. Dosimetry results together with individual patient characteristics were combined to guide a single therapeutic activity to achieve a high tumor dose without exceeding toxicity threshold. Toxicity was assessed for hematologic, hepatic as well as renal function. Response was evaluated by RECIST, SIOPEN-like score, change in PET uptake and quantitative PET parameters (SUVmax, SUVpeak, MTV, TLG) as well as visual decrease in number and/or in visual intensity of lesions on baseline to follow-up 124I-mIBG-PET/CT. Results: The mean therapeutic activity was 14 GBq. Eleven of 14 patients (79%) received each more than 10 GBq. One male patient was treated with a single activity of 50 GBq. Three patients were treated with lower activities between 3.5 and 7.0 GBq. Median overall survival was 85 months (95% CI), median progression-free survival was 25 months (95% CI). Four (29%) and 5 (36%) patients demonstrated response (CR or PR) by RECIST and functional imaging, respectively. One patient exceeded whole-body dose of 2 Gy and demonstrated grade 3 hematologic toxicity, which resolved spontaneously within 12 months after the therapy without the need for further treatment. Three patients (21%) demonstrated transient grade 1 renal toxicity. Conclusion: 124I-mIBG dosimetry-guided high-activity 131I-mIBG therapy in patients with advanced pheochromocytoma or neuroblastoma resulted in durable responses with a low rate of manageable adverse events. Efficacy of 124I-mIBG-guided activity escalation should further be assessed in a prospective setting.
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Affiliation(s)
- Ines Maric
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Germany
| | - Andre Prochnow
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Germany
| | - Jochen Schmitz
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Germany
| | - Nicole Unger
- German Cancer Consortium (DKTK), partner site Essen, Germany
| | | | | | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Germany
| | - Andreas Bockisch
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Germany
| | - Walter Jentzen
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Germany
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Grzywotz A, Li Y, Unger N, Kiewert C, Chmielewski WX, Sure U, Uerschels A, Wrede K, Kreitschmann-Andermahr I. Pituitary enlargement in patients with cerebrospinal fluid drainage due to ventricular shunt insertion: know the condition and do not mistake for adenoma. Pituitary 2023; 26:164-170. [PMID: 36652088 PMCID: PMC9908659 DOI: 10.1007/s11102-022-01296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Childhood hydrocephalus patients treated by ventriculo-peritoneal (v.-p.) shunting are sometimes referred years after this therapy for evaluation of suspicious pituitary enlargement. Since pituitary size has been shown to depend on cerebrospinal fluid (CSF) pressure, we assume this phenomenon to be caused by shunt overdrainage. Therefore, we studied pituitary size and morphology in shunted hydrocephalus patients with radiological signs of high CSF drainage. PATIENTS AND METHODS Retrospective study of pituitary size and morphology in 15 shunted patients with non-tumoral hydrocephalus and 7 shunted hydrocephalus patients due to childhood brain tumor compared to a population mean. In five brain tumor patients also pre- and postsurgical comparisons were performed. RESULTS Pituitary mid-sagittal size and pituitary volume were significantly higher in both hydrocephalus groups, compared to the population mean (midsagittal size t = 5.91; p < 0.001; pituitary volume, t = 3.03; p = 0.006). In patients available for pre- and postoperative comparison, there was also a significant increase in pituitary size and volume postoperatively (mean preoperative midsagittal height 2.54 ± 1.0 mm vs. 6.6 ± 0.7 mm post-surgery; mean pre-operative pituitary volume 120.5 ± 69.2 mm3 vs. 368.9 ± 57.9 mm3 post-surgery). CONCLUSION Our results confirmed a significant increase in pituitary size and volume, mimicking pituitary pathology, after v.-p. shunt insertion. This phenomenon can be explained by the Monro-Kellie doctrine, stating that intracranial depletion of CSF-as caused by v.p. shunting-leads to compensatory intracranial hyperemia, especially in the venous system, with the consequence of engorged venous sinuses, most likely responsible for enlargement of the pituitary gland.
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Affiliation(s)
- Agnieszka Grzywotz
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Yan Li
- Institute of Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Cordula Kiewert
- Department of Pediatric Endocrinology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Witold X Chmielewski
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Anne Uerschels
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Chmielewski WX, Walbrodt S, Rauschenbach L, Chihi M, Gembruch O, Darkwah Oppong M, Schroer S, Wrede KH, Dammann P, Jabbarli R, Kreitschmann-Andermahr I, Sato T, Unger N, Mattheis S, Sure U, Ahmadipour Y. Pre-Surgery Patient Health Contributes to Aggravated Sino-Nasal Outcome and Quality of Life after Pituitary Adenomectomy. Medicina (B Aires) 2023; 59:medicina59010127. [PMID: 36676751 PMCID: PMC9864056 DOI: 10.3390/medicina59010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Objectives: The transphenoidal bi-nostril endoscopic resection of pituitary adenomas is regarded as a minimally invasive treatment nowadays. However, sino-nasal outcome and health-related quality of life (HRQoL) might still be impaired after the adenomectomy, depending on patients' prior medical history and health status. A systematic postoperative comparison is required to assess differences in perceived sino-nasal outcome and HRQoL. Methods: In this single-center observational study, we collected data from 81 patients, operated between August 2016 and August 2021, at a 3-6-month follow-up after adenomectomy. We employed the sino-nasal outcome test for neurosurgery (SNOT-NC) and the HRQoL inventory Short Form (SF)-36 to compare sino-nasal and HRQoL outcome in patients with or without allergies, previous nose surgeries, presence of pain, snoring, sleep apnea, usage of continuous positive airway pressure (cpap), and nose drop usage. Results: At the 3-6-month follow-up, patients with previous nasal surgery showed overall reduced subjective sino-nasal health, increased nasal and ear/head discomfort, increased visual impairment, and decreased psychological HRQoL (all p ≤ 0.026) after pituitary adenomectomy. Patients with pain before surgery showed a trend-level aggravated physical HRQoL (p = 0.084). Conclusion: Our data show that patients with previous nasal surgery have an increased risk of an aggravated sino-nasal and HRQoL outcome after pituitary adenomectomy. These patients should be thoroughly informed about potential consequences to induce realistic patient expectations. Moreover, the study shows that patients with moderately severe allergies, snoring, and sleep apnea (± cpap) usually do not have to expect a worsened sino-nasal health and HRQoL outcome.
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Affiliation(s)
- Witold X. Chmielewski
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
- Correspondence: ; Tel.: +49-201-723-84235
| | - Sebastian Walbrodt
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Mehdi Chihi
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Oliver Gembruch
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Sebastian Schroer
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Karsten H. Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Taku Sato
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
- Department of Neurosurgery, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, 45147 Essen, Germany
| | - Stefan Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, 45147 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
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Brandenburg T, Unger N, Fuhrer D, Tan S. Paraganglioma-induced Catecholamine-mediated Gangrene. JCEM Case Rep 2023; 1:luac009. [PMID: 37908240 PMCID: PMC10578404 DOI: 10.1210/jcemcr/luac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Indexed: 11/02/2023]
Affiliation(s)
- Tim Brandenburg
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Dagmar Fuhrer
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Susanne Tan
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
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Shaik N, Bellanti F, Comisar C, Girish S, Rhee M, Singh R, Unger N, Palaparthy R. PP 5.1 – 00045 Impact of Intrinsic and Extrinsic Factors on the Pharmacokinetics of Long-Acting Lenacapavir for Treatment of HIV. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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11
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Tsiomidou S, Pamporaki C, Geroula A, Van Baal L, Weber F, Dralle H, Schmid KW, Führer D, Unger N. Clonidine suppression test for a reliable diagnosis of pheochromocytoma: When to use. Clin Endocrinol (Oxf) 2022; 97:541-550. [PMID: 35274752 DOI: 10.1111/cen.14724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In clinical practice, false-positive results in biochemical testing for suspected pheochromocytoma/paraganglioma (PPGL) are not infrequent and may lead to unnecessary examinations. We aimed to evaluate the role of the clonidine suppression test (CST) in the era of analyses of plasma-free metanephrines for the diagnosis or exclusion of PPGL in patients with adrenal tumours and/or arterial hypertension. DESIGN AND METHODS This single-centre, prospective trial investigated the use of CST in 60 patients with suspected PPGL associated with out-patient elevations of plasma normetanephrine (NMN) and/or metanephrine (MN), in most cases accompanied with hypertension or an adrenal mass. Measurements of plasma catecholamines and free metanephrines were performed by liquid chromatography with electrochemical detection and tandem mass spectrometry, respectively. RESULTS Forty-six patients entered final analysis (n = 20 with PPGL and n = 26 with a nonfunctional adrenal mass and/or hypertension). CST reliably excluded false-positive baseline NMN results with a specificity of 100%. The sensitivity of CST improved from 85% to 94% when tumours with isolated MN increase (n = 3) were not considered. In patients with elevated baseline NMN (n = 24), CST correctly identified all patients without PPGL. Patients with falsely elevated baseline NMN results (n = 7, 26.9%) exhibited increases of baseline NMN up to 1.7-fold above the upper reference limit. CONCLUSION CST qualifies as a useful diagnostic tool for differential diagnosis of borderline elevated plasma-free NMN in patients with suspected PPGL. In this context, CST helps to correctly identify all false-positive NMN screening results.
