111 research outputs found
Role of “old” pharmacological agents in the treatment of Cushing’s syndrome
No full textDespite recent advances in the management of endogenous Cushing’s syndrome (CS), its treatment remains a challenge. When surgery has been unsuccessful or unfeasible as well in case of recurrence, the “old” pharmacological agents represent an important alternative for both ACTH-dependent and independent hypercortisolism. Especially in the latter, the advent of novel molecules directly targeting ACTH secretion has not outweighed the “old” drugs, which continue to be largely employed and have recently undergone a reappraisal. This review provides a survey of the “old” pharmacological agents in the treatment of CS
VALUTAZIONE DELLA FUNZIONE SURRENALICA IN PAZIENTI ADULTI AFFETTI DA ΒETA-TALASSEMIA
No full textBetter transfusion and chelation regimens have changed the natural history of β-thalassaemia from high pediatric mortality to survival well into adulthood. On the other hand, increased survival led to the development of additional disorders and endocrinopathies rank among the most frequent long-term complications in thalassaemic patients. Only scant information is available on adrenocortical function in these patients, thus the risk of insufficient cortisol secretion in response to stressful events is unknown.
Aims of the present study were a) to estimate the prevalence of adrenocortical insufficiency in a large series of adult thalassaemic patients; b) to explore the usefulness of salivary cortisol for the diagnosis of adrenocortical insufficiency; c) to establish the impact of this endocrinopathy on the quality of life of patients with thalassaemia.
We recruited 72 patients (44 women, 28 men, age range 25-60 years) and measured serum and salivary cortisol after 1 μg ACTH stimulation test. All patients were administered SF-36 Health Survey for assessment of quality of life.
Subnormal serum cortisol responses to ACTH stimulation (i.e., <18 μg/dl) were registered in 14 patients (19%). Salivary cortisol increased in parallel with serum cortisol at all timepoints and a clear-cut positive correlation between both parameters was detected (r = 0.478, p<0.001 for peak cortisol). Peak salivary cortisol values after ACTH stimulation were significantly lower in patients with impaired adrenal reserve (0.7 ± 0.29 vs 1.3 ± 0.47 μg/dl, p<0.005) and proved good predictors of adrenocortical insufficiency at ROC analysis (Youden index J 0.693, 95% confidence interval 0.474; 0.855). Physical (PCS) and mental (MCS) health scores were below average in thalassaemic patients per se (PCS 47.1% ± 1.12; MCS 47.8% ± 1.36) without significant differences between patients with impaired or preserved adrenal reserve.
In conclusion, our study demonstrates that a significant proportion of adult thalassaemic patients present impaired adrenal reserve and underlines the need for testing for adrenal insufficiency in these patients. Serum and salivary cortisol levels during ACTH stimulation were closely correlated and salivary cortisol may represent a surrogate to serum cortisol for testing in thalassaemic patients
Drugs and the HPA axis
No full textThis paper outlines the interferences of the most widely used drugs with hypothalamo-pituitary-adrenal function and the related laboratory parameters, with the purpose of providing practical help to clinicians during testing for hypo- or hypercortisolemic states
Variability in laboratory parameters used for management of Cushing's syndrome
No full textThe progress in assay methodology, from the use of radioactive tracers to chemiluminescent signals, from competitive to chromatographic techniques and from serum or urine to saliva has considerably impacted on hormonal measurements. The clinician now may choose among multiple tests but the inherent variability in cortisol and ACTH secretion, coupled to lack of harmonization among assay procedures and normal ranges mandates careful interpretation of any result. The present review will examine factors which affect interpretation of cortisol and ACTH measurements and their impact on tests used for management of Cushing's syndrome
Pseudo-cushing : a clinical challenge?
No full textThe distinction between Cushing's syndrome and pseudo-Cushing is a major clinical challenge. Indeed, any endocrinologist used to dealing with Cushing's syndrome has certainly faced this dilemma more than once and is aware that there are no clear-cut solutions. Several factors contribute to this ongoing quandary, such as unbalanced epidemiology, overlap in clinical features and inherent variability in test responses. Thus, extreme care has to be taken in both excluding and confirming Cushing's syndrome in patients with mild clinical features and borderline laboratory alterations
New perspectives in the treatment of neuroendocrine tumors
No full textCharacterization of new and specific molecular features of the neuroendocrine tumors (NET) has prompted the development of more selective targeted pharmacological agents, potentially useful in the therapy of these tumors. NET express in a high percentage of cases the somatostatin receptors and type I and II interferon receptors. In addition, these tumors seem to have an extraordinary vascularization with high expression of proangiogenic molecules, such as vascular endothelial growth factor, and specific tyrosine kinase receptors. In this review article, we discuss the potential role and future perspectives of universal somatostatin analogues, new types of interferons and emerging inhibitors of angiogenesis in the treatment of NET.Characterization of new and specific molecular features of the neuroendocrine tumors (NET) has prompted the development of more selective targeted pharmacological agents, potentially useful in the therapy of these tumors. NET express in a high percentage of cases the somatostatin receptors and type I and II interferon receptors. In addition, these tumors seem to have an extraordinary vascularization with high expression of proangiogenic molecules, such as vascular endothelial growth factor, and specific tyrosine kinase receptors. In this review article, we discuss the potential role and future perspectives of universal somatostatin analogues, new types of interferons and emerging inhibitors of angiogenesis in the treatment of NET
Secular Reason as a Tool of the Early Jesuit Mission to China
No full textThis paper provides an investigation into Jesuits’ use of secular dialectical strategies during the early part of their evangelization mission in China. In order to prove the relevance of rhetoric stratagems – i. e. scientific verification, logic and universalism of norms – in their attack against Buddhism, this article examines a neglected text, Posthumous Disputes (Bianxue yidu 辯學遺牘). While the Posthumous Disputes (PD) was improperly attributed to Ricci, it is a prime example of Ricci’s accommodation method. Documenting the first real confrontation between a Buddhist and a Christian in China, this text provides an extraordinary window into the first dispute between Europe and China. The secular method of accommodation modelled by Ricci to convert Chinese literati was grounded in the universality of reason that he inherited from Aristotle and Aquinas and the fascination with Western science and techniques. The author uses the universality of reason to both reject Buddhism and Daoism as irrational, unscientific, and non-universal and to present the Christian faith as the most rational doctrine
Specificity of firstline tests for the diagnosis of Cushing's syndrome. Assessment in a large series.
