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Introduction/Objective. Hypothyroidism is a common disease and treatment with levothyroxine (LT4) is effective. However, variations in management are frequent. The aim of this study was to identify practices and attitudes of Serbian... more
Introduction/Objective. Hypothyroidism is a common disease and treatment with levothyroxine (LT4) is effective. However, variations in management are frequent. The aim of this study was to identify practices and attitudes of Serbian physicians relating to the treatment of hypothyroidism. Methods. An anonymized questionnaire was distributed electronically to members of the Serbian Thyroid Society, Serbian Association of Endocrine Surgeons, and Section for Endocrinology of the Serbian Medical Society. Results. Out of 170 invitations, 99 responses were received. LT4 was the first choice for the treatment of hypothyroidism in 90% of patients. After starting LT4 replacement therapy most respondents would recheck thyroid-stimulating hormone (TSH) in 4?6 weeks (n = 51, 62%) and in eight weeks (n = 29, 35%). In total, 61% of respondents (n = 60) indicated that they would consider treating euthyroid patients with LT4, the commonest indication being female infertility with high levels of thyr...
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... Keywords: PRL. MIUR subjects: Settore MED/31 - Otorinolaringoiatria. Citation: Dosaggio routinario della macroprolattina nei pazienti iperprolattinemici / R. Cozzi, R. Attanasio, G. Lasio, A. Lodrini, G. Felisati, P. Loli.... more
... Keywords: PRL. MIUR subjects: Settore MED/31 - Otorinolaringoiatria. Citation: Dosaggio routinario della macroprolattina nei pazienti iperprolattinemici / R. Cozzi, R. Attanasio, G. Lasio, A. Lodrini, G. Felisati, P. Loli. ((Intervento ...
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Growth hormone (GH) and prolactin (PRL) secretion after GH-releasing hormone (GHRH) and domperidone (DOM), an antidopaminergic drug which does not cross the blood-brain barrier (BBB), was evaluated in 8 healthy elderly men (65-91 years)... more
Growth hormone (GH) and prolactin (PRL) secretion after GH-releasing hormone (GHRH) and domperidone (DOM), an antidopaminergic drug which does not cross the blood-brain barrier (BBB), was evaluated in 8 healthy elderly men (65-91 years) and in 7 young adults (23-40 years). All received in random order at 2-day intervals: GHRH(1-40) (50 micrograms i.v.) bolus, DOM (5 mg/h) infusion, GHRH(1-40) (50 micrograms i.v.) plus DOM (5 mg/h i.v.), saline solution. In elderly men GH increase after GHRH was significantly lower than in young men. DOM alone did not change GH secretion in either of these groups, whereas it increased the GH response to GHRH only in young adults. PRL levels increased in both young and elderly men during both DOM and GHRH plus DOM, but the PRL release was more marked in young than in elderly men. Both integrated secretion of GH after GHRH and of PRL after DOM were inversely correlated to chronological age. Our data show an impairment of GH rise after GHRH and of PRL after DOM in elderly adults. It is also stressed that peripheral blockade of dopamine receptors by DOM is unable to amplify the GH response to GHRH only in elderly men. A reduction in GH release after GHRH might be related to aging, perhaps through a reduction of dopaminergic tonus.
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Introduction: This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in adults. However, pregnancy is not considered. Methods: This GL has been developed following the... more
Introduction: This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in adults. However, pregnancy is not considered. Methods: This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinologi (AME) has identified potentially relevant outcomes, which have then been rated for their impact on therapeutic choices. Only outcomes classified as “critical” and “important” have been considered in the systematic review of evidence and only those classified as “critical” have been considered in the formulation of recommendations. Results: The present GL provides recommendations regarding the role of pharmacological and neurosurgical treatment in the management of prolactinomas. We recommend cabergoline (Cab) vs. bromocriptine (Br) as the first-choice pharmacological treatment to be employed at the minimal effective dose capable of achieving the regression of the clinical picture. We suggest that medication and surgery are offered as suitable alternative first-line treatments to patients with non-invasive PRL-secreting adenoma, regardless of size. We suggest Br as an alternative drug in patients who are intolerant to Cab and are not candidates for surgery. We recommend pituitary tumor resection in patients 1) without any significant neuro-ophthalmologic improvement within two weeks from the start of Cab, 2) who are resistant or do not tolerate Cab or other dopamine-agonist drugs (DA), 3) who escape from previous efficacy of DA, and 4) who are unwilling to undergo a chronic DA treatment. We recommend that patients with progressive disease notwithstanding previous tumor resection and ongoing DA should be managed by a multidisciplinary team with specific expertise in pituitary diseases using a multimodal approach that includes repeated surgery, radiotherapy, DA, and possibly, the use of temozolomide. Conclusion: The present GL is directed to endocrinologists, neurosurgeons, and gynecologists working in hospitals, in territorial services or private practice, and to general practitioners and patients.