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Affiliation(s)
- Spyridoula Tsiomidou
- Department of Endocrinology, Diabetes and Metabolism, Endocrine Tumour Centre at WTZ and Member of ENDO-ERN, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christina Pamporaki
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Aikaterini Geroula
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lukas Van Baal
- Department of Endocrinology, Diabetes and Metabolism, Endocrine Tumour Centre at WTZ and Member of ENDO-ERN, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Frank Weber
- Division of Endocrine Surgery, Endocrine Tumour Centre at WTZ and Member of ENDO-ERN, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Henning Dralle
- Division of Endocrine Surgery, Endocrine Tumour Centre at WTZ and Member of ENDO-ERN, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Kurt W Schmid
- Institute of Pathology, Endocrine Tumour Centre at WTZ and Member of ENDO-ERN, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, Endocrine Tumour Centre at WTZ and Member of ENDO-ERN, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, Endocrine Tumour Centre at WTZ and Member of ENDO-ERN, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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12
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Nowotny H, Neumann U, Tardy-Guidollet V, Ahmed SF, Baronio F, Battelino T, Bertherat J, Blankenstein O, Bonomi M, Bouvattier C, Brac de la Perrière A, Brucker S, Cappa M, Chanson P, Claahsen-van der Grinten HL, Colao A, Cools M, Davies JH, Dörr HG, Fenske WK, Ghigo E, Giordano R, Gravholt CH, Huebner A, Husebye ES, Igbokwe R, Juul A, Kiefer FW, Léger J, Menassa R, Meyer G, Neocleous V, Phylactou LA, Rohayem J, Russo G, Scaroni C, Touraine P, Unger N, Vojtková J, Yeste D, Lajic S, Reisch N. Prenatal dexamethasone treatment for classic 21-hydroxylase deficiency in Europe. Eur J Endocrinol 2022; 186:K17-K24. [PMID: 35235536 PMCID: PMC9010809 DOI: 10.1530/eje-21-0554] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/02/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the current medical practice in Europe regarding prenatal dexamethasone (Pdex) treatment of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. DESIGN AND METHODS A questionnaire was designed and distributed, including 17 questions collecting quantitative and qualitative data. Thirty-six medical centres from 14 European countries responded and 30 out of 36 centres were reference centres of the European Reference Network on Rare Endocrine Conditions, EndoERN. RESULTS Pdex treatment is currently provided by 36% of the surveyed centres. The treatment is initiated by different specialties, that is paediatricians, endocrinologists, gynaecologists or geneticists. Regarding the starting point of Pdex, 23% stated to initiate therapy at 4-5 weeks postconception (wpc), 31% at 6 wpc and 46 % as early as pregnancy is confirmed and before 7 wpc at the latest. A dose of 20 µg/kg/day is used. Dose distribution among the centres varies from once to thrice daily. Prenatal diagnostics for treated cases are conducted in 72% of the responding centres. Cases treated per country and year vary between 0.5 and 8.25. Registries for long-term follow-up are only available at 46% of the centres that are using Pdex treatment. National registries are only available in Sweden and France. CONCLUSIONS This study reveals a high international variability and discrepancy in the use of Pdex treatment across Europe. It highlights the importance of a European cooperation initiative for a joint international prospective trial to establish evidence-based guidelines on prenatal diagnostics, treatment and follow-up of pregnancies at risk for CAH.
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Affiliation(s)
- Hanna Nowotny
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Uta Neumann
- Centre for Chronic Sick Children, Department of Paediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Véronique Tardy-Guidollet
- Laboratoire de Biochimie et Biologie Moléculaire, Hospices Civils de Lyon, Centre National de Référence ‘Développement Génital: du fœtus à l’adulte DEV-GEN’ Université Lyon I, Lyon, France
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Federico Baronio
- Paediatric Endocrinology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, University Children’s Hospital, Ljubljana, Slovenia
| | - Jérôme Bertherat
- Service d’Endocinologie et Maladies Métaboliques, Hôpitaux Universitaires Paris-Centre, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Oliver Blankenstein
- Centre for Chronic Sick Children, Department of Paediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Bonomi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, IRCSS Istituto Auxologico Italiano, Milan, Italy
| | - Claire Bouvattier
- Service d’Endocrinologie de l’Enfant, GHU Paris-Sud, Hôpital de Bicêtre, Paris, France
- Centre National de Référence ‘Développement Génital: du fœtus à l’adulte DEV-GEN’, Paris, France
| | - Aude Brac de la Perrière
- Fédération d’Endocrinologie, de Diabétologie et des Maladies Métaboliques, Hospices Civils des Lyon, Centre National de Référence ‘Développement Génital: du fœtus à l’adulte DEV-GEN’, Lyon, France
| | - Sara Brucker
- Department of Women’s Health, University Women’s Hospital, University of Tübingen, Tübingen, Germany
| | - Marco Cappa
- Endocrinology Unit, Paediatric University Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de Hypophyse, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Hedi L Claahsen-van der Grinten
- Department of Paediatric Endocrinology, Amalia Children’s Hospital, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Annamaria Colao
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita’ Federico II di Napoli, Naples, Italy
| | - Martine Cools
- Department of Paediatric Endocrinology, Ghent University Hospital, University of Ghent, Ghent, Belgium
| | - Justin H Davies
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Helmut-Günther Dörr
- Paediatric Endocrinology, Department of Paediatrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wiebke K Fenske
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Ezio Ghigo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy
| | - Roberta Giordano
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Angela Huebner
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Eystein Sverre Husebye
- Department of Clinical Science and KG Jebsen Centre for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Rebecca Igbokwe
- West Midlands Regional Genetics Laboratory, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Florian W Kiefer
- Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Juliane Léger
- Department of Paediatric Endocrinology and Diabetology and Reference Centre for Rare Diseases of Growth and Development, AP-HP Paris Nord Université de Paris, CHU Robert-Debre, Paris, France
| | - Rita Menassa
- Laboratoire de Biochimie et Biologie Moléculaire, Hospices Civils de Lyon, Centre National de Référence ‘Développement Génital: du fœtus à l’adulte DEV-GEN’ Université Lyon I, Lyon, France
| | - Gesine Meyer
- Division of Endocrinology, Department of Internal Medicine 1, Goethe University Frankfurt Faculty 16 Medicine, Frankfurt am Main, Germany
| | - Vassos Neocleous
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Leonidas A Phylactou
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Julia Rohayem
- Centre of Reproductive Medicine and Andrology, Clinical and Operative Andrology, University of Münster, Münster, Germany
| | - Gianni Russo
- Department of Paediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Carla Scaroni
- Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Centre for Rare Endocrine and Gynaecological Disorders, Sorbonne Université, Assistance Publique Hopitaux de Paris, Paris, France
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, Essen, Germany
| | - Jarmila Vojtková
- Department of Paediatrics, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
| | - Diego Yeste
- Paediatric Endocrinology Service, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
- CIBERER, ISCIII, Madrid, Spain
| | - Svetlana Lajic
- Department of Women’s and Children’s Health, Karolinska Institutet/Karolinska University Hospital, Paediatric Endocrinology Unit (QB83), Stockholm, Sweden
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
- Correspondence should be addressed to N Reisch;
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Lahner H, Mathew A, Klocker AL, Unger N, Theysohn J, Rekowski J, Jöckel KH, Theurer S, Schmid KW, Herrmann K, Führer D. Streptozocin/5-fluorouracil chemotherapy of pancreatic neuroendocrine tumours in the era of targeted therapy. Endocrine 2022; 75:293-302. [PMID: 34480724 PMCID: PMC8763729 DOI: 10.1007/s12020-021-02859-y] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/26/2021] [Indexed: 12/04/2022]
Abstract
PURPOSE The role of streptozocin-based chemotherapy (STZ CTx) in advanced, well-differentiated pancreatic neuroendocrine tumours (PanNET) and the best sequence of treatments in advanced PanNET are unclear. We examined the outcomes after STZ CTx in patients who had been selected according to the current therapeutic guidelines. METHODS Data from 50 PanNET patients consecutively treated with STZ CTx between 2010 and 2018 were analysed. The endpoints of the study were the objective-response rate (ORR), progression-free survival (PFS), and overall survival (OS). RESULTS STZ CTx was the first-line treatment in 54% of patients. The PanNET grades were as follows: 6% G1, 88% G2, and 6% well-differentiated G3. The ORR was 38%. Stable disease was the best response in 38% of patients and 24% showed progressive disease. Treatment was discontinued because of toxicity in one patient. Median PFS and OS were 12 (95% confidence interval (CI), 8.5-15.5) and 38 months (95% CI, 20.4-55.6), respectively. In the Kaplan-Meier analysis, the median OS was 89 months (95% CI, 34.9-143.1) for STZ CTx as first-line therapy compared with 22 months (95% CI, 19.3-24.7; p = 0.001, log-rank test) for subsequent lines. Bone metastases negatively impacted survival (HR, 2.71, p = 0.009, univariate analysis, HR, 2.64, p = 0.015, multivariate analysis, and Cox regression). CONCLUSIONS In patients selected according to current guidelines, PFS, and OS after STZ CTx were lower than previously reported, whereas ORR was unchanged. First-line treatment was positively associated with OS and the presence of bone metastases was negatively associated with OS. Pre-treatment with targeted or peptide-receptor radionuclide therapy did not alter ORR, PFS, or OS.
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Affiliation(s)
- Harald Lahner
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University of Duisburg-Essen, Essen, Germany.
| | - Annie Mathew
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University of Duisburg-Essen, Essen, Germany
| | - Anna Lisa Klocker
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University of Duisburg-Essen, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University of Duisburg-Essen, Essen, Germany
| | - Jens Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany
| | - Jan Rekowski
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Sarah Theurer
- Institute of Pathology, University of Duisburg-Essen, Essen, Germany
| | | | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University of Duisburg-Essen, Essen, Germany
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Siegel S, Kirstein CF, Schröder B, Unger N, Kreitschmann-Andermahr I. Illness-related burden, personal resources and need for support in patients with acromegaly: Results of a focus group analysis. Growth Horm IGF Res 2021; 60-61:101422. [PMID: 34404019 DOI: 10.1016/j.ghir.2021.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE It was the aim of this study to evaluate illness-related burdens and support needs of patients with acromegaly to identify hitherto unadressed research questions and to open up avenues for improvements in patient care. This was done by using the focus group approach as a qualitative research method. DESIGN Seven patients with acromegaly took part in a focus group moderated by an external medical communication specialist. The discourse focused on topics such as impact of the illness on everyday life, support needs and personal resources. The discussion was recorded and transcribed and analyzed by qualitative content analysis. RESULTS Participants reported a huge impact of acromegaly on daily life, ranging from time expenditure for managing their illness, to bodily and mental sequelae and strain caused by physical disfigurement. Patients' coping strategies included family support, physical activities and humor. The participants wished for a sound patient-doctor relationship, more interdisciplinary and holistic treatment, medical rehabilitation services with special knowledge on acromegaly-related morbidity, a stable contact person in the medical process and reliable information material for themselves and their relatives. CONCLUSIONS The results provide multi-facetted impressions of the overwhelming impact of acromegaly and unmet support needs of the afflicted patients. Further quantitative research is necessary to examine the generalisibility of the present results in order to implement tailored support measures. We suggest to develop standardized questionnaires to explore the prevalence and severity of the addressed problems in a large patient sample and to establish screening instruments to monitor disease burden in clinical practice.
