Aim of the study is a prospective evaluation of the simultaneous presence of antinuclear antibodi... more Aim of the study is a prospective evaluation of the simultaneous presence of antinuclear antibodies (ANA) in patients with Hashimoto's thyroiditis as a sign of a possible occurrence of another autoimmune disease. Thirty two patients with Hashimoto's thyroiditis have been selected. No other immunological parameters have been used for the selection. All the patients have been submitted to ANA research and to thyroid colour-Doppler ultrasonography. Moreover, subgroups of patients have been submitted to the research of other autoimmunity parameters: 25 patients to AMA (anti-mitochondrial antibodies), ASMA (anti-smooth muscle antibodies), ENA (extractable nuclear antigens) and anti-double stranded-DNA; 7 patients to anti-gastric mucosa; 8 patients to ACA (anti-cardiolipin antibodies) IgM and IgG; 12 patients to rheuma-screen. Twenty five patients were under L-thyroxine therapy at the time of the samples. Forty-seven percent of the patients were ANA positive. Of them 60% showed a ...
Gender- and sex- related differences represent a new frontier towards patient-tailored medicine, ... more Gender- and sex- related differences represent a new frontier towards patient-tailored medicine, taking into account that theoretically every medical specialty can be influenced by both of them. Sex hormones define the differences between males and females, and the different endocrine environment promoted by estrogens, progesterone, testosterone, and their precursors might influence both human physiology and pathophysiology. With the term Gender we refer, instead, to behaviors, roles, expectations, and activities carried out by the individual in society. In other words, “gender” refers to a sociocultural sphere of the individual, whereas “sex” only defines the biological sex. In the last decade, increasing attention has been paid to understand the influence that gender can have on both the human physiology and pathogenesis of diseases. Even the clinical response to therapy may be influenced by sex hormones and gender, but further research is needed to investigate and clarify how the...
Introduction Treatment of acromegaly resistant to first generation somatostatin analogues (first ... more Introduction Treatment of acromegaly resistant to first generation somatostatin analogues (first gen-SSA) is often difficult. We aimed to investigate the role of partial response and resistance to first gen-SSA in the choice of second line treatments and their outcomes. Patients and methods A retrospective and multicenter study was conducted on 100 SSA-resistant acromegaly patients and treated with Pasireotide Lar (Pasi-Lar), Peg-V in monotherapy (m-Peg-V) or in combination with first gen-SSA (c-Peg-V). Results Thirty-three patients (33%) were treated with m-Peg-V, 36 (36%) with c-Peg-V and 31 with Pasi-Lar (31%). According to logistic regression, m-Peg-V was chosen in older patients (p = 0.01) and with not-invasive adenomas (p = 0.009), c-Peg-V therapy in younger patients (p = 0.001), with invasive adenomas (p = 0.02), Pasi-Lar was in invasive adenomas (p = 0.01) and in patients partially responsive to first-gen SSA (p = 0.01). At the last follow-up, 68 patients (68%) reached the a...
Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs has been use... more Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs has been used for over two decades for the treatment of well-differentiated neuroendocrine tumors (NETs), and the publication of the NETTER-1 trials has further strengthened its clinical use. However, many aspects of this treatment are still under discussion. The purpose of this review is to collect and discuss the new available evidence, published in 2021, on the use of 177Lu-Oxodotreotide (DOTATATE) or 90Y-Edotreotide (DOTATOC) in adult patients with NETs focusing on the following hot topics: 1) PRRT use in new clinical settings, broaden its indications; 2) the short- and long-term safety; and 3) the identification of prognostic and predictive factors. The review suggests a possible future increase of PRRT applications, using it in other NETs, as a neoadjuvant treatment, or for rechallenge. Regarding safety, available studies, even those with long follow-up, supported the low rates of adverse even...
BackgroundImmune checkpoint inhibitors (ICIs), by unleashing the anticancer response of the immun... more BackgroundImmune checkpoint inhibitors (ICIs), by unleashing the anticancer response of the immune system, can improve survival of patients affected by several malignancies, but may trigger a broad spectrum of adverse events, including autoimmune hypophysitis. ICI-related hypophysitis mainly manifests with anterior hypopituitarism, while the simultaneous involvement of both anterior and posterior pituitary (i.e., panhypophysitis) has rarely been described.Case PresentationIn June 2015, a 64-year-old man affected by liver metastases of a uveal melanoma was referred to us due to polyuria and polydipsia. Two months prior, he had started ipilimumab therapy (3 mg/kg iv every 21 days). The treatment was well-tolerated (only mild asthenia and diarrhea were reported). A few days before the fourth cycle, the patient complained of intense headaches, profound fatigue, nocturia, polyuria (up to 10 L urine/daily), and polydipsia. Laboratory tests were consistent with adrenal insufficiency, hypot...
