1,720,974 research outputs found
Modern approach to bone comorbidity in prolactinoma
No full textProlactinomas account for more than half of pituitary adenomas, and besides their clinical impact on fertility and gonadal function, they lead to detrimental effects on bone. Patients with prolactinoma are prone to deterioration of bone structure caused not only by prolactin (PRL) induced hypogonadism but also by its direct actions on bone cells and calcium metabolism. However, clinical studies have shown inconsistent evidence regarding whether PRL could have a deleterious effect independently from gonadal insufficiency on skeletal integrity. Seminal studies from our group reported an increased prevalence of vertebral fractures (VFs) in both female and male patients with prolactinoma. Treatment of prolactinoma with dopamine agonists can restore gonadal function and improve bone mineral density. Since the presence of VFs may be related to more aggressive disease, bone comorbidities in prolactinoma should be managed by a multidisciplinary team in line with the recent concept of ‘pituitary tumors centers of excellence’. The review aims to evaluate the mechanism of PRL actions on bone, as well as to provide practical indications for a modern approach to the management of skeletal complications of patients with prolactin-secreting adenoma considering different clinical characteristics and outcomes
Clinical pharmacology of oral octreotide capsules for the treatment of acromegaly
No full textThe primary goal of acromegaly treatment is to normalize biochemical parameters as it significantly reduces the risks of complications and comorbidities associated with the disease. First-line medical treatment is commonly represented by injectable somatostatin analogues (SRLs) after surgery. In June 2020, with the integration of Transient Permeation Enhancer® technology, oral octreotide capsules (OOCs) received regulatory approval from the US Food and Drug Administration for long-term maintenance treatment in patients with acromegaly who have responded to and tolerated treatment with octreotide or lanreotide. We reviewed the clinical pharmacological data on the development and clinical use of OOCs. The pharmacokinetic and pharmacodynamic data on OOCs showed a dose–dependent increase in octreotide levels and remarkable suppression of growth hormone secretion. The efficacy and safety of OOCs were investigated in four clinical trials conducted on patients with complete or partially controlled acromegaly. The trials resulted in the maintenance of biochemical control after switching from injectable SRLs to OOCs, with a comparable side-effect profile. Moreover, the acromegaly symptoms improved in patients on OOC. The data showed a patient preference to continue in the OOC arm for the extension phase of the trials. From the clinical pharmacological perspective, oral formulation of octreotide has the advantage of efficacy and safety with respect to injectable octreotide
New tools for bone health assessment in secreting pituitary adenomas
No full textPituitary hormones regulate skeletal physiology, and excess levels affect bone remodeling and alter bone microstructure. Vertebral fractures (VFs) are an early phenomenon of impaired bone health in secreting pituitary adenomas. However, they are not accurately predicted by areal bone mineral density (BMD). Emerging data demonstrate that a morphometric approach is essential for evaluating bone health in this clinical setting and is considered to be the gold standard method in acromegaly. Several novel tools have been proposed as alternative or additional methods for the prediction of fractures, particularly in pituitary-driven osteopa-thies. This review highlights the novel potential biomarkers and diagnostic methods for bone fragility, including their pathophysiological, clinical, radiologi-cal, and therapeutic implications in acromegaly, prolactinomas, and Cushing's disease
The utility of serum tumor markers CEA and CA 15–3 for breast cancer prognosis and their association with clinicopathological parameters
No full textLong-term endocrinological outcomes of gamma knife radiosurgery in acromegaly patients