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Affiliation(s)
- Sonja Siegel
- Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Cedric Fabian Kirstein
- Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Bernadette Schröder
- Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
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15
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van Baal L, Wichert M, Zwanziger D, Dralle H, Weber F, Kreitschmann-Andermahr I, Führer D, Unger N. Distinct Late-Night Salivary Cortisol Cut-Off Values for the Diagnosis of Hypercortisolism. Horm Metab Res 2021; 53:662-671. [PMID: 34607366 DOI: 10.1055/a-1608-1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Due to high morbidity and mortality of untreated hypercortisolism, a prompt diagnosis is essential. Measurement of late-night salivary cortisol provides a simple and non-invasive method. However, thresholds and reference ranges differ among studies. The goal of this study was to define a threshold of late-night salivary cortisol for the diagnosis of hypercortisolism based on the used assay. Moreover, the influence of different aetiologies of hypercortisolism and individual comorbidities were investigated. Prospective analyses of 217 patients, including 36 patients with proven hypercortisolism were carried out. A sum of 149 patients with suspicion of hypercortisolism but negative endocrine testing and 32 patients with hypercortisolism in remission served as control group. Late-night salivary cortisol was measured using an automated chemiluminescence immunoassay. Cut-off values were calculated by ROC analysis. The calculated cut-off value for the diagnosis of hypercortisolism was 10.1 nmol/l (sensitivity 94%; specificity 84%). Only slightly lower thresholds were obtained in patients with suspected hypercortisolism due to weight gain/obesity (9.1 nmol/l), hypertension or adrenal tumours (both 9.8 nmol/l) or pituitary adenomas (9.5 nmol/l). The late-night salivary cortisol threshold to distinguish between Cushing's disease and Cushing's disease in remission was 9.2 nmol/l. The cut-off value for the diagnosis of ectopic ACTH-production was 109.0 nmol/l (sensitivity 50%, specificity 92%). Late-night salivary cortisol is a convenient and reliable parameter for the diagnosis of hypercortisolism. Except for ectopic ACTH-production, thresholds considering different indications for evaluation of hypercortisolism were only slightly different. Therefore, they might only be useful if late-night salivary cortisol results near the established cut-off value are present.
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Affiliation(s)
- Lukas van Baal
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | - Marc Wichert
- Department of Clinical Chemistry, University Duisburg-Essen, Essen, Germany
| | - Denise Zwanziger
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
- Department of Clinical Chemistry, University Duisburg-Essen, Essen, Germany
| | - Henning Dralle
- Division of Endocrine Surgery, University Duisburg-Essen, Essen, Germany
| | - Frank Weber
- Division of Endocrine Surgery, University Duisburg-Essen, Essen, Germany
| | | | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
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16
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Weber M, Schmitz J, Maric I, Pabst KM, Umutlu L, Walz M, Herrmann K, Rischpler C, Weber F, Jentzen W, Theurer S, Poeppel TD, Unger N, Fendler WP. Diagnostic performance of [ 124I]m-iodobenzylguanidine PET/CT in patients with pheochromocytoma. J Nucl Med 2021; 63:869-874. [PMID: 34556526 DOI: 10.2967/jnumed.121.262797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
123/131I-MIBG scintigraphy has shown a high specificity for imaging pheochromocytoma and paraganglioma however with low sensitivity due to low spatial resolution. 124I-MIBG PET may overcome this limitation to improve the staging of patients with (suspected) pheochromocytoma. Methods: We analyzed the sensitivity, specificity, positive and negative predictive values (PPV, NPV) of 124I-MIBG PET in 43 consecutive patients with suspected (recurrence of) pheochromocytoma using histopathological (n = 25) and clinical validation (n = 18) as standard of truth. Furthermore, we compared 124I-MIBG PET versus contrast enhanced CT (CE-CT) per-patient and per-lesion detection rate of 124I-MIBG PET in 13 additional patients with known metastatic malignant pheochromocytoma (MMP). Results: 124I-MIBG PET/CT was positive in 19/43 (44%) patients with suspected pheochromocytoma. Presence of pheochromocytoma was confirmed in 22/43 (51%). 124I-MIBG PET/CT sensitivity, specificity, PPV, NPV were 86%, 100%, 100%, 88%, respectively. 124I-MIBG PET was positive in 11/13 (85%) MMP patients. Combined 124I-MIBG PET and CE-CT detected 173 lesions, of which 166 (96%) and 118 (68%) were visible on 124I-MIBG PET and CE-CT, respectively. Discussion: 124I-MIBG PET detects pheochromocytoma with high accuracy at initial staging and high detection rate at re-staging. Superior diagnostic performance aids guidance of surgical and medical management including personalized 131I-MIBG therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Nicole Unger
- University Hospital Essen Clinic for Endocrinology
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17
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Nieman LK, Boscaro M, Scaroni CM, Deutschbein T, Mezosi E, Driessens N, Georgescu CE, Hubalewska-D A, Berker D, Jarzab BM, Maiter DM, Reincke M, Loli P, Zampetti B, Atmaca A, Badiu CP, Beckers AM, Bolanowski M, Cavagnini F, Unger N, Giordano R, Hanzu FA, Terzolo M, Bostnavaron M, Toth M. Metyrapone Treatment in Endogenous Cushing’s Syndrome: Results at Week 12 From PROMPT, a Prospective International Multicenter, Open-Label, Phase III/IV Study. J Endocr Soc 2021. [PMCID: PMC8090655 DOI: 10.1210/jendso/bvab048.1053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Metyrapone is a steroidogenesis inhibitor approved in Europe for the treatment of endogenous Cushing’s syndrome (CS) based on observational retrospective studies published over more than 50 years. We present data from the first prospective study designed to confirm metyrapone efficacy and good tolerance in patients with CS. Methods: This single arm, open-label, multicenter, international trial enrolled 50 patients with CS who had three baseline 24 hours urine free cortisol (UFC) values at least 50% above the upper limit of normal (ULN=165 nmol/24h). Metyrapone was titrated over 12 weeks (W12) to achieve normal urine (mean of 3 values, mUFC) and serum cortisol levels. Patients whose mUFC did not exceed 2-fold the ULN could enter a 6-month extension period. The primary efficacy endpoint was the proportion of patients with mUFC ≤ ULN at W12 assessed in a central laboratory using LC-MS/MS. The most important secondary endpoint was mUFC decrease of ≥ 50% at W12. Results: At baseline: mean age was 47 years, median mUFC (range) was 570 (291 - 8476) nmol/24h (3.5 x ULN). Hypercortisolism was in 96% of patients either moderate (mUFC ≥ 2xULN; < 5x ULN) in 63% or severe (≥5 x ULN) in 33%. Hypertension (69%) and diabetes mellitus (47%) were the most common comorbidities. At W12: 47% (23/ 49) met primary endpoint. Another 40% (19 / 49) had mUFC ≤ 2xULN. Median percentage decrease in mUFC from baseline to W12 was -74%. Secondary endpoint was met by 80% of patients who had a mUFC decrease of 50%. Final median metyrapone dose was 1500 (250; 5500) mg/day. Physical signs and symptoms were normalized or improved in 66% of patients. Circulating cholesterol, HbA1C and fasting glucose and insulin improved with median decrease of 12%, 3%, 5% and 9% respectively and median systolic and diastolic blood pressure also decreased by 4 and 5mmHg respectively. Among patients with antihypertensive treatments, 10 (31%) had a decrease in number of drugs and 5 (16%) had an increase in number of drugs during the study. Median ACTH increased by 11 % from baseline. Twenty six (52%) patients experienced mild to moderate study drug related adverse events (AEs). One patient discontinued before W12 because of an unrelated SAE on day 2 (pneumonia with septic shock). The most common AEs were nausea (24%), decreased appetite (18%), fatigue (14%), headache (10%), peripheral edema (6.0%), hypokalemia (6.0%) and hypertension (6.0%). Reversible adrenal insufficiency occurred in 6 (12%) patients. Few patients 14% (7/50) experienced at least one AE that led to a dose interruption or dose adjustment. Cushing Quality of Life Questionnaire increased of 10 points from baseline which is close to minimal clinically important difference = 10.1. Conclusions: This prospective study in patients with CS confirms that metyrapone effectively lowers UFC levels with a tolerability profile similar to the previously reported safety profile and improves QoL, at Week 12.
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Affiliation(s)
- Lynnette K Nieman
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Marco Boscaro
- Endocrinology department, University Hospital, Padova, Italy
| | | | - Timo Deutschbein
- Dept. of Internal Medicine, Div. of Endocrinology and Diabetes, University Hospital, University of Würzburg, Wurzburg, Germany
| | - Emese Mezosi
- Department of Internal Medicine, University Medical School, Pecs, Hungary
| | - Natacha Driessens
- CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Carmen Emanuela Georgescu
- Dept of Endocrinology, Cluj County Emergency Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Alicja Hubalewska-D
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | - Dilek Berker
- Endocrinology department, Numune Training and Research Hospital, Ankara, Turkey
| | - Barbara Maria Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Dominique M Maiter
- Endocrinology department, University Hospital Saint Luc, Brussels, Belgium
| | - Martin Reincke
- Endocrinology department, University Clinic, Munich, Germany
| | - Paola Loli
- Clinica San Carlo, Endocrinology department, Milan, Italy
| | | | - Ayşegül Atmaca
- Endocrinology department, Ondokuz Mayıs University, Samsun, Turkey
| | - Corin P Badiu
- ”C.I Parhon”, National Institute of Endocrinology, University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Marek Bolanowski
- Dept. of Endocrinology, Diabetes and Isotope Therapy, Medical University, Wroclaw, Poland
| | | | - Nicole Unger
- Department of Endocrinology and Metabolism, University Hospital, Essen, Germany
| | | | | | - Massimo Terzolo
- Dept. of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Miklos Toth
- Semmelweis University, Department of Internal Medicine and Oncology, Budapest, Hungary
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18
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Siegel S, Unger N, Streetz-van der Werf C, Karges W, Schilbach K, Schröder B, Szybowicz J, Sauerwald J, Zopf K, Grzywotz A, Bidlingmaier M, Kirstein C, Sommer H, Strasburger CJ, Kreitschmann-Andermahr I. Adults' Adherence to Growth Hormone Replacement in Relation to Medication-Related Beliefs, Coping and Quality of Life - An Exploratory Analysis. Front Endocrinol (Lausanne) 2021; 12:680964. [PMID: 34108940 PMCID: PMC8181747 DOI: 10.3389/fendo.2021.680964] [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: 03/15/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Little is known about psychological reasons associated with adherence to growth hormone (GH) replacement therapy (GHRx) in adults. As in other chronic diseases, medication-related beliefs, coping strategies and disease impact on quality of life (QoL) might play an important role. We thus explored these psychological factors in relation to adherence in patients with GH deficiency (GHD) in order to find leverage points for the improvement of adherence. PATIENTS AND METHODS Cross-sectional analysis including 107 adult GHD patients on GHRx who completed self-assessment inventories on health-related QoL (Short-Form SF-36), coping style (Freiburg questionnaire on coping with illness, FKV-LIS) and medication beliefs (Beliefs about Medicine questionnaire, BMQ). Results were correlated to general and GH-specific adherence to medication. RESULTS In the BMQ, 92.5% of the patients (n=99) reported a strong belief in the need for their medication, which correlated significantly with general adherence (rs = 0.325). Active coping was significantly related to general (rs = 0.307) and GH-specific adherence (rs = 0.226). Better mental QoL (rs = 0.210) but worse physical QoL (rs = -0.198; all p < 0.05) were related to higher GH-specific adherence. Older age was associated with a higher degree of active coping, a higher belief in the necessity of medication and worse physical QoL. CONCLUSION We provide preliminary data that most GHD patients on GHRx are strongly convinced of their need for medication and that adherence to GHRx is influenced by coping strategies and QoL. Patients with impaired psychological QoL are less able to translate their convictions into good adherence, a phenomenon to be addressed in future research.