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BACKGROUND. The standard treatment for hypothyroidism is levothyroxine (LT4), which in the Republic of Belarus is available in tablet form whereas liothyronine (LT3) is not registered, but patients can purchase them on their own... more
BACKGROUND. The standard treatment for hypothyroidism is levothyroxine (LT4), which in the Republic of Belarus is available in tablet form whereas liothyronine (LT3) is not registered, but patients can purchase them on their own abroad.AIM. This study aimed to investigate Belarusian endocrinologists’ attitude of thyroid hormones in hypothyroid and euthyroid patients.MATERIALS AND METHODS. An online survey was conducted, for which members of the Belarusian Medical Association of Endocrinology and Metabolism were invited by posting information in the group chat and by e-mail. The research period was from October 1 to December 26, 2020. 210 questionnaires were received, 146 of which were used.RESULTS. The majority of participants, 145 (99.3%), indicated that they were using LT4 as the first-choice drug for the treatment hypothyroidism. Sixty-one (41.8%) doctors answered that LT3 + LT4 combination likely can be used in patients with long-term untreated hypothyroidism and 15 (10.3%) — in...
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Aims: Metformin is the most widely used drug for the first-line treatment of type 2 diabetes mellitus (T2DM), but its use and schedule have been poorly investigated in elderly patients. Methods: We conducted an observational,... more
Aims: Metformin is the most widely used drug for the first-line treatment of type 2 diabetes mellitus (T2DM), but its use and schedule have been poorly investigated in elderly patients. Methods: We conducted an observational, cross-sectional, multicentric study on metformin in T2DM outpatients older than 65 years who were taking the drug for at least 6 months and referred to Italian Endocrinology and Diabetology Services. The primary endpoint was daily metformin dose, and secondary endpoints were the correlations between metformin dose and age, comorbidities, and concomitant use of other drugs. The study was open to all members of AME (Associazione Medici Endocrinologi). Results: Fifteen Italian centers recruited 751 consecutive participants (42.9% older than 75 years, 48.6% females). T2DM duration was 12.9 ± 9.7 years (longer than 10 years in 53.8%). Metformin had been used for 10.3 ± 6.8 years (longer than 10 years in 52.4%). Metformin dose was 1.6 ± 0.9 g/day (>1.5 g/day in 63...
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BackgroundReplacement of thyroid hormones (TH) with Levothyroxine (LT4) is the treatment of choice for hypothyroidism, however, there are aspects of treatment where uncertainties exist and practice varies. Factors influencing initiation... more
BackgroundReplacement of thyroid hormones (TH) with Levothyroxine (LT4) is the treatment of choice for hypothyroidism, however, there are aspects of treatment where uncertainties exist and practice varies. Factors influencing initiation and choice of TH replacement may impact patient satisfaction, safety, and health care costs.MethodsThe aim of the study was to examine the attitudes of Irish endocrinologists regarding the treatment of hypothyroid and euthyroid patients with TH. Members of the Irish Endocrine Society (IES) were invited to participate in an online survey.ResultsForty-eight invitations were sent, and 39 (81.3%) participants responded. All respondents favoured LT4 tablet therapy for treatment of hypothyroidism, but 20.5% prescribed combination therapy (LT4 and liothyronine), and 13% regularly used desiccated thyroid extract. A significant proportion (51%) might prescribe TH in euthyroid patients; 41% for thyroid auto-antibody positive women seeking pregnancy, 18% for go...
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Aim: This guideline (GL) is aimed at providing a reference for the management of non-functioning, benign thyroid nodules causing local symptoms in adults outside of pregnancy. Methods: This GL has been developed following the methods... more
Aim: This guideline (GL) is aimed at providing a reference for the management of non-functioning, benign thyroid nodules causing local symptoms in adults outside of pregnancy. Methods: This GL has been developed following the methods described in the Manual of the National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology(AME) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as “critical” and “important” were considered in the systematic review of evidence and only those classified as “critical” were considered in the formulation of recommendations. Results: The present GL contains recommendations about the respective roles of surgery and minimally invasive treatments for the management of benign symptomatic thyroid nodules. We suggest hemithyroidectomy plus isthmectomy as the first-choice surgical treatment, provided that clinically significant disease is not...