In the last decade, increasing attention has been paid to understanding the influence that gender... more In the last decade, increasing attention has been paid to understanding the influence that gender can have on both human physiology and the pathogenesis of diseases. What makes women different from men is essentially represented by sex hormones and, in fact, the attention of scientific literature has been, and continues to be, an understanding of the biological mechanisms activated by sex hormones that underlie the pathophysiological diversity between men and women. Our attention has been focused on the effects that these hormones, and above all estrogens, can have in explaining gender differences in the endocrine field. Diseases such as thyroid disease, diabetes mellitus, osteoporosis, acromegaly clearly present gender differences, mainly due to the different sexual hormone structure. Energy metabolism is also gender-specific, being greatly influenced by estrogen, both at rest and during exercise. These hormones also have a significant effect on the pathogenesis of autoimmune endoc...
Recombinant human TSH (rhTSH) is currently used in follow-up of patients affected by differentiat... more Recombinant human TSH (rhTSH) is currently used in follow-up of patients affected by differentiated thyroid cancer (DTC). Age, sex, weight, body mass index, body surface area (BSA) and renal function are known factors affecting serum TSH peak levels, but the proper rhTSH dose to deliver to single patient remains elusive. In this study, the correlations of basal metabolic rates with serum TSH peak following rhTSH administration were investigated. We evaluated 221 patients affected by thyroid cancer that received a standard dose rhTSH. Blood samples were collected at pre-established time points. Data on body weight, height, and BSA were collected. The Mifflin-St Jeor and Fleisch equations were used to assess basal metabolism. The median value (range) of serum TSH peaks was 142 ± 53 μU/ml. Serum TSH peaks were significantly lower in males than in females ( = 0.04). TSH values also increased with age. Data showed a significant decrease of TSH peak levels at day 3 from the administration...
Background Acromegaly is a rare disease due to chronic growth hormone (GH) excess and the consequ... more Background Acromegaly is a rare disease due to chronic growth hormone (GH) excess and the consequent increase in insulin-like growth factor-1 (IGF-1) levels. Both GH and IGF-1 play a role in intermediate metabolism affecting glucose homeostasis. The association between hyperinsulinemia/impaired glucose tolerance and an increased risk of cancer has been clarified. Insulin has a mitogenic effect through its interaction with the IGF-1 receptor (IGF-1R) that also binds IGF-1. On the other hand, metformin, an anti-hyperglycemic drug that decreases serum levels of insulin and IGF-1, could have a protective role in the treatment of endocrine tumors. Methods A retrospective, observational, multicenter study in 197 acromegalic patients, receiving/not receiving metformin, was performed to assess whether the prevalence of neoplasms might be correlated with insulin resistance and could eventually be modified by metformin treatment. Results In general, the occurrence of secondary neoplasia among...
Aim of the study is a prospective evaluation of the simultaneous presence of antinuclear antibodi... more Aim of the study is a prospective evaluation of the simultaneous presence of antinuclear antibodies (ANA) in patients with Hashimoto's thyroiditis as a sign of a possible occurrence of another autoimmune disease. Thirty two patients with Hashimoto's thyroiditis have been selected. No other immunological parameters have been used for the selection. All the patients have been submitted to ANA research and to thyroid colour-Doppler ultrasonography. Moreover, subgroups of patients have been submitted to the research of other autoimmunity parameters: 25 patients to AMA (anti-mitochondrial antibodies), ASMA (anti-smooth muscle antibodies), ENA (extractable nuclear antigens) and anti-double stranded-DNA; 7 patients to anti-gastric mucosa; 8 patients to ACA (anti-cardiolipin antibodies) IgM and IgG; 12 patients to rheuma-screen. Twenty five patients were under L-thyroxine therapy at the time of the samples. Forty-seven percent of the patients were ANA positive. Of them 60% showed a ...
Gender- and sex- related differences represent a new frontier towards patient-tailored medicine, ... more Gender- and sex- related differences represent a new frontier towards patient-tailored medicine, taking into account that theoretically every medical specialty can be influenced by both of them. Sex hormones define the differences between males and females, and the different endocrine environment promoted by estrogens, progesterone, testosterone, and their precursors might influence both human physiology and pathophysiology. With the term Gender we refer, instead, to behaviors, roles, expectations, and activities carried out by the individual in society. In other words, “gender” refers to a sociocultural sphere of the individual, whereas “sex” only defines the biological sex. In the last decade, increasing attention has been paid to understand the influence that gender can have on both the human physiology and pathogenesis of diseases. Even the clinical response to therapy may be influenced by sex hormones and gender, but further research is needed to investigate and clarify how the...
Introduction Treatment of acromegaly resistant to first generation somatostatin analogues (first ... more Introduction Treatment of acromegaly resistant to first generation somatostatin analogues (first gen-SSA) is often difficult. We aimed to investigate the role of partial response and resistance to first gen-SSA in the choice of second line treatments and their outcomes. Patients and methods A retrospective and multicenter study was conducted on 100 SSA-resistant acromegaly patients and treated with Pasireotide Lar (Pasi-Lar), Peg-V in monotherapy (m-Peg-V) or in combination with first gen-SSA (c-Peg-V). Results Thirty-three patients (33%) were treated with m-Peg-V, 36 (36%) with c-Peg-V and 31 with Pasi-Lar (31%). According to logistic regression, m-Peg-V was chosen in older patients (p = 0.01) and with not-invasive adenomas (p = 0.009), c-Peg-V therapy in younger patients (p = 0.001), with invasive adenomas (p = 0.02), Pasi-Lar was in invasive adenomas (p = 0.01) and in patients partially responsive to first-gen SSA (p = 0.01). At the last follow-up, 68 patients (68%) reached the a...
Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs has been use... more Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs has been used for over two decades for the treatment of well-differentiated neuroendocrine tumors (NETs), and the publication of the NETTER-1 trials has further strengthened its clinical use. However, many aspects of this treatment are still under discussion. The purpose of this review is to collect and discuss the new available evidence, published in 2021, on the use of 177Lu-Oxodotreotide (DOTATATE) or 90Y-Edotreotide (DOTATOC) in adult patients with NETs focusing on the following hot topics: 1) PRRT use in new clinical settings, broaden its indications; 2) the short- and long-term safety; and 3) the identification of prognostic and predictive factors. The review suggests a possible future increase of PRRT applications, using it in other NETs, as a neoadjuvant treatment, or for rechallenge. Regarding safety, available studies, even those with long follow-up, supported the low rates of adverse even...
BackgroundImmune checkpoint inhibitors (ICIs), by unleashing the anticancer response of the immun... more BackgroundImmune checkpoint inhibitors (ICIs), by unleashing the anticancer response of the immune system, can improve survival of patients affected by several malignancies, but may trigger a broad spectrum of adverse events, including autoimmune hypophysitis. ICI-related hypophysitis mainly manifests with anterior hypopituitarism, while the simultaneous involvement of both anterior and posterior pituitary (i.e., panhypophysitis) has rarely been described.Case PresentationIn June 2015, a 64-year-old man affected by liver metastases of a uveal melanoma was referred to us due to polyuria and polydipsia. Two months prior, he had started ipilimumab therapy (3 mg/kg iv every 21 days). The treatment was well-tolerated (only mild asthenia and diarrhea were reported). A few days before the fourth cycle, the patient complained of intense headaches, profound fatigue, nocturia, polyuria (up to 10 L urine/daily), and polydipsia. Laboratory tests were consistent with adrenal insufficiency, hypot...
In the last decade, increasing attention has been paid to understanding the influence that gender... more In the last decade, increasing attention has been paid to understanding the influence that gender can have on both human physiology and the pathogenesis of diseases. What makes women different from men is essentially represented by sex hormones and, in fact, the attention of scientific literature has been, and continues to be, an understanding of the biological mechanisms activated by sex hormones that underlie the pathophysiological diversity between men and women. Our attention has been focused on the effects that these hormones, and above all estrogens, can have in explaining gender differences in the endocrine field. Diseases such as thyroid disease, diabetes mellitus, osteoporosis, acromegaly clearly present gender differences, mainly due to the different sexual hormone structure. Energy metabolism is also gender-specific, being greatly influenced by estrogen, both at rest and during exercise. These hormones also have a significant effect on the pathogenesis of autoimmune endoc...
Recombinant human TSH (rhTSH) is currently used in follow-up of patients affected by differentiat... more Recombinant human TSH (rhTSH) is currently used in follow-up of patients affected by differentiated thyroid cancer (DTC). Age, sex, weight, body mass index, body surface area (BSA) and renal function are known factors affecting serum TSH peak levels, but the proper rhTSH dose to deliver to single patient remains elusive. In this study, the correlations of basal metabolic rates with serum TSH peak following rhTSH administration were investigated. We evaluated 221 patients affected by thyroid cancer that received a standard dose rhTSH. Blood samples were collected at pre-established time points. Data on body weight, height, and BSA were collected. The Mifflin-St Jeor and Fleisch equations were used to assess basal metabolism. The median value (range) of serum TSH peaks was 142 ± 53 μU/ml. Serum TSH peaks were significantly lower in males than in females ( = 0.04). TSH values also increased with age. Data showed a significant decrease of TSH peak levels at day 3 from the administration...
Background Acromegaly is a rare disease due to chronic growth hormone (GH) excess and the consequ... more Background Acromegaly is a rare disease due to chronic growth hormone (GH) excess and the consequent increase in insulin-like growth factor-1 (IGF-1) levels. Both GH and IGF-1 play a role in intermediate metabolism affecting glucose homeostasis. The association between hyperinsulinemia/impaired glucose tolerance and an increased risk of cancer has been clarified. Insulin has a mitogenic effect through its interaction with the IGF-1 receptor (IGF-1R) that also binds IGF-1. On the other hand, metformin, an anti-hyperglycemic drug that decreases serum levels of insulin and IGF-1, could have a protective role in the treatment of endocrine tumors. Methods A retrospective, observational, multicenter study in 197 acromegalic patients, receiving/not receiving metformin, was performed to assess whether the prevalence of neoplasms might be correlated with insulin resistance and could eventually be modified by metformin treatment. Results In general, the occurrence of secondary neoplasia among...
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