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Affiliation(s)
- Sonja Siegel
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Christine Streetz-van der Werf
- Division of Endocrinology and Diabetes, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
| | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität (LMU) Klinikum, Munich, Germany
| | - Bernadette Schröder
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Janine Szybowicz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Janina Sauerwald
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - Kathrin Zopf
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - Agnieszka Grzywotz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität (LMU) Klinikum, Munich, Germany
| | - Cedric Kirstein
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | | | - Christian J. Strasburger
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
- *Correspondence: Ilonka Kreitschmann-Andermahr,
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19
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Kreitschmann-Andermahr I, Siegel S, Unger N, Streetz-van der Werf C, Karges W, Schilbach K, Schröder B, Szybowicz J, Sauerwald J, Zopf K, Grzywotz A, Bidlingmaier M, Sommer H, Strasburger CJ. Motivation for and adherence to growth hormone replacement therapy in adults with hypopituitarism: the patients' perspective. Pituitary 2020; 23:479-487. [PMID: 32441023 PMCID: PMC7426293 DOI: 10.1007/s11102-020-01046-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION While reasons for non-adherence in children requiring growth hormone (GH) replacement (GH-Rx) are well researched, few studies have investigated adherence in adult GH deficient patients. Against the background of the adverse medical sequelae of untreated severe GH deficiency (GHD) in adults, we explored adherence to GH-Rx and associated factors in this patient group. METHOD Cross-sectional analysis including 107 adult patients with severe GHD on GH-Rx, 15 untreated GDH patients and 19 who had discontinued therapy. Patients completed self-developed ad hoc surveys on adherence to medication and GH-Rx, specific beliefs about GH-Rx, side effects and burden of injection, reasons for never receiving or dropping out of therapy, respectively. RESULTS Adherence to GH-Rx was high (mean 15.8/18 points on the self-developed adherence score) and significantly correlated with general medication adherence. Higher age was significantly associated with better adherence to GH-Rx, while injection side effects, duration of treatment or device used were not. The most frequent reasons for not being on GH-Rx apart from medical reasons included fear of side effects, lack of belief in treatment effects and dislike of injections. In patients not on GH-Rx, the proportion of patients in employment was significantly smaller than in the treatment group, despite similar age and comorbidities. CONCLUSIONS Adherence to GH-Rx was high for those patients on therapy. Instead of focusing on improving adherence in those adults already on GH-Rx, efforts should be undertaken to ally fear of side effects and provide education on positive treatment effects for those eligible but not receiving therapy.
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Affiliation(s)
- Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Sonja Siegel
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | | | - Wolfram Karges
- Division of Endocrinology and Diabetology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Bernadette Schröder
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Janine Szybowicz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | | | - Kathrin Zopf
- Hexal AG, Industriestrasse 25, 83607, Holzkirchen, Germany
| | - Agnieszka Grzywotz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Heide Sommer
- Hexal AG, Industriestrasse 25, 83607, Holzkirchen, Germany
| | - Christian J Strasburger
- Department of Endocrinology, Diabetes and Nutritional Medicine, Campus Charité Mitte, Charité Universitaetsmedizin, Charitéplatz 1, 10117, Berlin, Germany
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20
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Schündeln MM, Hauffa PK, Munteanu M, Kiewert C, Unger N, Bauer JJ, Hauffa BP, Grasemann C. Prevalence of Osteopathologies in Children and Adolescents After Diagnosis of Acute Lymphoblastic Leukemia. Front Pediatr 2020; 8:509. [PMID: 32984219 PMCID: PMC7479062 DOI: 10.3389/fped.2020.00509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/20/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Impaired bone health is a late effect of childhood malignancies which can be difficult to detect in juvenile survivors. It may, however, lead to compromised quality of life, or even permanent disability later in life due to osteoporosis, pain or fractures if left untreated. Acute lymphoblastic leukemia (ALL) is the most frequent childhood malignancy with an over 85% five-year survival. ALL and its treatment cause bone alterations in adults, but little information on the bone health status in juvenile survivors is available. Objective: To report data on skeletal late effects in juvenile survivors of childhood ALL based on a comprehensive assessment of bone health and to assess the influence of a vitamin D deficiency on bone health in this cohort. Methods: In a single center cross sectional study 128 pediatric patients (11.9 ± 4.76 years) with a mean follow up of 5.88 ± 3.75 years after diagnosis of ALL were recruited. The bone health status of the survivors was assessed based on clinical examination, review of medical records, biochemical and radiographic analyses, by clinical experts. A score which utilized 8 different parameters was formed and used to assess the effect of a vitamin D deficiency on bone health. Results: In this cohort, 18% of survivors displayed overt osteopathologies as defined by clinical expert assessment. Impaired bone health, defined by at least one pathological screening parameter, was detected in 77%. Despite recommendations for adequate vitamin D supplementation, 15% displayed a vitamin D deficiency associated with hyperparathyroidism. The applied score identified survivors with osteopathologies with high sensitivity and specificity. The median score did not differ between patients without and with severe vitamin D deficiency. Conclusion: Our findings suggest that impaired bone health and osteopathologies are common skeletal late effects following treatment of childhood ALL. Major contributing factors are BMT, irradiation and older age at diagnosis. Vitamin D deficiency likely accounts for hyperparathyroidism in some patients but does not seem to further affect bone health in this cohort. Survivors of ALL need thorough surveillance to investigate bone health, since bone morbidity is common and still poorly understood. Early detection and appropriate intervention may improve bone health.
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Affiliation(s)
- Michael M. Schündeln
- Pediatric Hematology and Oncology, Department of Pediatrics III, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Pia K. Hauffa
- Pediatric Hematology and Oncology, Department of Pediatrics III, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Martin Munteanu
- Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Cordula Kiewert
- Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jens J. Bauer
- Division of Rare Diseases, Department of Pediatrics, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Berthold P. Hauffa
- Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Corinna Grasemann
- Division of Rare Diseases, Department of Pediatrics, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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Kreitschmann-Andermahr I, Grzywotz A, Möller-Hartmann C, Junker A, Führer-Sakel D, Unger N. SUN-272 Significant Response to Temozolomide in Two Aggressively Growing Pituitary Adenomas. J Endocr Soc 2020. [PMCID: PMC7208177 DOI: 10.1210/jendso/bvaa046.1196] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction: Aggressive atypical pituitary tumors are characterized by invasive growth, recurrence and resistance to standard therapies. We present two female patients with pituitary adenomas in whom multiple other therapies had failed, who presented with significant response to temozolomide. Case presentations: In patient #1 (w, 78y), the diagnosis of macroprolactinoma had been made in a community hospital and dopaminagonistic treatment with bromocriptin had been initiated. After failure to achieve significant tumor reduction under this treatment and persisting visual field disturbances, first transnasal-transphenoidal surgery (TSS) was performed in 07/2011, followed by cabergoline exposure in increasing dose due to failure to control prolactin levels. Repeat TSS and stereotactic radiosurgery were performed in both 2014 and 2018 because of invasive tumor growth and double vision. She was then put on temozolomide. Patient #2 (w, 58y) presented with apoplectic gonadotropinoma in 2013. She also underwent 3 courses of TSS as well as stereotactic radiosurgery because of repeated tumor growth leading to visual field disturbances and double vision. Despite these measures, the tumor could not be controlled and she, as well, was put on temozolomide in 2018. In both cases costs were reimbursed by the patient’s health care insurance and in both the first cycle was conducted with 150 mg/ body surface area (BSA) with escalation to 200 mg/BSA in the second. After only 2 cycles, double vision resolved in both patients and the tumor had shrunk by approximately 20% on MRI in patient #1 and even more in patient #2. In both patients, temozolomide dose was reduced again to 150 mg/BSA due to side effects. Nevertheless, in both patients tumor volume further continued to decrease under therapy. Conclusion: This promising clinical course after exposure to temozolomide with early, significant tumor shrinkage in two heavily pretreated patients with aggressive pituitary adenomas indicates that this therapy can be considered also in older patients and may yield astonishing results. Although temozolomide is increasingly becoming a therapeutic option for those patients whose pituitary tumors are refractory to standard therapies, further research and observance over time of temozolomide therapy in aggressive pituitary adenomas and carcinomas is indicated.
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Elbelt U, Schlaffer SM, Buchfelder M, Knappe UJ, Vila G, Micko A, Deutschbein T, Unger N, Lammert A, Topuzoglu-Müller T, Bojunga J, Droste M, Johanssen S, Kolenda H, Ritzel K, Buslei R, Strasburger CJ, Petersenn S, Honegger J. Efficacy of Temozolomide Therapy in Patients With Aggressive Pituitary Adenomas and Carcinomas-A German Survey. J Clin Endocrinol Metab 2020; 105:5634134. [PMID: 31746334 DOI: 10.1210/clinem/dgz211] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Despite growing evidence that temozolomide (TMZ) therapy is effective for the treatment of aggressive pituitary tumors (APTs) or carcinomas (PCs), individual therapy decisions remain challenging. OBJECTIVE We therefore aimed to report on clinical characteristics leading to initiation of TMZ therapy and to add evidence on TMZ long-term effectiveness. DESIGN AND SUBJECTS Retrospective survey on TMZ treatment in patients with APTs or PCs. TMZ therapy was initiated in 47 patients (22 females) with APTs (n = 34) or PCs (n = 13). Mean age at diagnosis was 45 ± 15 years. The immunohistochemical subtypes were corticotroph (n = 20), lactotroph (n = 18), and nonfunctioning (n = 9) tumors. TMZ therapy started 8 years after initial diagnosis using a standard regimen (median 6 cycles) for the majority of patients. RESULTS Long-term radiological response to TMZ after a median follow-up of 32 months with 4 patients still on TMZ therapy was tumor regression for 9 (20%), stable disease for 8 (17%), and tumor progression for 29 patients (63%) (outcome data available for 46 patients). Progression occurred 16 months after initiation of TMZ. Median estimated progression-free survival was 23 months. Disease stabilization and median progression-free survival did not differ between patients with APTs or PCs. Predictors of tumor response were not identified. Overall, TMZ was well tolerated. CONCLUSION We performed a nationwide survey on TMZ therapy in patients with APTs and PCs. While early response rates to TMZ are promising, long-term outcome is less favorable. Prolonged TMZ administration should be considered. We were not able to confirm previously reported predictors of tumor response to TMZ.
