1,721,113 research outputs found
Cushing's syndrome: Overview of clinical presentation, diagnostic tools and complications
No full textCushing's syndrome (CS) is a severe condition that results from chronic exposure to elevated circulating cortisol levels; it is a rare but potentially life-threating condition, especially when not timely diagnosed and treated. Even though the diagnosis can be straightforward in florid cases due to their typical phenotype, milder forms can be missed. Despite the availability of different screening tests, the diagnosis remains challenging as none of the available tools proved to be fully accurate. Due to the ubiquitous effect of cortisol, it is easy understandable that its excess leads to a variety of systemic complications including hypertension, metabolic syndrome, bone damages and neurocognitive impairment. This article discusses clinical presentation of CS with an eye on the most frequent cortisol-related comorbidities and discuss the main pitfalls of first- and second-line tests in endogenous hypercortisolism diagnostic workup
Who and how to screen for endogenous hypercortisolism in a high-risk population: a special issue of the journal of endocrinological investigations
No full textCOVID-19 outbreak and steroids administration: are patients treated for Sars-Cov-2 at risk of adrenal insufficiency?
Full text linkVirtual model and acoustic characterisation of the ancient Roman theatre in Brescia
No full textThis paper deals with the ancient Roman theatre of Brescia. Built in the Augustan age (late first century BC - early first century AD), it was one of the largest roman theatres in northern Italy. The importance of the theatre is confirmed by its location, close to the Capitoline Temple and the Roman Forum. Over the centuries, major changes and damages occurred to the whole archaeological area. No acoustic investigation has been conducted before the one presented in this paper. On-site measurements were performed by using an Exponential Sine Sweep (ESS) signal. The impulse responses of the site were obtained through the Time Reversal Mirror (TMR) technique. Due to the current state of conservation of the site, the experimental results were not sufficient to describe the acoustic quality of the theatre; therefore, two numerical models have been realized, one referred to the original building and the other referred to the renovation occurred during the Severan age. Four different scenarios, relating to different configurations of coating materials and the presence of spectators, were simulated by means of a pyramid tracing software. The models allowed also to determine the acoustic quality parameters of the theatre. Thanks to the availability of the impulse responses obtained from the models, it was possible to convolve them with anechoic recordings, thus simulating the perception of different types of performances
Terapia estroprogestinica in età fertile
No full textIl capitolo tratta la terapia estro-progestinica in età fertile:
- indicazioni
- terapia sostitutiva ormonale
- contraccettivi orali
- controindicazioni
- modalità di somministrazion
Pituitary-adrenal axis and peripheral cortisol metabolism in obese patients
No full textBackground and aim: A close relationship between adiposity and increased cortisol levels is well established in patients with endogenous hypercortisolism. Nevertheless, hypothalamic-pituitary-adrenal (HPA) axis regulation in overweight subjects is still a matter of concern. We studied free cortisol (urinary free cortisol, UFC and late night salivary cortisol, LNSC), pituitary feedback (serum cortisol after 1 mg dexamethasone suppression test, 1 mg DST) and peripheral cortisol metabolism (urinary cortisol to cortisone ratio, F/Eratio) in a large series of overweight subjects without Cushing’s Syndrome. Materials and methods: We considered 234 patients divided in 5 BMI classes, matched for age and gender (BMI ≤ 25 kg/m2n = 38; 25–30 n = 58; 30–35 n = 52; 35–40 n = 52; >40 n = 34). UFC, LNSC and urinary F/Eratio were assessed with LC-MS. Results: We collected 183 LNSC, 176 UFC, 152 1 mg DST and 64 F/Eratio tests. UFC levels were higher in lean subjects, and they decreased according to the BMI classes (p = 0.022). Non-suppressed cortisol levels (>50 nmol/L) after 1 mg DST were observed especially in patients with normal weight or mild obesity. Patients with BMI ≥ 35 kg/m2 revealed a reduced F/Eratio (0.39 vs. 0.61, p = 0.006). The specificity of tests (false positive results) was higher considering 1 mg DST or UFC in obese patients, on the contrary impaired cortisol rhythm (LNSC above normality) was observed in 47 subjects, irrespective of weight. Conclusions: Overweight and obese subjects are characterised by an original regulation of HPA axis (reduced UFC levels, increased suppression after 1 mg DST) and peripheral cortisol metabolism (reduced F/Eratio), suggesting an effort to counteract hypercortisolism
Frequently Asked Questions in Patients With Adrenal Insufficiency in the Time of COVID-19
Full text linkAdrenal insufficiency (AI) is a life-threatening disorder, with increased morbidity and mortality, especially in case of an acute illness that can increase the requirement of cortisol. A novel infectious disease, termed Coronavirus Disease 2019 (COVID-19), appeared in 2020. Therefore, AI patients are experiencing a novel challenge: the risk of infection. In our experience, a prompt contact to the Endocrine center (with a telemedicine consultation) and a full awareness of diseases (cortisol deficiency, COVID-19 and the self-management of an adrenal crisis) are important to motivate patients. Vaccine is an effective treatment to prevent hospitalization and aggressive course of COVID-19. Some patients manifest challenges due to inequitable access and vaccine hesitancy, resulting in a delay in the acceptance of vaccines despite the availability of vaccination services. Therefore, an effort of all physicians must be conducted in order to advise patients with AI. In this short review, we try to answer some frequently asked questions regarding the management of patients with AI
What we have to know about corticosteroids use during Sars-Cov-2 infection
Full text linkPurpose: Glucocorticoids (GCs), alone or associated to other drugs, were widely used in the management of patients affected by severe acute respiratory syndrome caused by SARS-CoV-2 infection, during the recent COVID-19 outbreak. This review summarizes the available data on HPA axis impairment in GC-treated SARS-CoV-2 patients, focusing on the risk of adrenal insufficiency and on potential drug interactions during concomitant treatments. Methods: Literature on the impact of GCs therapy on HPA axis and on the consequences of coadministration of GCs and other drugs in SARS-CoV-2 patients has been reviewed. Results: GC treatment can cause symptoms of hypercortisolism, especially in patients with individual hypersensibility, or hypoadrenalism after drug withdrawal, due to hypothalamic–pituitary–adrenal (HPA) axis suppression, with consequences in terms of increased morbidity and mortality risk. On the other hand, in SARS-CoV-2-infected patient’s cortisol secretion could be insufficient also due to critical illness-related corticosteroid insufficiency (CIRCI). In addition, in this clinical context, the co-administration of antiretroviral drugs and corticosteroids may trigger drug–drug interaction and enhance the exposure to the latter ones, metabolized through the CYP450 CYP3A pathway, severely impacting on HPA axis. Conclusion: Physicians involved in the management of patients affected by COVID-19 should be aware of the need of an appropriate GC dose tapering, and of potential interaction of GCs with antiviral therapy and drugs used to treat associated co-morbidities
Small intestinal Neuroendocrine Neoplasms in MEN 1syndrome. Could it be a MEN 4 Syndrome?
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