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Research Interests: Medicine and Acromegaly
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Acromegaly is a clinical condition characterized by chronic growth hormone (GH) and insulin-like growth factor-I (IGF-I) excess caused in most cases by a somatotroph pituitary adenoma. It is associated to increased mortality, mostly due... more
Acromegaly is a clinical condition characterized by chronic growth hormone (GH) and insulin-like growth factor-I (IGF-I) excess caused in most cases by a somatotroph pituitary adenoma. It is associated to increased mortality, mostly due to cardiovascolar and cerebrovascular diseases, and probably to colon cancer too. Acromegalic patients may have important subjective symptoms and co-morbid systemic illnesses such as arthropaties, skeletal changes, cosmetic disfigurement, severe headache, hypertension and heart diseases, diabetes mellitus, goitre, and sleep-apnoea. Regardless of which treatment modality (medical, surgical or radiant) is employed to attenuate GH levels, it has been shown that only lowering of GH to < 2.5 \u3bcg/L restores the life expectancy to that of age-matched population controls. Thus stringent control of GH and IGF-I is a primary therapeutical goal. In recent years great advances in the medical therapy of acromegaly have been performed with the introduction in clinical practice of long-acting somatostatin analogs. GH antagonists, a new revolutionary agent that blocks GH action is now in phase 3 study, and will be soon available. Up to now, however, in most patients trans-sphenoidal surgery remains the cornerstone in the therapy of this disease. In fact it offers the possibility of definitive cure of acromegaly (success-rate 50-60%), it is rapidly effective and safe
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AKT A protein-serine-threonine kinase that is activated by phosphorylation in response to growth factors or insulin CD117 Antigen specific for the proto-oncogene c-kit CD56 Antigen expressed by all lymphocytes CD99 Cluster of... more
AKT A protein-serine-threonine kinase that is activated by phosphorylation in response to growth factors or insulin CD117 Antigen specific for the proto-oncogene c-kit CD56 Antigen expressed by all lymphocytes CD99 Cluster of differentiation CDX-2 Transcription factor expressed specifically in gut epithelium CEACAM1 Cell adhesion molecule
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RiassuntoL’intervento chirurgico di adenomectomia rappresenta uno dei capisaldi del trattamento dell’acromegalia; peraltro, la sua efficacia nei tumori ipofisari GH-secernenti di grosse dimensioni e con spiccate caratteristiche invasive è... more
RiassuntoL’intervento chirurgico di adenomectomia rappresenta uno dei capisaldi del trattamento dell’acromegalia; peraltro, la sua efficacia nei tumori ipofisari GH-secernenti di grosse dimensioni e con spiccate caratteristiche invasive è molto limitata. L’obiettivo di questo studio retrospettivo e multicentrico è stato quello di verificare se l’intervento chirurgico di asportazione parziale dell’adenoma ipofisario GH-secernente potesse migliorare la risposta agli analoghi della somatostatina. Sono stati studiati 86 pazienti (42 donne e 44 uomini, età media 42±14 anni). I pazienti erano trattati con octreotide, lanreotide o octreotide a lento rilascio prima e dopo intervento chirurgico di adenomectomia parziale per almeno 6 mesi. Il parametro preso in considerazione per valutare l’andamento della risposta al trattamento con analoghi della somatostatina è stato la determinazione dei livelli di IGF-1 circolanti per classi d’età. Prima dell’intervento neurochirurgico, il trattamento con analoghi della somatostatina riduceva significativamente i livelli circolanti di GH e IGF-1 in tutti i pazienti. I livelli di GH erano <2, 5 µg/litro in 12 pazienti (14%) e quelli di IGF-1 si normalizzavano in 9 pazienti (10%). L’intervento chirurgico riduceva la massa tumorale di oltre il 75% in 50 pazienti (58%), tra il 50 e il 75% in 21 pazienti (24%), tra il 25 e il 50% in 10 pazienti (12%) e di meno del 25% in 5 pazienti (6%). Dopo l’intervento chirurgico, il trattamento con analoghi della somatostatina riduceva i livelli circolanti di GH <2, 5 µg/litro in 49 pazienti (56%) e normalizzava i livelli di IGF-1 in 48 pazienti (55%). Il controllo della malattia con analoghi della somatostatina dopo l’intervento chirurgico era quindi significativamente superiore a quello ottenuto con gli stessi farmaci prima dell’intervento (p<0.0001). I livelli circolanti di GH (r=−0, 48, p<0.0001) e quelli di IGF-1 (r=−0, 38, p=0.0003) erano correlati con la quantità di tessuto adenomatoso rimosso. La funzione ipofisaria prima dell’intervento chirurgico era compromessa nel 14% dei pazienti e dopo l’intervento nel 32, 6%; peraltro, dopo l’intervento chirurgico il 13,9% dei pazienti aveva il recupero della funzione ipofisaria. In conclusione, l’intervento chirurgico di adenomectomia parziale (con rimozione di oltre il 75% della massa tumorale) determina un aumento della risposta agli analoghi della somatostatina senza compromissione significativa della funzione ipofisaria. Per questo motivo l’intervento chirurgico di debulking riveste un ruolo importante nell’algoritmo terapeutico dell’acromegalia.