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Affiliation(s)
- Ulf Elbelt
- Department of Endocrinology, Diabetes and Nutrition, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sven M Schlaffer
- Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ulrich J Knappe
- Department of Neurosurgery, Johannes Wesling Klinikum, Universitätsklinikum der Ruhruniversität Bochum, Minden, Germany
| | - Greisa Vila
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria
| | - Alexander Micko
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, Essen, Germany
| | - Alexander Lammert
- Vth Department of Medicine, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Tengü Topuzoglu-Müller
- Department of Endocrinology, Diabetes and Preventive Medicine, University Hospital of Cologne, Cologne, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany
| | | | | | - Herbert Kolenda
- Department of Neurosurgery, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - Katrin Ritzel
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rolf Buslei
- Institute of Pathology, SozialStiftung Bamberg, Bamberg, Germany
| | - Christian J Strasburger
- Department of Endocrinology, Diabetes and Nutrition, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jürgen Honegger
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
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23
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Weber F, Belker J, Unger N, Lahner H, Theurer S, Schmid KW, Führer D, Dralle H. [Pheochromocytomatosis after adrenalectomy: metastasis or cell seeding?]. Chirurg 2019; 91:345-353. [PMID: 31781805 DOI: 10.1007/s00104-019-01070-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pheochromocytomatosis is defined as a multifocal cell dissemination limited to the operatively opened space with no signs of distant metastasis. After primary adrenalectomy due to a pheochromocytoma this is a rare and underrecognized manifestation of a tumor recurrence. Between 2010 and 2019 a total of 5 patients with the presentation of pheochromocytomatosis were treated in this center. Clinical and survival data were compared to 12 patients with a metastasized pheochromocytoma. Patients presenting with pheochromocytomatosis showed a better but not significant overall survival (136.8 vs. 107 months). Furthermore, patients with pheochromocytomatosis presented more often with a noradrenaline secretion type. Tumor recurrence in the pheochromocytomatosis group occurred on average 69.2 months after the initial diagnosis and was therefore much later than in patients with distant metastases from a pheochromocytoma (39 months, p = 0.13). This article outlines this special manifestation of recurrence of a pheochromocytoma based on this patient collective. Besides technical operative aspects there appears to be evidence for tumor-specific factors that promote the development of pheochromocytomatosis. Importantly, it seems that all patients with a pheochromocytoma should receive lifelong aftercare and that patients should be closely monitored during the first 5 years after surgery.
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Affiliation(s)
- F Weber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45124, Essen, Deutschland.
| | - J Belker
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45124, Essen, Deutschland
| | - N Unger
- Klinik für Endokrinologie und Stoffwechselerkrankungen, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45124, Essen, Deutschland
| | - H Lahner
- Klinik für Endokrinologie und Stoffwechselerkrankungen, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45124, Essen, Deutschland
| | - S Theurer
- Institut für Pathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45124, Essen, Deutschland
| | - K W Schmid
- Institut für Pathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45124, Essen, Deutschland
| | - D Führer
- Klinik für Endokrinologie und Stoffwechselerkrankungen, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45124, Essen, Deutschland
| | - H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45124, Essen, Deutschland
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Munteanu M, Kiewert C, Matar N, Hauffa BP, Unger N, Hiort O, Thiele S, Buiting K, Bramswig NC, Grasemann C. Resistance to GHRH but Not to PTH in a 15-Year-Old Boy With Pseudohypoparathyroidism 1A. J Endocr Soc 2019; 3:1383-1389. [PMID: 31286103 PMCID: PMC6608559 DOI: 10.1210/js.2019-00073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/14/2019] [Indexed: 12/26/2022] Open
Abstract
Pseudohypoparathyroidism 1A (PHP1A) consists of signs of Albright hereditary osteodystrophy (AHO) and multiple, variable hormonal resistances. Elevated PTH levels are the biochemical hallmark of the disease. Short stature in PHP1A may be caused by a form of accelerated chondrocyte differentiation leading to premature growth plate closure, possibly in combination with GH deficiency in some patients. Treatment of short stature with recombinant growth hormone (rhGH) in pediatric patients may improve final height if started during childhood. The 10 11/12-year-old boy with clinical signs of AHO presented for evaluation of short stature [height standard deviation score (SDS) −2.72]. Clinically his mother was affected by AHO as well. A heterozygous mutation c.505G>A (p.E169K) in exon 6 of the GNAS gene confirmed a diagnosis of PHP1A in the boy. However, hormonal assessment was unremarkable except for low serum IGF-1 (SDS −2.67). On follow-up, GH deficiency due to GHRH resistance was suspected and confirmed by clonidine and arginine stimulation tests. Treatment with rhGH (0.035 mg/kg) for 2 years resulted in catch-up growth (height SDS −1.52). At age 15 years the PTH levels and bone age of the patient remain within the normal range. In patients with PHP1A, short stature is caused by the effects of Gs-α deficiency on the growth plate. However, resistance to GHRH and the resulting GH deficiency might also contribute. Recombinant GH treatment increases growth in these patients. Diagnostic workup for GH deficiency as a factor contributing to short stature is recommended even in the absence of other hormonal resistances.
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Affiliation(s)
- Martin Munteanu
- Pediatric Endocrinology and Diabetology, Children's Hospital, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Cordula Kiewert
- Pediatric Endocrinology and Diabetology, Children's Hospital, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nora Matar
- Pediatric Endocrinology and Diabetology, Children's Hospital, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Rare Diseases Essen, EZSE, University Hospital Essen, Essen, Germany
| | - Berthold P Hauffa
- Pediatric Endocrinology and Diabetology, Children's Hospital, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Olaf Hiort
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Susanne Thiele
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Karin Buiting
- Institute for Human Genetics, University of Duisburg-Essen, Essen, Germany
| | - Nuria C Bramswig
- Center for Rare Diseases Essen, EZSE, University Hospital Essen, Essen, Germany.,Institute for Human Genetics, University of Duisburg-Essen, Essen, Germany
| | - Corinna Grasemann
- Pediatric Endocrinology and Diabetology, Children's Hospital, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Rare Diseases Essen, EZSE, University Hospital Essen, Essen, Germany
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Kreitschmann-Andermahr I, Grzywotz A, Müller O, Gammel C, Unger N, Siegel S. MON-452 Development of Concepts for Improved Patient Care: What Do Patients with Acromegaly Expect from Their Caregivers? J Endocr Soc 2019. [PMCID: PMC6550585 DOI: 10.1210/js.2019-mon-452] [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: 12/02/2022] Open
Abstract
Introduction:Traditional patient-clinician relationships are paternalistic in the sense that the clinician makes the decision of what is best for the patient. However, modern medicine requires a paradigm shift away from this type of interaction and a drive towards more patient-centered care, implying that physicians must gain a broader knowledge about the patients’ view of their illness. This also hold true for neuroendocrine disorders such as acromegaly. Here, we present the results of a focus group with acromegaly patients on their perceptions and needs concerning their illness. Patients and method:As a pre-project for a larger questionnaire study, a focus group research was conducted. Six patients with acromegaly who could not be cured by neurosurgery but required further therapies such as medical treatment and/or radiotherapy took part in this group, which was moderated by an external medical communication company (SDMed. Cologne, Germany). The group discussion focused on topics such as impact of the illness on everyday life and support needs. Results: The patients reported that the diagnosis “acromegaly” was experienced as a nightmare but also a relief after a long medical odyssey. The management of numerous doctors’ visits, procuring and applying medication (“illness as a part-time job”), the irreversible bodily changes due to acromegaly (“buying shoes ruins my day”, “I cannot look at photographs of myself”, “buying work gloves is simply impossible”), treating physicians’ lack of knowledge about the disease, but also a lack of reliable information for patients and relatives, maintaining the cold chain for medication when travelling and fears of the results of medical investigations were named as chronic stressors of living with acromegaly. Patients’ coping strategies included family support, sport, activities to balance out work and everyday life, and humor. The participants wished for a more interdisciplinary treatment of their illness, medical rehabilitation services with special knowledge on acromegaly-related morbidity, a stable contact person in the medical process and reliable information material about their illness for themselves and their relatives. Conclusion: Next to traditional medical care, a successful management of acromegaly requires knowledge about the everyday illness-related stressors and patients’ desires for successful treatment. Placing the focus solely on normalization of IGF-I levels does not seem to be adequate. This study was sponsored under a grant from Ipsen. Ipsen had no input into the study design, analysis or interpretation of results.
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Affiliation(s)
| | | | - Oliver Müller
- Department of Neurosurgery, UK Essen, Essen, , Germany
| | - Christa Gammel
- Department of Neurosurgery, UK Erlangen, Erlangen, , Germany
| | - Nicole Unger
- Endocrinology, Department of Endocrinology, UK Essen, Essen, , Germany
| | - Sonja Siegel
- Department of Neurosurgery, UK Essen, Essen, , Germany
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Unger N. Erratum zu: Inzidentalome der Nebennieren. Diagnostisches und therapeutisches Konzept aus endokrinologischer Sicht. Chirurg 2019; 90:235. [DOI: 10.1007/s00104-019-0809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pavel M, Unger N, Borbath I, Ricci S, Hwang TL, Brechenmacher T, Park J, Herbst F, Beaumont JL, Bechter O. Safety and QOL in Patients with Advanced NET in a Phase 3b Expanded Access Study of Everolimus. Target Oncol 2017; 11:667-675. [PMID: 27193465 DOI: 10.1007/s11523-016-0440-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS An open-label, multi-center, expanded access study was conducted in patients with advanced neuroendocrine tumors (NET) treated with everolimus (10 mg/day) to assess safety and health-related quality of life (HRQOL). METHODS Of the 246 patients enrolled, 126 have pancreatic NET (pNET) and 120 have non-pNET. Patients continued treatment until disease progression, unacceptable toxicity, death, until commercial availability of everolimus, or May 2012, whichever came first. Adverse events (AEs) were analyzed according to Common Terminology Criteria version 4.0. HRQOL was assessed at baseline, for three 28-day cycles, and then at every three cycles until end of treatment (EOT) with EQ-5D, EORTC QLQ-C30, and EORTC QLQ-GINET21 instruments. RESULTS The most common grade 3 or 4 AEs included hyperglycemia, infections, stomatitis, fatigue, and abdominal pain. In patients with pNET, mean (± SD) EQ VAS score remained stable at EOT (baseline, 68.8 ± 19.9 vs. EOT, 66.5 ± 20.6) without clinically significant change in QLQ-C30 global health status (change from baseline, - 3.9; n = 86). For patients with non-pNET, a reduction in EQ VAS score (63.9 ± 19.0 vs. 55.3 ± 23.0) with clinically significant changes in QLQ-C30 global health status (-13.0; n = 69) was seen by EOT. EQ-5D utility scores remained stable in patients with pNET and a moderate decrease was reported by patients with non-pNET. CONCLUSIONS The safety profile of everolimus was consistent with the previous studies without adversely affecting HRQOL in pNET. Lower baseline HRQOL scores and more frequent comorbidities might have contributed to the worse outcomes in non-pNET. TRIAL REGISTRATION EudraCT no. 2010-023032-17.
