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Evolution of computed tomography-detectable adrenal nodules in patients with bilateral primary aldosteronism
Full text linkIdiopathic hyperaldosteronism due to bilateral autonomous production of aldosterone is the most common subtype of primary hyperaldosteronism and is diagnosed by adrenal venous sampling. The aim of our study was to assess the over time evolution of computed tomography (CT)-detectable adrenal nodule(s) in patients with idiopathic hyperaldosteronism. Thirty-two patients (23 males and 9 females; age 50±9 years) diagnosed as bilateral PA and having nodular adrenal lesions (median diameter 12 mm, range 8 to 28 mm; 28 unilateral and 4 bilateral), were studied. Adrenal was described as nodular when unilateral or bilateral nodule(s) of at least 8 mm in diameter were detected using CT with contrast and fine cuts. The diagnosis of a benign adrenal nodule rested on the following CT criteria: size <4 cm, regular shape with well-defined margins, homogeneous and hypodense content. All patients had CT imaging re-evaluated 3 to 6 years (median 45 months) after diagnosis. A unilateral nodular lesion enlargement ≥25% was detected in 2 cases; a slight increase (<25%) or no variations or a decrease of nodule size occurred in the remaining 30 cases. No patients showed appearance of radiological picture of malignancy or new masses in the ipsilateral/contralateral glands. At follow-up all patients reported compliance to medications, and 29/32 patients had a persistent clinical/biochemical control of the disease. Three patients showed hypertension resistant to a combination of four different antihypertensive drugs. Over time CT variations of adrenal nodules are uncommon and without apparent signs of malignancy in patients with AVS-confirmed bilateral PA. A diagnosti
Left ventricular geometry and 24-h blood pressure profile in Cushing’s syndrome
Full text linkCushing's syndrome (CS) is associated with cardiovascular disease. The impact of the hemodynamic load on left ventricular mass (LVM) in patients with CS is not well known. In fact, the effects of 24-h blood pressure (BP) load and BP circadian rhythm on cardiac structure and function have not been studied. Aim of the present study has thus been to assess the presence of cardiac remodeling in patients with newly diagnosed CS, combining evaluation of cardiac remodeling and assessment of BP burden derived by 24-h ambulatory blood pressure monitoring (ABPM). 25 patients (4 M, 21 F) with CS underwent echocardiography in order to assess cardiac morphology and geometry (relative wall thickness-RWT). As controls, 25 subjects similar for demographic characteristics and 24-h BP were used. CS Patients were similar to controls by age, sex, mean 24-h BP, and body mass index. There was a significant increase in left ventricular mass (LVM; 44.4 ± 14.7 vs. 36.9 ± 10 g/m2.7, p = 0.03) and a significant increase in RWT (0.46 ± 0.07 vs. 0.41 ± 0.08, p = 0.02) in CS patients compared to controls. The prevalence of CS patients with pressure non-dipping profile was greater than that of controls (56 vs. 16 %, p < 0.05), with no significant association with LVM or geometry. 24-h urinary cortisol was not associated with LVM (r = 0.1, p = 0.5) or RWT (r = 0.02, p = 0.89) in the CS group. In conclusion, LVM and the concentric pattern of the left ventricle are relatively independent from 24-h BP load and profile (dipping/non-dipping) in CS patient
Heart rate variability is reduced in acromegaly patients and improved by treatment with somatostatin analogues
Full text linkBACKGROUND: Cardiovascular complications, including arrhythmias and cardiac
sudden death, are the most common causes of enhanced mortality in acromegaly.
However, few data are available on cardiac autonomic functions and sympathovagal
balance in acromegalic patients.
OBJECTIVE: The aim of this study was to investigate both the time and frequency
domain parameters of Heart Rate Variability (HRV), in order to characterize the
cardiac autonomic functions in patients affected by acromegaly. This study
correlated anthropometric, metabolic, echocardiographic parameters and blood
pressure with those relating to HRV, to identify the main factors responsible for
the HRV related alterations possibly present. We also aimed to analyze the
effects of the treatment with somatostatin analogues (SSAs) on HRV.