Research Interests: Humanities and Medicine
Hypovitaminosis D is becoming a notable health problem worldwide. A consensus exists among several different medical societies as to the need for adequate levels of vitamin D for bone and general health. The correct method by which to... more
Hypovitaminosis D is becoming a notable health problem worldwide. A consensus exists among several different medical societies as to the need for adequate levels of vitamin D for bone and general health. The correct method by which to restore normal vitamin D levels is still a matter of debate. Although cholecalciferol remains the most commonly distributed form of vitamin D supplementation worldwide, several drugs with vitamin D activity are available for clinical use, and making the correct selection for the individual patient may be challenging. In this narrative review, we aim to contribute to the current knowledge base on the possible and appropriate use of calcifediol—the 25-alpha-hydroxylated metabolite—in relation to its chemical characteristics, its biological properties, and its pathophysiological aspects. Furthermore, we examine the trials that have aimed to evaluate the effect of calcifediol on the restoration of normal vitamin D levels. Calcifediol is more soluble than c...
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Acromegaly is an infrequent disease attributable to endogenous excess of GH and IGF-I. Human studies have associated the GH-IGF-I axis with the development of colorectal cancer; however, the question of whether colorectal cancer is a... more
Acromegaly is an infrequent disease attributable to endogenous excess of GH and IGF-I. Human studies have associated the GH-IGF-I axis with the development of colorectal cancer; however, the question of whether colorectal cancer is a problem in acromegaly is currently unresolved. We performed a cross-sectional study to assess the risk of colonic neoplasia in patients with acromegaly. Colonoscopic screening was performed in 235 patients with acromegaly at five tertiary care hospitals in Italy between January 1, 1996, and December 31, 2001. A repeat colonoscopy was performed in 121 patients after a mean interval of 32.1 months. Colonoscopic findings in patients with acromegaly were compared with those of 233 patients with nonspecific abdominal complaints who were referred for endoscopy during the study period. A total of 65 patients (27.7%) and 36 controls (15.5%) had colonic neoplasia.
Background: The discharge from hospital of insulin-treated hyperglycemic patients is always challenging. This is even more so in patients requiring glucocorticoid treatment, such as those with COVID-19. Patients and method: A... more
Background: The discharge from hospital of insulin-treated hyperglycemic patients is always challenging. This is even more so in patients requiring glucocorticoid treatment, such as those with COVID-19. Patients and method: A retrospective monocentric study of 23 inpatients with newly diagnosed or already known diabetes mellitus (DM) who were naïve to insulin treatment, , and who were hospitalized with COVID-19 in non-critical settings and then discharged. Patients were followed-up for one month after discharge for the management of insulin treatment by a multi-professional team through phone consultations. Results: Insulin prescriptions at discharge were 24.6 ± 14 U/day injected in 2 ± 1.5 daily shots. A mean of three phone consultations were required. One month later, the mean insulin reduction was 1.5 ± 1.3 shots and 6 ± 5 U/day. All patients reached their glycemic target without hypoglycemic events, drop-outs, or readmissions. Conclusion: This study demonstrates the feasibility,...