No full textGamma knife radiosurgery (GKS) is a treatment option for recurrent or persistent disease in patients with acromegaly. Objective: We aimed to retrospectively evaluate acromegaly patients who had undergone GKS in terms of pituitary hormone status, efficacy of GKS, and prognostic factors. Method: One-hundred and ten acromegaly patients who underwent GKS, and who were referred to our outpatient endocrinology clinic between 2007 and 2017, were included in the study. Anterior pituitary hormones and radiology imaging during follow-up were recorded. Remission for acromegaly was defined as a normal insulin-like growth factor 1 (IGF-1) level adjusted for age and gender, and a random growth hormone (GH) level < 1 ng/ml. Endocrine control was defined as normal GH and IGF-1 levels under medication. Results: After a mean follow-up of 6.5 4.7 years; remission, endocrine control, and uncontrolled status was observed in 16.4%, 60%, and 23.6% of patients; respectively. Adenoma volume was decreased after GKS (P < .0001). Remnant adenoma diameter was higher in the uncontrolled group compared to the remission and endocrine control group. The presence of tumor extension was associated with disease status (P = .03) and higher initial GH and IGF-1 levels. The mean time after GKS to remission was 26.5 months. Six (5.4%) patients had new-onset pituitary deficiency after GKS. In the multivariate analysis, pre-GKS IGF-1 levels and patient's age were associated with disease status. Conclusion: GKS is an effective adjuvant treatment with minimal side effects to control GH and IGF-1 levels, increase remission rates, endocrine control, and reduce tumor diameter in persistent acromegaly patients after surgery
Long-term endocrinological outcomes of gamma knife radiosurgery in acromegaly patients (vol 55, 101335, 2020)
Full text linkSerum 25(OH) Vitamin D Levels in Severely Obese Patients Evaluated Before Bariatric Surgery
No full textObjective: Obesity is a risk factor for vitamin D deficiency, which is reported to be detected differently in each population. This study aimed to evaluate the 25(OH) vitamin D (25(OH)D) levels, intact parathormone (iPTH) levels, and their relationship with body mass index (BMI) in obese patients, screened prior to bariatric surgery. Material and Methods: This retrospective study comprised of 1.082 obese patients (41 +/- 10 years, female/male: 823/259) who were candidates for bariatric surgery. BMI, waist circumference (WC), serum 25(OH)D, iPTH, calcium, phosphorus values of these patients were recorded from patient files. Results: BMI, WC, iPTH, and 25(OH)D levels were 48 +/- 8.9 kg/m(2), 128 +/- 11.9 cm, 64 +/- 36 pg/mL, and 15 +/- 18 ng/mL, respectively. Mean 25(OH)D level of 79.1% of the patients belonged to the deficiency range. Very low 25(OH) vitamin D levels (<10 ng/mL) were witnessed among 40.9% (443/1.082) of the study group. Female obese subjects possessed significantly lower serum 25(OH)D levels as compared to male obese patients. Significant negative correlations were perceived between 25(OH)D levels and iPTH (r=-0.34, p<0.0001), BMI (r=-0.20, p<0.0001), and waist circumferences (r=-0.14, p=0.002) in the whole group. Multivariate analysis indicated that BMI to be an independent risk factor for vitamin D deficiency. Conclusion: A high rate of vitamin D deficiency was documented in our morbidly obese patients who were candidates for bariatric surgery. BMI is a determinant of 25(OH)D levels. It is essential to screen for vitamin D deficiency and possible osteomalacia among the candidates for bariatric surgery of obese patients and should be treated appropriately before bariatric surgery
Prevalence of vertebral fractures and serum sclerostin levels in acromegaly
No full textObjective An increased prevalence of vertebral fractures (VFs) has been reported in previous studies. The aim of this study was to evaluate the association between bone mineral density (BMD), bone turnover markers, serum sclerostin levels, and vertebral fractures (VFs) in acromegaly patients. We also evaluated the effects of gonadal status, disease activity, treatment modality, age, sex, and body mass index (BMI) on skeletal endpoints. Design Case-control study. Patients and measurements Seventy acromegaly patients (M/F:36/34, mean age 45.5 +/- 11.9 years) and 70 controls (M/F:31/39; mean age 45.66 +/- 11.9 years) were included. VFs, BMD, calcium metabolism, markers of bone turnover, and sclerostin levels were evaluated. BMD was measured by dual-energy X-ray absorptiometry (Hologic QDR 4500). Conventional lateral radiography of the spine was performed and the Genant method was used for the assessment of fractures of T4-L5 vertebrae. Results The prevalence of vertebral fractures was higher in acromegalic patients as compared with the control group (72.9 vs. 20%; p < 0.001). Serum phosphate (P) levels (3.46 +/- 0.59 mg/dl vs. 3.11 +/- 0.44 mg/dl; p < 0.001) and b-cross laps (CTx) levels (0.47 mu g/l, range 0.04-2.38 vs. 0.28 mu g/l, range 0.11-0.80; p < 0.001) were significantly higher in acromegaly patients than control subjects. Serum sclerostin levels were similar between either acromegaly patients and control subjects or acromegaly patients with VF and without VF. In