MATERIALS AND METHODS: This study enrolled 47 acromegalic patients (23 males, age
49.1 ± 13.5 years) and 37 (13 males) age matched (52.3 ± 13.3 years) healthy
subjects. All participants underwent 12-lead 24 h ECG Holter recordings and a HRV
analysis of the ECG tracings was performed. The parameters obtained from the time
domain analysis of HRV included pNN50, SDNN, SDNN index, SDANN and RMSSD. The
power spectral analysis of HRV was obtained by summing powers of the LF (low
frequency) and the HF (high frequency) band. Sympathovagal balance was estimated
by calculating the LF/HF ratio during 24 h and 15 min of clinostatism. The HRV of
28 acromegalic patients was studied before and after SSAs treatment.
RESULTS: Acromegalic patients showed significantly lower SDNN and SDANN compared
to controls. Diabetic and non-diabetic acromegalic patients showed decreased SDNN
and SDANN, when compared to healthy subjects. Diabetic acromegalic patients had a
lower LF/HF ratio during 24 h when compared to non-diabetic acromegalic patients.
Similar results were obtained analyzing patients affected by acromegaly and
impaired glucose tolerance. SDNN and SDANN were lowered by hypertension in the
acromegalic population, when compared to controls, and hypertensive acromegalic
patients also displayed a decreased LF/HF ratio during 24 h when compared to
normotensive acromegalic subjects. Patients with ventricular arrhythmias in Lown
classes 3-5 showed a decreased SDANN compared to patients in Lown class 0-2. The
treatment with SSAs was able to ameliorate all the time domain parameters of HRV,
without altering the 24 h LF/HF ratio.
CONCLUSION: Cardiac autonomic functions and sympathovagal balance are altered in
patients affected by acromegaly and could be ameliorated by SSAs therapy. HRV
analysis allows an estimation of the autonomic sympathovagal balance and may be a
useful clinical tool for the cardiac risk stratification in acromegalic patients
Ambulatory Arterial Stiffness Indexes in Cushing’s Syndrome
Full text linkLong-standing exposure to endogenous cortisol excess is associated with high cardiovascular risk. The aim of our study was to investigate arterial stiffness, which has been recognized as an independent predictor of adverse cardiovascular outcome, in a group of patients with Cushing's syndrome. Twenty-four patients with Cushing's syndrome (3 males, mean age 49±13 years; 20 pituitary-dependent Cushing's disease and 4 adrenal adenoma) underwent 24-h ambulatory blood pressure monitoring (ABPM) and evaluation of cardiovascular risk factors. The Ambulatory Arterial Stiffness Index (AASI) and symmetric AASI (sAASI) were derived from ABPM tracings. Cushing patients were divided into 8 normotensive (NOR-CUSH) and 16 hypertensive (HYP-CUSH) patients, and were compared with 8 normotensive (NOR-CTR) and 16 hypertensive (HYP-CTR) control subjects, matched for demographic characteristics, 24-h ABPM and cardiometabolic risk factors. The AASI and sAASI indexes were significantly higher in Cushing patients than in controls, either in the normotensive (p=0.048 for AASI and p=0.013 for sAASI) or in the hypertensive (p=0.004 for AASI and p=0.046 for sAASI) group. No difference in metabolic parameters was observed between NOR-CUSH and NOR-CTR or between HYP-CUSH and HYP-CTR groups. AASI and sAASI were both correlated with urinary cortisol in patients with endogenous hypercortisolism (Spearman's rho=0.40, p=0.05, and 0.61, p=0.003, respectively), while no correlation was found in controls. Both AASI and sAASI are increased in Cushing syndrome, independent of BP elevation, and may represent an additional cardiovascular risk factor in this disease. The role of excess cortisol in arterial stiffness has to be further clarified
Cushing in a Leaf: Endocrine Disruption From a Natural Remedy
No full textInformation regarding the safety of herbal drugs is often not reported. We describe the case of a 65-year-old woman referred to us for a iatrogenic hypercortisolism, who denied any previous steroid consumption. She reported only a chronic application of a phytocosmetic cream, containing ethanol extract of the Cardiospermum halicacabum (CH) plant. Adrenal insufficiency occurred after the cream application was stopped. CH is used in traditional and Western medicine for its documented anti-inflammatory properties. Once the presence of synthetic glucocorticoids was ruled out in the phytocosmetic product, we investigated whether and how its chronic application could have caused the iatrogenic hypercortisolism
Recovery rate and recovery time in cows with luteal and follicular ovarian cysts after treatment with buserelin
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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