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Affiliation(s)
- Marianne Pavel
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
| | | | - Ivan Borbath
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Tsann-Long Hwang
- Chang Gung Memorial Hospital, Chang Gung University, Lin-Kou, Taiwan
| | | | - Jinhee Park
- Novartis Pharmaceuticals Corporation, Florham Park, NJ, USA
| | | | | | - Oliver Bechter
- University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
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Unger N, Klocker A, Führer D. Genetische Ursachen bei endokrinen Erkrankungen am Beispiel endokriner Tumorsyndrome. Dtsch Med Wochenschr 2017; 142:665-672. [DOI: 10.1055/s-0042-111373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
A coupled global aerosol–carbon–climate model is applied to assess the impacts of aerosol physical climate change on the land ecosystem services gross primary productivity (GPP) and net primary productivity (NPP) in the 1996–2005 period. Aerosol impacts are quantified on an annual mean basis relative to the hypothetical aerosol-free world in 1996–2005, the global climate state in the absence of the historical rise in aerosol pollution. We examine the separate and combined roles of fast feedbacks associated with the land and slow feedbacks associated with the ocean. We consider all fossil fuel, biofuel and biomass burning aerosol emission sources as anthropogenic. The effective radiative forcing for aerosol–radiation interactions is −0.44 W m−2 and aerosol–cloud interactions is −1.64 W m−2. Aerosols cool and dry the global climate system by −0.8 °C and −0.08 mm per day relative to the aerosol-free world. Without aerosol pollution, human-induced global warming since the preindustrial would have already exceeded the 1.5 °C aspirational limit set in the Paris Agreement by the 1996–2005 decade. Aerosol climate impacts on the global average land ecosystem services are small due to large opposite sign effects in the tropical and boreal biomes. Aerosol slow feedbacks associated with the ocean strongly dominate impacts in the Amazon and North American Boreal. Aerosol cooling of the Amazon by −1.2 °C drives NPP increases of 8% or +0.76 ± 0.61 PgC per year, a 5–10 times larger impact than estimates of diffuse radiation fertilization by biomass burning aerosol in this region. The North American Boreal suffers GPP and NPP decreases of 35% due to aerosol-induced cooling and drying (−1.6 °C, −0.14 mm per day). Aerosol–land feedbacks play a larger role in the eastern US and Central Africa. Our study identifies an eco-climate teleconnection in the polluted earth system: the rise of the northern hemisphere mid-latitude reflective aerosol pollution layer causes long range cooling that protects Amazon NPP by 8% and suppresses boreal NPP by 35%.
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Affiliation(s)
- N. Unger
- College of Engineering, Mathematics and Physical Sciences
- University of Exeter
- Exeter
- UK
| | - X. Yue
- Climate Change Research Centre
- Institute of Atmospheric Physics
- Chinese Academy of Sciences
- Beijing 100029
- China
| | - K. L. Harper
- School of Forestry and Environmental Studies
- Yale University
- New Haven
- USA
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Grasemann C, Unger N, Hövel M, Arweiler-Harbeck D, Herrmann R, Schündeln MM, Müller O, Schweiger B, Lausch E, Meissner T, Kiewert C, Hauffa BP, Shaw NJ. Loss of Functional Osteoprotegerin: More Than a Skeletal Problem. J Clin Endocrinol Metab 2017; 102:210-219. [PMID: 27809640 DOI: 10.1210/jc.2016-2905] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Received: 08/05/2016] [Accepted: 10/31/2016] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Juvenile Paget's disease (JPD), an ultra-rare, debilitating bone disease due to loss of functional osteoprotegerin (OPG), is caused by recessive mutations in TNFRFSF11B. A genotype-phenotype correlation spanning from mild to very severe forms is described. AIM This study aimed to describe the complexity of the human phenotype of OPG deficiency in more detail and to investigate heterozygous mutation carriers for clinical signs of JPD. PATIENTS We investigated 3 children with JPD from families of Turkish, German, and Pakistani descent and 19 family members (14 heterozygous). RESULTS A new disease-causing 4 bp-duplication in exon 1 was detected in the German patient, and a microdeletion including TNFRFSF11B in the Pakistani patient. Skeletal abnormalities in all affected children included bowing deformities and fractures, contractures, short stature and skull involvement. Complex malformation of the inner ear and vestibular structures (2 patients) resulted in early deafness. Patients were found to be growth hormone deficient (2), displayed nephrocalcinosis (1), and gross motor (3) and mental (1) retardation. Heterozygous family members displayed low OPG levels (12), elevated bone turnover markers (7), and osteopenia (6). Short stature (1), visual impairment (2), and hearing impairment (1) were also present. CONCLUSION Diminished OPG levels cause complex changes affecting multiple organ systems, including pituitary function, in children with JPD and may cause osteopenia in heterozygous family members. Diagnostic and therapeutic measures should aim to address the complex phenotype.
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Affiliation(s)
- Corinna Grasemann
- Pediatric Endocrinology and Diabetology, Klinik für Kinderheilkunde II and
- Center for Rare Bone Diseases, EZSE and Departments of
| | - Nicole Unger
- Center for Rare Bone Diseases, EZSE and Departments of
- Endocrinology, Diabetology, and Metabolism
| | - Matthias Hövel
- Center for Rare Bone Diseases, EZSE and Departments of
- Orthopedics and Trauma Surgery
| | | | - Ralf Herrmann
- Pediatric Neonatology, Klinik für Kinderheilkunde I and
| | - Michael M Schündeln
- Pediatric Hematology and Oncology, Klinik für Kinderheilkunde III and Departments of
| | | | - Bernd Schweiger
- Radiology and Neuroradiology, University Hospital Essen and The University of Duisburg-Essen, 45122 Essen, Germany
| | - Ekkehart Lausch
- Pediatric Genetics, Children's Hospital, University of Freiburg, 79106 Freiburg, Germany
| | - Thomas Meissner
- Department of General Paediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Cordula Kiewert
- Pediatric Endocrinology and Diabetology, Klinik für Kinderheilkunde II and
| | - Berthold P Hauffa
- Pediatric Endocrinology and Diabetology, Klinik für Kinderheilkunde II and
| | - Nick J Shaw
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham B4 6 NH, United Kingdom; and
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B4 6 NH, United Kingdom
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Abstract
Sunitinib treatment leads to improvement in progression-free survival in patients with advanced pancreatic neuroendocrine tumours (pNETs). However, limited data exist regarding the effectiveness, safety and tolerability in clinical practice. We present the results of the first detailed pNET cohort analysis since sunitinib was approved. Patients with advanced, differentiated pNET treated with sunitinib were retrospectively analysed. All patients had progressive disease before start of sunitinib treatment. Twenty-one patients, with a median age of 64 years (range 28-78), were included in this study. Nineteen patients could be analysed for treatment effectiveness. Twelve (57%) patients exhibited either a partial response (1 patient) or stable disease (11 patients) according to the RECIST criteria. The median progression-free survival was 7.0 months (95% CI 3.0-12.0); the probability of being event-free at 6 months was 52.6% (95% CI 28.4-72.1). Potential influencing factors as Ki-67 index, age or duration of disease did not show significant correlations with the response to sunitinib therapy. Considering the differences in patients' characteristics, sunitinib in daily practice showed effectiveness parameters similar to the phase III trial.
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Affiliation(s)
- H Lahner
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - A Rinke
- Department of Gastroenterology and Endocrinology, Philipps University Marburg, Marburg Germany
| | - N Unger
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - T D Poeppel
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany
| | - H Kühl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany
| | - N Lehmann
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - D Führer
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
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Szwako A, Acuña L, Rolón C, Glatzle F, Lemkemeyer C, Unger N, Wiebe J. SEROPREVALENCIA DE LEPTOSPIROSIS BOVINA EN EL CHACO CENTRAL, DEPARTAMENTO DE BOQUERON, PARAGUAY. Compend cienc vet 2015. [DOI: 10.18004/compend.cienc.vet.2015.05.01.26-30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Unger N, Simon A, Lahner H, Mellies U, Stehling F, Sutharsan S, Sommerwerck U, Teschler H, Kiewert C, Grasemann C, Hauffa BP, Führer D. Endocrine disorders in adolescents and young adults with cystic fibrosis. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lahner H, Gromotka E, Unger N, Führer D. Streptozotocin-based chemotherapy in pNET: A single-centre experience. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Becker S, Kribben A, Meister S, Diamantidis CJ, Unger N, Mitchell A. User profiles of a smartphone application to support drug adherence--experiences from the iNephro project. PLoS One 2013; 8:e78547. [PMID: 24194946 PMCID: PMC3806829 DOI: 10.1371/journal.pone.0078547] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [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: 03/11/2013] [Accepted: 09/20/2013] [Indexed: 01/15/2023] Open
Abstract
Purpose One of the key problems in the drug therapy of patients with chronic conditions is drug adherence. In 2010 the initiative iNephro was launched (www.inephro.de). A software to support regular and correct drug intake was developed for a smartphone platform (iOS). The study investigated whether and how smartphone users deployed such an application. Methods Together with cooperating partners the mobile application “Medikamentenplan” (“Medication Plan”) was developed. Users are able to keep and alter a list of their regular medication. A memory function supports regular intake. The application can be downloaded free of charge from the App Store™ by Apple™. After individual consent of users from December 2010 to April 2012 2042338 actions were recorded and analysed from the downloaded applications. Demographic data were collected from 2279 users with a questionnaire. Results Overall the application was used by 11688 smartphone users. 29% (3406/11688) used it at least once a week for at least four weeks. 27% (3209/11688) used the application for at least 84 days. 68% (1554/2279) of users surveyed were male, the stated age of all users was between 6–87 years (mean 44). 74% of individuals (1697) declared to be suffering from cardiovascular disease, 13% (292) had a previous history of transplantation, 9% (205) were suffering from cancer, 7% (168) reported an impaired renal function and 7% (161) suffered from diabetes mellitus. 69% (1568) of users were on <6 different medications, 9% (201) on 6 – 10 and 1% (26) on more than 10. Conclusion A new smartphone application, which supports drug adherence, was used regularly by chronically ill users with a wide range of diseases over a longer period of time. The majority of users so far were middle-aged and male.
