169,999 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
Frequently Asked Questions in Patients With Adrenal Insufficiency in the Time of COVID-19
No full textAdrenal 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
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?
No full textVirtual 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
Small intestinal Neuroendocrine Neoplasms in MEN 1syndrome. Could it be a MEN 4 Syndrome?
No full textPharmacokinetics of ibuprofen microencapsulated granules
No full textTwo new granule prepns. (resin and microencapsulated) of ibuprofen [15687-27-1] were compared in a cross-over double-blind single dose pharmacokinetic study. Eight healthy volunteers, mean age 23 yr, were alternatively given the 2 600 mg granule prepns. in a randomized sequence. The differences between formulations were not statistically significant except for t1/2 which showed a slight clin. not important increase with the microencapsulated granules. The mean relative bioavailability of the microencapsulated vs. resin granules was 93.4%. The gastroresistance of the microencapsulated formulation represents a favorable theor. feature for a further improvement of ibuprofen safety
Unmet needs on the current medical management of Cushing’s syndrome: results from a Delphi panel of Italian endocrinologists
No full textBackground: Cushing's syndrome (CS) is a rare clinical condition caused by excessive cortisol secretion from adrenal glands. CS is associated with increased mortality and morbidity; therefore, a prompt diagnosis and an effective therapeutic approach are strongly necessary to improve the patient's clinical management. The first-line treatment for CS is surgery, while medical treatment has historically played a minor role. However, thanks to the availability of novel compounds, the possibility of improving hypercortisolism control using different drug combinations emerged. Purpose: No absolute recommendations are available to guide the therapeutic choice for patients with CS and, consequently, the awareness of unmet needs in CS management is growing. Although new data from clinical trials are needed to better define the most appropriate management of CS, an expert consensus approach can help define unmet needs and optimize the current CS management and treatment. Methods: Twenty-seven endocrinologists from 12 Italian regions, working among the main Italian referral centers for hospital endocrinology where they take care of CS patients, were involved in a consensus process and used the Delphi method to reach an agreement on 24 statements about managing CS patients. Results: In total, 18 statements reached a consensus. Some relevant unmet needs in the management of CS were reported, mainly related to the lack of a pharmacological treatment successful for the majority of patients. Conclusion: While acknowledging the difficulty in achieving complete disease control, a significant change in CS management requires the availability of medical treatment with improved efficacy and safety over available therapeutic options at the time of the current study
Italian Society for the Study of Diabetes (SID)/Italian Endocrinological Society (SIE) guidelines on the treatment of hyperglycemia in Cushing's syndrome and acromegaly
No full textHyperglycemia is a common feature associated with states of increased growth hormone secretion and glucocorticoid levels.
AIMS:
The purpose of these guidelines is to assist clinicians and other health care providers to take evidence-based therapeutic decisions for the treatment of hyperglycemia in patients with growth hormone and corticosteroid excess.
METHODOLOGY:
Both the SID and SIE appointed members to represent each society and to collaborate in Guidelines writing. Members were chosen for their specific knowledge in the field. Each member agreed to produce--and regularly update--conflicts of interest. The Authors of these guidelines prepared their contributions following the recommendations for the development of Guidelines, using the standard classes of recommendation shown below. All members of the writing committee provided editing and systematic review of each part of the manuscript, and discussed the grading of evidence. Consensus was guided by a systematic review of all available trials and by interactive discussion
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