the means of treatment modality, VFs were more frequent in patients treated with adjuvant gamma knife radiosurgery (GKS) (p = 0.07). In the binary logistic regression analysis, the age of the acromegaly patients, the presence of hypogonadism, and GKS treatment were the factors significantly correlated with the occurrence of spinal fractures. Conclusions The prevalence of VFs in patients with acromegaly is higher than in control subjects. Since advanced age, the presence of hypogonadism and GKS treatment were the factors predicting VFs in acromegaly; radiological evaluations should be considered as an emerging tool especially in those patients. Although markers of bone turnover elevated in acromegaly, they were not useful for the prediction of fractures. Serum sclerostin levels showed no discrepancy between the two groups and further studies are required for assessment of sclerostin role in this form of secondary osteoporosis
Skin Autofluorescence and Carotid Intima-Media Thickness Evaluation Following Bariatric Surgery in Patients with Severe Obesity
No full textPurpose Advanced glycation end product (AGE) is a marker of metabolic memory. Accumulated AGEs in skin collagen measured with skin autofluorescence (SAF) was found to be associated with subclinical atherosclerosis. We aimed to evaluate SAF and carotid intima-media thickness (CIMT) and its association with clinical and biochemical parameters in severely obese patients before and after bariatric surgery. Materials and Methods In this observational study, 432 morbid obese patients evaluated before and after 6 and 12 months of bariatric surgery for metabolic and anthropometric parameters, CIMT and SAF. SAF was assessed in the forearm with an AGE Reader. Results SAF measurements were higher in diabetic (2.04 +/- 0.52 AU) obese patients compared to non-diabetic (1.78 +/- 0.40 AU) obese patients (p < 0.0001). Although bariatric surgery-induced weight loss resulted in a decrease in CIMT in the 6th and 12th months compared to baseline, weight loss and metabolic improvements were not associated with a parallel decrease in SAF measurements. SAF measurements were positively correlated with body mass index (r 0.527, p < 0.0001), HbA1c (r 0.362, p < 0.0001), and CIMT (r 0.319, p < 0.0001). Multivariate analysis showed the presence of diabetes (but not BMI, age, and sex) was independently associated with SAF (R-2 = 7.62%), and the presence of diabetes, low-density cholesterol, and systolic blood pressure were independently associated with CIMT measurements (R-2 = 21.7%). Conclusion Bariatric surgery-induced weight loss and metabolic improvement were found to be associated with improvement in CIMT, while skin AGE accumulation was not regressed in the first year of surgery
Pulmonary Function and Serum Carboxymethyl-Lysine Level Evaluation in Acromegaly Patients
No full textObjective: We aimed to evaluate the pulmonary function tests (PFTs) and serum carboxymethyl-lysine (CML) level and their association with the disease activity in patients with acromegaly. Material and Methods: This cross-sectional study included 65 acromegalic patients (F/M:28/37) and 52 controls ( F/M:23/29). PFTs such as spirometry and diffusing capacity of the lungs for carbon monoxide (DLCO) were performed to determine the lungs' ability to exchange gases. Serum CML levels were measured with the enzyme-linked immunosorbent assay. Basal and nadir growth hormone (GH), hemoglobin A1c (HbA1c), and insulin-like growth factor-1 (IGF-1) were also assessed. Results: Serum CML levels were significantly higher in acromegalic patients (208.1 +/- 80 ng/mL) than in controls (174.2 +/- 11 ng/mL), (p=0.02). The evaluated PFTs were expressed as predicted values [forced expiratory volume in the 1st second % (p=0.01), forced vital capacity % (p=0.007), functional residual capacity % (p=0.03), residual volume % (p=0.03), vital capacity % (p=0.007), total lung capacity % (p=0.01), and DLCO% (p=0.02)) that were found to be elevated in acromegalic patients than in controls. CML levels positively correlated with HbA1c (r=0.53, p=0.02) but did not con-elate with basal GH levels (r=0.35, p=0.06). GH and IGF-1 levels positively correlated with lung volume in acromegalic patients. Conclusion: Serum CML levels increased in acromegaly patients but had no association with the PFTs results. Increased lung volume was the most prominent lung function alteration in acromegalic patients; relevantly, we found elevated GH and IGF-1 levels to be associated with the increased lung volumes. Future studies need to evaluate the association between the advanced glycation end-products and complications of acromegaly
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