1,721,146 research outputs found
Insulin autoimmune syndrome: from diagnosis to clinical management
No full textAutoimmune forms of hypoglycemia are a rare cause of low blood sugar levels among
Caucasians, and often go misdiagnosed, exposing patients to lengthy series of
pointless, potentially harmful and expensive tests. There are two types of
autoimmune hypoglycemia. One is insulin autoimmune syndrome (IAS), which is
characterized by hyperinsulinemic hypoglycemia, elevated insulin autoantibody
(IAA) titers, no prior exposure to exogenous insulin, and no of pathological
abnormalities of the pancreatic islets. This condition is also known as "Hirata's
disease". The other is type B insulin resistance syndrome (TBIRS), a rare
autoimmune disorder resulting in a broad array of abnormalities in glucose
homeostasis-from hypoglycemia to extremely insulin-resistant hyperglycemia-caused
by the presence of insulin receptor autoantibodies (IRAbs). This review focuses
on these two syndromes, describing their epidemiology, possible genetic
background, clinical presentation, pathophysiology, diagnosis and treatment
Cure and survival of sporadic medullary thyroid carcinoma following systematic preoperative calcitonin screening
Full text linkBackground: The improvement in outcome of sporadic medullary thyroid carcinoma (MTC) during the last decades remains controversial, even if a trend toward a better prognosis has been recently proposed. This study was aimed to determine the time trend cure and survival rates in sporadic MTC according to the use of systematic preoperative calcitonin screening. Methods: Retrospective analysis of 178 sporadic MTC patients operated between 1980 and 2017 was performed. The impact of prognostic factors on cure and survival following the introduction of routine preoperative calcitonin screening in 2001 was evaluated according to the year of surgery. Results: Since 2001, a significant decline of node-positive tumors (from 56.1 to 34.7%) and advanced stage at diagnosis (stage III/IV from 56.1 to 34.7%) occurred, with a concomitant significant increase in cure rate (64.5% vs 38.6%; p = 0.0012) and survival (p < 0.05). At univariate analysis, the cure was achieved more frequently in more recently operated patients (64.5% vs 38.6%; p = 0.0012), in disease staging I/II (86.5% vs 13.5%; p < 0.0001), in patients undergoing preoperative calcitonin screening (63.8% vs 23.5%; p < 0.0001) and in the absence of lymph node metastases (86.5% vs 13.5%; p < 0.0001). At multivariate analysis, only preoperative calcitonin screening and stage at diagnosis turned out to be significant independent prognostic factors for cure and survival. Conclusion: The outcome of sporadic MTC improved in the new millennium; diagnosis was achieved earlier, at a less advanced stage. Routine preoperative calcitonin screening may have contributed to improve cure and survival rates
L’elastosonografia come sostituto dell’esame citologico nei nodi soffici
No full textContesto: l’elastosonografia è una metodica sempre più utilizzata nello studio ecografico dei nodi tiroidei. In un nostro precedente studio abbiamo dimostrato la maggior affidabilità dello Strain Index (SI), ovvero l’elasticità misurata del nodo, rispetto allo Strain Ratio (SR), cioè il rapporto dell’elasticità del tessuto tiroideo e di quella del nodo, e alla scala colorimetrica di Itoh, sia per quanto riguarda la riproducibilità intra- e inter-operatore, sia per l’accuratezza.
Scopo dello studio: si ipotizzava che, per l’elevata sensibilità dimostrata, nei nodi soffici lo SI potesse essere un’alternativa alla citologia, riservando quest’ultima ai soli nodi ipoelastici. Questo lavoro si propone di dimostrare tale ipotesi.
Materiali e Metodi: abbiamo valutato 166 nodi tiroidei, sottoposti consecutivamente a FNAC presso l’UO di Endocrinologia di Padova nel periodo giugno 2012-marzo 2013. confrontando il dato elastografico con quello citologico. Solo per i 12 nodi risultati TIR3 alla citologia, abbiamo tenuto conto dell’esito dell’esame istologico per definirne malignità o benignità. Di ogni nodo abbiamo valutato lo SI (media di due misurazioni) e i fattori di sospetto ecografico classici (ecogenicità, margini, microcalcificazioni).
Risultati: il miglior cut-off per definire soffice un nodulo è risultato SI≥0.15, con sensibilità del 93% e specificità del 71%. Utilizzando tale cut-off, solo 2 nodi sospetti allo
FNAC sono risultati “falsi negativi” all’elastografia: un carcinoma follicolare, che allo FNAC era risultato TIR3, e un TIR4 che in realtà si è rilevato all’intervento un falso positivo della citologia. La sensibilità dei criteri ecografici classici era inferiore (73%), a fronte di una maggiore specificità (89%), con 8 falsi negativi rispetto allo FNAC.
Unendo i criteri ecografici con lo SI non si aggiungeva nulla alla sensibilità rispetto al solo SI. Conclusioni: lo SI si conferma il più importante criterio nella diagnostica ecografica dei nodi tiroidei, permettendo di predire con notevole precisione l’esito negativo di un esame citologico nei noduli soffici (e istologico nei TIR3). Ciò consente di ridurre drasticamente il numero di nodi da sottoporre a FNAC. Tale metodica risulta quindi vantaggiosa per il paziente, che evita un’indagine invasiva, e cost-effective (con risparmio di tempo e risorse)
Differences in autoimmune thyroid diseases between females and males: the result of a complex interconnection of factors
No full textPurpose: The aim of this paper is to review the scientific evidence for the link between autoimmune thyroid diseases (AITDs) and sex, and the plausible causes of the female prevalence in AITDs. Methods: An extensive literature search of published articles was conducted using online search engines. Results: AITDs are more frequent in the female sex. Numerous studies have focused on the differences between males and females in their presentation of AITD and their response to therapy, sometimes with conflicting results. Several factors are considered to be responsible for the higher incidence of AITDs in females, crucial among which is the relationship between sex hormones and the immune system. In addition to hormones, there is also evidence that sex chromosomes, epigenetic factors, foetal microchimerism, the microbiota and endocrine-disrupting chemicals (EDCs) play an important role in the predisposition of females to AITDs. Conclusion: The prevalence of AITDs in the female sex appears to be attributable to numerous factors, the most important being the influence of sex hormones on the immune system
Other markers of medullary thyroid cancer, not only calcitonin
No full textBackground: Medullary thyroid cancer (MTC) is a rare neuroendocrine tumor originating from parafollicular C-cells. It represents 2% of all thyroid malignancies and 0.4-1.4% of all thyroid nodules. MTC has a variable clinical course, with complete remission often difficult to achieve. An early diagnosis is still crucial in MTC management, enabling a radical surgical treatment, the only chance for curing the patient. Calcitonin (Ct) is a very sensitive MTC tumor marker in patients with thyroid nodules, although Ct-negative MTCs have been described, but not all clinical guidelines recommend the Ct routine measurement in thyroid nodules because of the absolute low prevalence of MTC in the general population and the consequent scarce positive predictive value of Ct. Moreover, the specificity of moderately high Ct levels is not high. Thus, the scientific community has been investigating the possible role of other tumor markers for MTC diagnosis and prognosis. Aim of the review: The present review is an attempt to summarize the knowledge available today on the role of other serum markers for MTC alternative to Ct. Conclusions: At present, literature data does not seem solid enough yet to establish effective flowcharts in evaluating a thyroid nodule for MTC, involving alternative serum markers, particularly in cases of moderately high CT levels. MTC is a rare diagnosis in thyroid nodules, and this makes the evaluation of any tumor serum marker accuracy problematic. More extensive and prospective studies are needed to shed more light on this intriguing challenge
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