1,721,280 research outputs found
Italian Society of Endocrinology Career Award Lecture: from somatostatin to...somatomedin.
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Diffuse Endocrine System, Neuroendocrine Tumors and Immunity: What's New?
No full textDuring the last two decades, research into the modulation of immunity by the neuroendocrine system has flourished, unravelling significant effects of several neuropeptides, including somatostatin (SRIH), and especially cortistatin (CST), on immune cells. Scientists have learnt that the diffuse neuroendocrine system can regulate the immune system at all its levels: innate immunity, adaptive immunity, and maintenance of immune tolerance. Compelling studies with animal models have demonstrated that some neuropeptides may be effective in treating inflammatory disorders, such as sepsis, and T helper 1-driven autoimmune diseases, like Crohn's disease and rheumatoid arthritis. Here, the latest findings concerning the neuroendocrine control of the immune system are discussed, with emphasis on SRIH and CST. The second part of the review deals with the immune response to neuroendocrine tumors (NETs). The anti-NET immune response has been described in the last years and it is still being characterized, similarly to what is happening for several other types of cancer. In parallel with investigations addressing the mechanisms by which the immune system contrasts NET growth and spreading, ground-breaking clinical trials of dendritic cell vaccination as immunotherapy for metastatic NETs have shown in principle that the immune reaction to NETs can be exploited for treatment
Ectopic Cushing and other paraneoplastic syndromes in thoracic neuroendocrine tumors
No full textOverproduction of corticotropin by the pituitary gland or extrapituitary tumors leads to hypercortisolism or Cushing syndrome. Diagnosis of suspected Cushing syndrome involves 3 major steps: confirmation of hypercortisolism, differentiation between corticotropin-independent and corticotropin-dependent causes of Cushing syndrome, and distinction between pituitary and ectopic corticotropin production. A definitive diagnosis of ectopic corticotropin secretion requires stringent criteria, including reversal of the clinical picture after resection of the tumor and/or demonstration of corticotropin immunohistochemical staining within the tumor tissue
Pre-surgical treatment with somatostatin analogues in patients with acromegaly: The case for
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Somatostatin, somatostatin analogs and somatostatin receptor dynamics in the biology of cancer progression.
No full textSecondary diabetes associated with principal endocrinopathies: the impact of new treatment modalities.
No full textThe secondary occurrence of type 2 diabetes with various hormonal diseases (e.g.
pituitary, adrenal and/or thyroid diseases) is a recurrent observation. Indeed,
impaired glucose tolerance (IGT) and overt diabetes mellitus are frequently
associated with acromegaly and hypercortisolism (Cushing syndrome). The increased
cardiovascular morbidity and mortality associated with acromegaly and Cushing
syndrome may partly be a consequence of increased insulin resistance that
normally accompanies hormone excess. Acromegalic patients are insulin resistant,
both in the liver and in the periphery, displaying hyperinsulinemia and increased
glucose turnover in the basal post-absorptive states. The prevalence of diabetes
mellitus and that of IGT in acromegaly is reported to range 16-56%, whereas the
degree of glucose tolerance seems correlated with circulating growth hormone (GH)
levels, age, and disease duration. Moreover, a family history of diabetes and
concomitant presence of arterial hypertension have been found to predispose to
diabetes as well. GH has physiological effects on glucose metabolism, stimulating
gluconeogenesis and lipolysis, which results in increased blood glucose and free
fatty acid levels. Conversely, insulin-like growth factor 1 (IGF-I) enhances
insulin sensitivity primarily on skeletal muscles. However, in acromegaly,
increased IGF-I levels are unable to counteract the insulin-resistance status
determined by GH excess. Therapy with somatostatin analogues (SSAs) induce
control of GH and IGF-I excess in the majority of patients, but their inhibitory
effect on pancreatic insulin secretion might complicate the overall effect of
this treatment on glucose tolerance. Hypercortisolism produces visceral obesity,
insulin resistance, and dyslipidemia that together with hypertension,
hypercoagulability, and ventricular morphologic and functional abnormalities
increase cardiovascular risk, and persist up to 5 years after resolution of
hypercortisolism. Hypercortisolism leads to hyperglycaemia and reduced glucose
tolerance, determines insulin resistance, stimulates hepatic gluconeogenesis and
glicogenolisis. In Cushing syndrome the prevalence of diabetes varies between 20
and 50%, but probably this prevalence is underestimated, as not always an oral
glucose tolerance test is performed in the presence of an apparently normal
fasting glycaemia. Again, disease duration, rather than hormone levels, seems to
be the major determinant in the occurrence of systemic complications in Cushing
syndrome. Due to the impact they have on mortality and morbidity in both
acromegaly and Cushing syndrome, these complications should be treated
aggressively. In patients with neuroendocrine tumours (NETs) the occurrence of
altered glucose tolerance may be due to a decreased insulin secretion, like it
happens in patients who underwent pancreatic surgery and in those with
pheochromocytoma, or to an altered counterbalance between hormones, such as in
patients with glucagonoma and somatostatinoma. Moreover, SSAs represent a valid
therapeutic choice in the symptomatic treatment of NETs, and also in this case
the medical therapy of the primary disease, may have a significant impact on the
prevalence of glucose metabolism imbalance. In thyroid disorders, an abnormal
glucose tolerance may be principally encountered in hyperthyroidism. The
pathogenesis is complex and scant data on prevalence and severity are found in
the literature. Adequate treatment for glucose imbalance is mandatory in these
peculiar patients in line with the American Diabetes Association and the European
Association for the Study of Diabetes consensus statement. In particular, since
traditional insulins have two features that may complicate therapy (absorption
profiles, delayed onset of action and peak activity), the new insulin analogues
could be of particular interest in the management of the secondary diabetes
associated with endocrinopathies, considering the frailty of these patients.
Indeed, it has been demonstrated that insulin glargine, given once daily, reduces
the risk of hypoglycaemia compared with other formulations, and can facilitate a
more aggressive insulin treatment in this class of patients
Routine Evaluation of Somatostatin Receptor Type 2 in Patients With Acromegaly: Do We Still Need More Evidence?
No full textManaging Cushing's disease: the state of the art.
No full textCushing's disease is a rare chronic disease caused by a pituitary adenoma, which leads to excess secretion of adrenocorticotropic hormone (ACTH). The over-production of ACTH leads to hyperstimulation of the adrenal glands and a chronic excess of cortisol, resulting in the signs and symptoms of a severe clinical state (Cushing's syndrome) that leads to significant morbidity, negative impacts on the patient's quality of life, and, if untreated, increased mortality. The management of patients with Cushing's disease is complicated by the heterogeneity of the condition, with signs and symptoms that overlap with those of other diseases, and high subclinical incidence rates. Controversies surrounding the tests used for screening and identifying patients with Cushing's disease add to the challenge of patient management. Surgical intervention to remove the adenoma is the first-line treatment for patients with Cushing's disease, but medical therapies are useful in patients who relapse or are unsuitable for surgery. The recent introduction of pasireotide, the first pituitary-directed medical therapy, expands the number of treatment options available for patients with Cushing's disease. This state-of-the-art review aims to provide an overview of the most recent scientific research and clinical information regarding Cushing's disease. Continuing research into improving the diagnosis and treatment of Cushing's disease will help to optimize patient management
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