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Affiliation(s)
- Stefan Becker
- Department of Internal Medicine I, Marienhospital Herne, University Hospital, Ruhr University Bochum, Herne, Germany
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Andreas Kribben
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
| | - Sven Meister
- Fraunhofer Institute for Software and Systems Engineering, Dortmund, Germany
| | - Clarissa Jonas Diamantidis
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Nicole Unger
- Department of Internal Medicine I, Marienhospital Herne, University Hospital, Ruhr University Bochum, Herne, Germany
| | - Anna Mitchell
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
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Bechter OE, Unger N, Borbath I, Ricci S, Hwang TL, Park YS, Tomasek J, Raef H, Laohavinij S, JeanLouis L, Panneerselvam A, Saletan S, Stergiopoulos SG, Pavel ME. Open-label, phase IIIb, multicenter, expanded access study of everolimus in patients with advanced neuroendocrine tumors (NET). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4138] [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: 11/20/2022] Open
Abstract
4138 Background: Everolimus (EVE) antitumor efficacy in patients (pts) with advanced NET was demonstrated in 2 double-blind, placebo (P)–controlled, phase III trials (RADIANT-2 and RADIANT-3). Median PFS in pancreatic (pNET) pts was 11.0 months (EVE) vs. 4.6 months (P) (HR 0.35, 95% CI 0.27-0.45, P <0.001) in RADIANT-3. Median EVE exposure in RADIANT-3 was 38 wks. EVE was approved for advanced pNET in the US and Europe in 2011. An expanded access protocol was launched to gather additional safety data and provide access to EVE for pts with advanced NET while awaiting regulatory approval. Methods: Pts aged ≥18 years with biopsy-proven NET; WHO performance status 0-2; and adequate bone, hepatic, and renal function were enrolled. Main exclusion criteria were poorly differentiated NET and cytotoxic therapy within 4 wks of enrollment. EVE (10 mg/d) was administered until disease progression, unacceptable toxicity, discontinuation, death, commercial availability of EVE, or until May 30, 2012. Pts were enrolled from April 21, 2011 to April 20, 2012. Primary objective was grade 3/4 and serious adverse events (AEs). Secondary objectives included investigator-assessed best overall response rate and PFS. Results: The full analysis set included 246 pts (pNET, n=126; non-pNET, n=120); the safety set included 240 pts (pNET, n=123; non-pNET, n=117). Median age was 61 and 66 years; 54% and 49% were male. Main primary tumor sites in non-pNET pts included small intestine (40%) and lung (22%). Median duration of EVE exposure was 12.1 wks and 24 wks in pNET and non-pNET. At data cutoff, there were 21 and 32 PFS events; 105 and 88 pts were censored. Grade 3/4 AEs were reported in 42.3% and 69.2% of pNET and non-pNET; those reported in ≥10% of pts in pNET and non-pNET included hyperglycemia (12.2% and 5.1%), diarrhea (10.6% and 31.6%), stomatitis (9.8% and 11.1%), nausea (8.1% and 10.3%), and anemia (5.7% and 11.1%). Median investigator-assessed PFS was 7.6 (95% CI 5.52-7.62) months and 10.8 (8.77-Not Estimable) months in pNET and non-pNET. Conclusions: EVE was well tolerated in pts with advanced NET. AEs were similar to those previously reported. Protocol-specified early termination of pts limits the interpretation of PFS medians. Clinical trial information: EudraCT Number: 2010-023032-17.
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Affiliation(s)
| | | | - Ivan Borbath
- Cliniques Universitaires Saint-Luc; Universite Catholique de Louvain, Brussels, Belgium
| | | | - Tsann-Long Hwang
- Chang Gung Memorial Hospital/Chang Gung University, Lin-Kou, Taiwan
| | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Hussein Raef
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sudsawat Laohavinij
- Oncology Unit, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | | | | | | | | | - Marianne E. Pavel
- Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
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Lahner H, Unger N, Schlamann M, Keyvani K, Sure U, Führer D. Malignant Prolactinoma - a therapeutic challenge. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Benson S, Neumann P, Unger N, Schedlowski M, Mann K, Elsenbruch S, Petersenn S. Effects of standard glucocorticoid replacement therapies on subjective well-being: a randomized, double-blind, crossover study in patients with secondary adrenal insufficiency. Eur J Endocrinol 2012; 167:679-85. [PMID: 22930487 DOI: 10.1530/eje-12-0351] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [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: 11/08/2022]
Abstract
OBJECTIVE For secondary adrenal insufficiency (SAI), established biochemical parameters for dosage control are lacking and no optimal substitution dosage and daily distribution have been determined yet. Therefore, in clinical practice, the individual total dose is often adjusted based on patients' subjective well-being. DESIGN Effects of three standard glucocorticoid replacement regimens on psychological variables were assessed in patients with SAI based on a randomized double-blind study design. METHODS SAI patients (n=18) were treated with three different established glucocorticoid replacement regimens in a randomized, double-blind, crossover study (treatment A, hydrocortisone 10 mg-placebo-5 mg-placebo; treatment B, hydrocortisone 10 mg-5 mg-placebo-5 mg; and treatment C, prednisone 5 mg-placebo-placebo-placebo). Following each 4-week replacement regimen, quality of life (SF-36) and emotional distress (brief symptom inventory (BSI)) were assessed along with diurnal changes in current well-being (Bf-S) and alertness (Stanford Sleepiness Scale (SSS)) using validated questionnaires, and additionally compared with patient (patients with pituitary disease and adrenal sufficiency) and healthy control groups. RESULTS SAI patients showed improvements in physical quality of life (i.e. SF-36 physical function, P<0.05; physical role function, P<0.05) and current well-being (at 1800 h, P<0.05) under treatment A (hydrocortisone 10-0-5-0 mg) compared with the other replacement regimens. Quality of life and current well-being were significantly impaired compared with healthy controls but did not differ from patient controls. CONCLUSIONS Although the observed improvements in psychological parameters were comparatively small, our results indicate beneficial effects of a 10-0-5-0 mg hydrocortisone replacement regimen. Nevertheless, treatment effects were insufficient to restore subjective health compared with healthy controls, indicating the need for improved replacement regimens and supportive psychosocial interventions in SAI patients.
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Affiliation(s)
- Sven Benson
- Institute of Medical Psychology and Behavioural Immunobiology, Essen, Germany
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Unger N, Ueberberg B, Schulz S, Saeger W, Mann K, Petersenn S. Differential Expression of Somatostatin Receptor Subtype 1–5 Proteins in Numerous Human Normal Tissues. Exp Clin Endocrinol Diabetes 2012; 120:482-9. [DOI: 10.1055/s-0032-1314859] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- N. Unger
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - B. Ueberberg
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - S. Schulz
- Institute of Pharmacology and Toxicology, University of Jena, Jena, Germany
| | - W. Saeger
- Institute of Pathology, Marienhospital, Hamburg, Germany
| | - K. Mann
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - S. Petersenn
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
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Unger N, Hinrichs J, Deutschbein T, Schmidt H, Walz M, Mann K, Petersenn S. Plasma and Urinary Metanephrines Determined by an Enzyme Immunoassay, but not Serum Chromogranin A for the Diagnosis of Pheochromocytoma in Patients with Adrenal Mass. Exp Clin Endocrinol Diabetes 2012; 120:494-500. [DOI: 10.1055/s-0032-1309007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- N. Unger
- Department of Endocrinology and Division of Laboratory Research, Medical Center, University of Duisburg-Essen
| | - J. Hinrichs
- Department of Surgery and Center of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany
| | - T. Deutschbein
- Department of Endocrinology and Division of Laboratory Research, Medical Center, University of Duisburg-Essen
| | - H. Schmidt
- Laboratory Dr. Limbach, Department of Endocrinology and Oncology, Heidelberg, Germany
| | - M. Walz
- Department of Surgery and Center of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany
| | - K. Mann
- Department of Endocrinology and Division of Laboratory Research, Medical Center, University of Duisburg-Essen
| | - S. Petersenn
- Department of Endocrinology and Division of Laboratory Research, Medical Center, University of Duisburg-Essen
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Petersenn S, Hu K, Maldonado M, Zhang Y, Lasher J, Bouillaud E, Wang Y, Mann K, Unger N. Tolerability and Dose Proportional Pharmacokinetics of Pasireotide Administered as a Single Dose or Two Divided Doses in Healthy Male Volunteers: A Single-Center, Open-Label, Ascending-Dose Study. Clin Ther 2012; 34:677-88. [DOI: 10.1016/j.clinthera.2012.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2012] [Indexed: 11/24/2022]
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Deutschbein T, Unger N, Yuece A, Eberhardt W, Gauler T, Lahner H, Mann K, Petersenn S. Chemotherapy in patients with progressive, undifferentiated neuroendocrine tumors: a single-center experience. Horm Metab Res 2011; 43:838-43. [PMID: 21989555 DOI: 10.1055/s-0031-1284354] [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: 10/16/2022]
Abstract
Treatment of patients with undifferentiated and histologically confirmed neuroendocrine tumors (NET) usually includes chemotherapeutic intervention. This retrospective study evaluated the outcome of 2 such chemotherapies. 18 patients (11 males; age 56.2 ± 2.5) with proven progressive disease were enrolled (mean Ki-67 34 ± 5%). Patients were treated from 2005 to 2007 with regimen A (carboplatin, etoposide, paclitaxel), and from 2007 to 2009 with regimen B (cisplatin, etoposide). This change was due to low tolerability of regimen A. The standard imaging procedure was computed tomography. 8 patients underwent treatment with regimen A (mean 3.3 ± 0.7 courses). Due to severe side effects, 3 patients had their therapy prematurely discontinued. The treatment responses of 6 patients who received more than 1 course were: 0% complete response (CR), 17% partial response (PR), 50% stable disease (SD), and 33% progressive disease (PD). The median progression free survival (PFS) was 6.7 months (range 3.2-10.0). In contrast, 12 patients received regimen B (mean 3.8 ± 0.4 courses), and none of them dropped out because of side effects. The overall responses were: 0% CR, 17% PR, 42% SD, and 42% PD. The median PFS was 6.3 months (range 2.8-26.4). The response rates of both regimes were not statistically different. Patients who were treated with regimen B demonstrated comparable PFS and less severe side effects than patients who received regimen A. However, patients need to be aware of the relatively short PFS time. In order to improve therapeutic outcome of patients with progressive undifferentiated NET, new therapeutic approaches and larger multi-center studies are needed.
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Affiliation(s)
- T Deutschbein
- Department of Endocrinology and Division of Laboratory Research, University Hospital of Essen, University of Duisburg-Essen, Germany
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Deutschbein T, Matuszczyk A, Moeller LC, Unger N, Yuece A, Lahner H, Mann K, Petersenn S. Treatment of advanced medullary thyroid carcinoma with a combination of cyclophosphamide, vincristine, and dacarbazine: a single-center experience. Exp Clin Endocrinol Diabetes 2011; 119:540-3. [PMID: 21667440 DOI: 10.1055/s-0031-1279704] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Experience with chemotherapy in patients with medullary thyroid carcinomas (MTC) is limited. This retrospective study evaluated the outcome of a combination of cyclophosphamide, vincristine, and dacarbazine ('CVD-regimen'), which has previously been suggested for treatment of malignant pheochromocytomas. METHODS 9 patients (5 males; age 55.0 ± 4.0 years) with MTC were enrolled. Prior to chemotherapy, progressive disease was established in all patients by use of WHO criteria. On day 1 of each cycle, patients started with cyclophosphamide 750 mg/m(2), vincristine 1.4 mg/m(2), and dacarbazine 600 mg/m(2); on day 2, patients received dacarbazine alone (600 mg/m(2)). Treatment cycles were repeated at 21-day intervals and 6 cycles were planned for each patient. The standard imaging procedure was computed tomography, and the primary end point was the objective tumor response rate. After chemotherapy, patients were followed up until progression. RESULTS 9 patients underwent a total of 57 cycles (mean 6.3 ± 0.3 cycles). Treatment responses were: 0% complete response, 11% partial response, 56% stable disease, and 33% progressive disease. The median progression free survival was 13.6 months (range 5.8-24.2 months). The median change (baseline vs. end of treatment) of calcitonin was -19% (range -70% to +174%). Reversible myelosuppression and moderate gastrointestinal symptoms were the most common adverse events. CONCLUSION Although objective tumor response rates were low, the CVD regimen allowed disease stabilization for a substantial period of time and had acceptable toxicity. After initial surgery, chemotherapy may therefore be considered as a medical treatment option.