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BACKGROUND Hypothyroidism is one of the leading conditions in endocrinology. Despite that fact, clinical indications for treatment still vary among Spanish specialists. AIMS To identify attitudes of Spanish specialists relating to the use... more
BACKGROUND Hypothyroidism is one of the leading conditions in endocrinology. Despite that fact, clinical indications for treatment still vary among Spanish specialists. AIMS To identify attitudes of Spanish specialists relating to the use of levothyroxine (LT4) and the management of hypothyroidism. METHODS The members of the Sociedad Española de Endocrinología y Nutrición (Spanish Society of Endocrinology and Nutrition) were invited to participate in a web-based survey. The survey, initially in English, was modified to reflect in accordance with the availability of thyroid hormone formulations in Spain. RESULTS A total of 505 of 1956 (25.8%) members (66% female) completed the survey; 97.4% declared that LT4 is the first-line therapy for hypothyroidism. The indications for LT4 therapy in euthyroidism were infertility in thyroid antibody-positive women (48.5%) and simple goitre (21.2%). However, 44.2% of specialists reported that there was no indication for LT4 therapy in such patients. Only a minority of respondents (2.6%) considered combining LT4 with liothyronine as the treatment of choice from inception, whereas 49% stated that it should never be used. CONCLUSIONS The standard of treatment of hypothyroidism in Spain is almost exclusively with LT4 tablets. Availability of other formulations of LT4 or combination therapy for hypothyroidism management remains to be explored, especially in patients with persistent symptoms. Notably, non-evidence-based use of LT4 is widely practiced in Spain for euthyroid women with autoimmune thyroiditis and fertility issues.
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Summary Cushing’s syndrome is associated with increased morbidity and mortality. Although surgery is the first-line treatment, drugs can still play a role as an ancillary treatment to be employed while waiting for surgery, after... more
Summary Cushing’s syndrome is associated with increased morbidity and mortality. Although surgery is the first-line treatment, drugs can still play a role as an ancillary treatment to be employed while waiting for surgery, after unsuccessful operation or in patients unsuitable for surgery. We were asked to evaluate a 32-year-old male waiting for cardiac transplantation. Idiopathic hypokinetic cardiomyopathy had been diagnosed since 6 years. He was on treatment with multiple drugs, had a pacemaker, an implantable cardioverter and an external device for the support of systolic function. Physical examination showed severely impaired general status, signs of hypercortisolism and multiple vertebral compression fractures. We administered teriparatide, and the few evaluable parameters supported the diagnosis of ACTH-dependent hypercortisolism: serum cortisol was 24.2 µg/dL in the morning and 20.3 µg/dL after overnight 1 mg dexamethasone, urinary free cortisol (UFC) was 258 µg/24 h and ACTH...
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In this study, we report the management, in Lombardy, Italy, of one patient with Cushing’s syndrome due to adrenal adenoma and another one with pheochromocytoma, whose surgeries were deferred owing to the COVID-19 pandemic.
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Objective and design: The aim of the study was the retrospective evaluation of pregnancy in acromegalic women attending our center. Patients and methods: Six active acromegalic women (30–35-years old, disease duration 5–17 years)... more
Objective and design: The aim of the study was the retrospective evaluation of pregnancy in acromegalic women attending our center. Patients and methods: Six active acromegalic women (30–35-years old, disease duration 5–17 years) underwent seven pregnancies. Four patients had macroadenoma and two microadenoma; four had surgery; and two had been treated primarily with drugs. Before conception, GH and IGF-I were 5.4G 0.8 and 430G58 mg/l respectively. GH (by an assay unable to distinguish pituitary hormone from placental variant), IGF-I, and prolactin (PRL) levels were assessed before conception, every 3 months, and after delivery; visual field and magnetic resonance imaging were performed before delivery in the only patient with macroadenoma not previously operated on and after delivery in all. Results: All the women conceived normally, after discontinuation of medications in five cases and, while on treatment with depot somatostatin analogs in two (discontinued after confirmation of ...
Background: Some endocrinologists were involved in the management of patients with suspected or confirmed COVID-19 during the first wave of the pandemic. This study aims to analyze burnout levels among the Association of Medical... more
Background: Some endocrinologists were involved in the management of patients with suspected or confirmed COVID-19 during the first wave of the pandemic. This study aims to analyze burnout levels among the Association of Medical Endocrinologists (AME) members before and during the pandemic. Methods: We recruited two AME members samples at two different times: before COVID-19 (n = 811) and during the first wave of the ongoing pandemic (n = 579). Both the samples filled the Maslach Burnout Inventory. We performed MANOVAs to evaluate demographic and COVID-19 related differences in burnout levels and Pearson’s Chi-square test to compare burnout severity before and during the pandemic. Results: Women reported higher Emotional Exhaustion and reduced Professional Accomplishment than men. The oldest physicians had lower levels of Emotional Exhaustion and Depersonalization and higher Professional Accomplishment than younger workers. Independent contractors displayed lower levels of burnout c...