No full textContext: The diagnosis of Cushing’s syndrome requires highly sensitive screening tests. Therefore, diagnostic cutoffs have been lowered
to maximize sensitivity and identify all patients. However, few studies have investigated the impact of these refinements on the specificity of first-line tests. Objective: The aim of the study was the assessment of the specificity of three widely used screening tests in a large series of Cushing’s syndrome suspects referred to our endocrine service.
Patients: We retrospectively reviewed the results of urinary free cortisol (UFC), 1-mg dexamethasone suppression test [overnight suppression test (OST)], and serum cortisol at midnight in 3461, 357, and 864 patients, respectively, with clinical features suggestive of Cushing’s syndrome but in whom this diagnosis was subsequently excluded.
Results: UFC and OST at the 5 μg/dl cutoff exhibited the highest specificities [91% (95% confidence intervals [CI] 90.2–92.1%) and 97% (95% CI 96.3–98.5%), respectively]. Conversely, midnight serum cortisol yielded 87% (95% CI 84.3–91.1%) specificity only with the 7.5 μg/dl cutoff, whereas the 1.8 μg/dl threshold resulted in an unacceptably
high proportion of false positives at only 20% specificity (95% CI 16.0–24.4%). Gender and age may lead to misleading results in all three screening tests. Conclusions: Specificity of tests for Cushing’s syndrome varies considerably, with OST and UFC presenting the best performances, and
circadian rhythm appearing heavily impaired by lowering of diagnostic cutoffs. Indeed, the vast majority of individuals in our series presented midnight serum cortisol values greater than 0.8 μg/dl; thus, caution has to be exercised when this criterion is used to exclude Cushing’s syndrome
Robert E. Allinson: The Philosophical Influences of Mao Zedong. Notations, Reflections and Insights.
No full textReview of Robert E Allinson: The Philosophical Influences of Mao Zedong. Notations, Reflections and Insights (London: Bloomsbury Academic, 2020)
This book is not merely a history of Mao’s thought, as it presents a philosophical inquest on its development. It is also a philosophical reflection on the state of contemporary Chinese society and culture employing Mao’s philosophical keys. What Allinson provides is a completely new narrative of the so-called Great Helmsman’s intellectual profile and all of 20th Chinese culture. This is the right book at the right moment for understanding China’s incredible growth and deep contradictions, but also the new Chinese diplomatic impatience towards unequal treatment on the international stage. Mao’s most unacceptable and dramatic decisions find a new coherency that, in this case, contradicts the thesis of the “banality of evil”. Allinson shows an excellent capacity to freely reflect with the thinker without lessening the tragic consequences of his political decisions. As the author states: “Mao represents a unique mixture between Plato’s philosopher king and Plato’s tyrant of the Republic” (p. 100)
Nothingness at the Crossroads of Minor Canons: A Dialogue between Wang Fuzhi and Charles de Bovelles
No full textIt is a mainstream assumption that Asian thinkers, and Chinese in particular, have devoted
much of their speculative energies to investigating emptiness and nothingness, whereas
these philosophical concepts would have been neglected (if not abhorred) in Western
thought. As Sorensen (2022, 77) says: “Having climbed to the precipice of being, the
Chinese and Indians pan across the vista of nothingness. They see an open horizon of
opportunity. The Greeks look down the cliff. They suffer vertigo”. In this article, we set
ourselves the task of questioning this assumption by presenting two authors who represent
opposing tendencies within their respective traditions. On the one hand, Wang
Fuzhi 王夫之 (1619–1692), normally described as a “materialist” and a bitter opponent
of the “emptiness” and “nothingness” of Buddhists and Daoists. On the other, Charles de
Bovelles (1479–1566), author of the short treatise Liber de Nihilo, in which nothingness
is posited as necessary to God for his existence and the unfolding of his power. Despite
being in different traditions and with different visions of nothingness, we will see how
their respective thoughts can meet and engage in dialogue in a productive manner
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