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Affiliation(s)
- T Deutschbein
- Department of Endocrinology and Division of Laboratory Research, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Petersenn S, Unger N, Hu K, Weisshaar B, Zhang Y, Bouillaud E, Reséndiz KH, Wang Y, Mann K. Pasireotide (SOM230), a novel multireceptor-targeted somatostatin analogue, is well tolerated when administered as a continuous 7-day subcutaneous infusion in healthy male volunteers. J Clin Pharmacol 2011; 52:1017-27. [PMID: 21673137 DOI: 10.1177/0091270011408727] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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
Pasireotide is a novel multireceptor-targeted somatostatin analogue that has shown efficacy in patients with acromegaly and Cushing's disease when administered by subcutaneous (SC) injection. This study assessed the safety, tolerability, and pharmacokinetics (PK) of a continuous infusion of pasireotide in healthy volunteers. In this single-center, open-label, dose escalation study, healthy male volunteers received a 7-day continuous SC infusion of pasireotide in sequential ascending-dose cohorts. Single and/or 8-hour blood samples were taken on days 1 to 10 to assess PK and on days 1, 2, and 7 and a control day to assess glucose metabolism. Adverse events were evaluated throughout. Forty-four participants were enrolled into 8 cohorts: pasireotide 450, 900, 1350, 1800 (3 cohorts were enrolled at this dose level), 2250, and 2025 µg/d. Doses were well tolerated up to 2025 µg/d. Adverse events were generally mild and gastrointestinal. Pasireotide steady-state clearance was reduced at high doses, and plasma concentrations increased disproportionately with increasing dose. Blood glucose levels increased after initiation of pasireotide infusion with attenuation by day 7. Insulin and glucagon levels decreased after pasireotide infusion, with insulin levels exhibiting a greater degree of suppression. Pasireotide has the potential to be administered as a long-acting release formulation, and future studies are warranted.
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Affiliation(s)
- Stephan Petersenn
- Division of Endocrinology, Medical Center, University of Duisburg-Essen, Essen, Germany.
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Deutschbein T, Unger N, Hauffa BP, Schaaf K, Mann K, Petersenn S. Monitoring Medical Treatment in Adolescents and Young Adults with Congenital Adrenal Hyperplasia: Utility of Salivary 17α-Hydroxyprogesterone Day Profiles. Exp Clin Endocrinol Diabetes 2010; 119:131-8. [DOI: 10.1055/s-0030-1255104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Deutschbein T, Unger N, Jaeger A, Broecker-Preuss M, Mann K, Petersenn S. Influence of various confounding variables and storage conditions on metanephrine and normetanephrine levels in plasma. Clin Endocrinol (Oxf) 2010; 73:153-60. [PMID: 20039892 DOI: 10.1111/j.1365-2265.2009.03761.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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: 01/03/2023]
Abstract
OBJECTIVE Measurements of plasma free metanephrines have been advocated as first-line tests for phaeochromocytoma. The aim of the study was to assess the impact of potential confounding variables. DESIGN Comparative study between 2008 and 2009. SUBJECTS Hundred and eighty healthy subjects. MEASUREMENTS The effects of age, BMI, gender, menstrual cycle (sampling every 2 days), time of day (sampling every 2 h), venepunture (0, 15, 30, 60, 90 and 120 min), physical exercise (0, 15 and 30 min), coffee (0 and 60 min), breakfast (0 and 60 min) and various body positions (standing and supine rest, each 0 and 120 min) were evaluated. In addition, whole blood and plasma samples were stored at 4 degrees C or at 22 degrees C for 0, 1, 3, 24 and 72 h. Plasma free metanephrines were measured using radioimmunoassay (LDN). RESULTS While metanephrine was significantly influenced by sex and age, BMI and sex were significant predictors of normetanephrine. Coffee (+20%) and food (+8%) elevated normetanephrine significantly (P < 0.05), while metanephrine remained stable. Physical exercise increased metanephrine (+82%) as well as normetanephrine (+84%) significantly (P < 0.005). Supine rest significantly decreased both metanephrine (-34%) and normetanephrine (-19%) when compared to standing rest (P < 0.01). Metanephrine and normetanephrine were not significantly influenced by time of day, menstrual cycle or venepuncture. When plasma samples were stored at 4 degrees C, metanephrine and normetanephrine were stable for 72 h. CONCLUSIONS Physical exercise may lead to relevant changes in metanephrine and normetanephrine and should therefore be avoided prior to sampling. Although effects of age, sex and BMI were small, these variables should be considered when interpreting biochemical results. Blood should be taken in the supine position, and samples should be immediately centrifuged and stored at 4 degrees C to improve stability.
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Affiliation(s)
- Timo Deutschbein
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
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Deutschbein T, Unger N, Mann K, Petersenn S. Diagnosis of secondary adrenal insufficiency: unstimulated early morning cortisol in saliva and serum in comparison with the insulin tolerance test. Horm Metab Res 2009; 41:834-9. [PMID: 19585406 DOI: 10.1055/s-0029-1225630] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [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: 12/18/2022]
Abstract
Unstimulated early morning cortisol has been suggested as a first line parameter to assess adrenal function in patients with suspected secondary adrenal insufficiency. The measurement of basal salivary cortisol (BSaC) instead of basal serum cortisol (BSeC) offers some advantages, such as painless sampling and the determination of the free hormone. The objective of this study was to evaluate the diagnostic value of BSeC and BSaC in comparison to the insulin tolerance test (ITT). Seventy-seven patients with hypothalamic-pituitary disease and 184 healthy controls were enrolled. ITT were performed in patients, and BSeC as well as BSaC levels were measured in patients and controls. Upper and lower thresholds (with >or=95% specificity either for adrenal sufficiency or adrenal insufficiency) were calculated by ROC analysis both for BSeC and BSaC. The ITT identified 41 patients as adrenal insufficient and 36 patients as adrenal sufficient. Upper and lower cutoffs were 470 and 103 nmol/l for BSeC, and 21.1 and 5.0 nmol/l for BSaC, respectively. Thereby, basal cortisol allowed a highly specific diagnosis (i.e., similar to the ITT result) in either 23% (BSeC) or 27% (BSaC) of patients. We suggest the determination of unstimulated early morning cortisol as first-line screening method for the diagnosis of secondary adrenal insufficiency. If upper and lower cutoffs are used, dynamic testing could be obviated in about one fourth of cases. Due to its easy and painless collection BSaC may be preferable to BSeC.
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Affiliation(s)
- T Deutschbein
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
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Deutschbein T, Unger N, Hinrichs J, Walz MK, Mann K, Petersenn S. Late-night and low-dose dexamethasone-suppressed cortisol in saliva and serum for the diagnosis of cortisol-secreting adrenal adenomas. Eur J Endocrinol 2009; 161:747-53. [PMID: 19726566 DOI: 10.1530/eje-09-0517] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [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: 11/08/2022]
Abstract
OBJECTIVE In patients with adrenal incidentalomas, hormonally active masses need to be considered, particularly cortisol-producing adenomas (CPA), aldosterone-producing adenomas, and pheochromocytomas. The screening for hypercortisolism relies on confirming excess cortisol secretion and insufficient suppression after dexamethasone. Because of its high correlation with free cortisol and its stress-free collection, salivary cortisol (SaC) may offer advantages over serum cortisol (SeC). We evaluated the value of SaC and SeC for the diagnosis of CPA. Design Comparative study between 2001 and 2006. METHODS Thirty-eight patients with confirmed CPA were compared with 18 healthy subjects as well as 48 control patients suffering from aldosterone-producing adenomas (n=13), pheochromocytomas (n=16), or nonfunctioning adenomas (n=19). Sampling of saliva and serum was performed at 2300 and at 0800 h following low-dose dexamethasone suppression. Receiver operating characteristics analysis was used to calculate thresholds with at least 95% sensitivity for CPA. RESULTS Regarding the cutoffs for late-night cortisol, SaC (4.8 nmol/l, sensitivity 97%, specificity 69%) was slightly more specific than SeC (115 nmol/l, sensitivity 97%, specificity 63%). In contrast, the cutoff for dexamethasone-suppressed SaC (3.7 nmol/l, sensitivity 97%, specificity 83%) was slightly less specific than SeC (94 nmol/l, sensitivity 97%, specificity 88%). However, the latter cutoffs demonstrated greater specificity when compared with the cutoffs for late-night cortisol. CONCLUSION The diagnostic accuracy of SaC is as good as SeC. Owing to its higher specificity, dexamethasone-suppressed cortisol is preferable to late-night cortisol when screening for Cushing's syndrome in patients with adrenal incidentalomas.
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Affiliation(s)
- Timo Deutschbein
- Department of Endocrinology and Division of Laboratory Research, Medical Center, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
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Abstract
Ghrelin is a peptide thought to be involved in the regulation of appetite. Furthermore, significant effects on the release of growth hormone (GH) and ACTH were demonstrated. Contributing to the physiological relevance of this hormone, we investigated the expression of ghrelin and its receptor (GHS-R) in several normal human tissues. RNA samples (BD Biosciences) underwent one-step TaqMan Real-Time RT-PCR. Immunohistochemistry was performed on paraffin-embedded tissues using specific primary antibodies against ghrelin and its receptor. Relevant ghrelin mRNA levels were detected in all human tissues with the highest levels in stomach, pituitary, and small intestine. By immunohistochemistry, ghrelin peptide expression was detectable in reproductive and endocrine organs (ovary, anterior pituitary, adrenal gland), and organs of the gastrointestinal tract (stomach, pancreas). GHS-R1a mRNA expression was demonstrated in 10 of 24 human organs analyzed with the highest levels in pituitary, adrenal gland, and spinal cord. Expression of the receptor peptide was detected by immunohistochemistry in endocrine and reproductive organs (anterior pituitary, thyroid, pancreas, testis), parts of the CNS (cerebrum, cerebellum), and in single cells of bone marrow. Expression of both ghrelin and its receptor in endocrine and reproductive organs may indicate new endocrine or paracrine mechanisms of regulation in these tissues.
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Affiliation(s)
- B Ueberberg
- Department of Endocrinology and Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
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