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Modulation of Secondary Cancer Risks from Radiation Exposure by Sex, Age and Gonadal Hormone Status: Progress, Opportunities and Challenges. J Pers Med 2022; 12:jpm12050725. [PMID: 35629147 PMCID: PMC9146871 DOI: 10.3390/jpm12050725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
Available data on cancer secondary to ionizing radiation consistently show an excess (2-fold amount) of radiation-attributable solid tumors in women relative to men. This excess risk varies by organ and age, with the largest sex differences (6- to more than 10-fold) found in female thyroid and breasts exposed between birth until menopause (~50 years old) relative to age-matched males. Studies in humans and animals also show large changes in cell proliferation rates, radiotracer accumulation and target density in female reproductive organs, breast, thyroid and brain in conjunction with physiological changes in gonadal hormones during the menstrual cycle, puberty, lactation and menopause. These sex differences and hormonal effects present challenges as well as opportunities to personalize radiation-based treatment and diagnostic paradigms so as to optimize the risk/benefit ratios in radiation-based cancer therapy and diagnosis. Specifically, Targeted Radionuclide Therapy (TRT) is a fast-expanding cancer treatment modality utilizing radiopharmaceuticals with high avidity to specific molecular tumor markers, many of which are influenced by sex and gonadal hormone status. However, past and present dosimetry studies of TRT agents do not stratify results by sex and hormonal environment. We conclude that cancer management using ionizing radiation should be personalized and informed by the patient sex, age and hormonal status.
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Antunes L, Bento MJ, Sobrinho-Simões M, Soares P, Boaventura P. Cancer incidence after childhood irradiation for tinea capitis in a Portuguese cohort. Br J Radiol 2020; 93:20180677. [PMID: 31674803 PMCID: PMC6948089 DOI: 10.1259/bjr.20180677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Our aim was to compare cancer incidence in a cohort exposed in childhood (1950-63) to a therapeutic dose of radiation in the North of Portugal and followed-up until the end of 2012, with the incidence rates for the same age and sex in the general population. METHODS A population-based North Region cancer registry (RORENO) was used to assess which members of the cohort developed cancer. The association between radiation exposure and overall and specific cancer sites was evaluated using standardised incidence ratios (SIR). RESULTS Over the full follow-up period, 3357 individuals of the 5356 original tinea capitis (TC) cohort (63%) were retrieved in the RORENO, and 399 new cancer cases were identified, representing an increased risk of 49% when compared with the general population (SIR = 1.49; 95% CI: 1.35-1.64). The risk was slightly higher in males than in females (SIR = 1.65; 95% CI: 1.43-1.89 vs SIR = 1.35; CI = 1.17-1.55). The risk was slightly higher in the individuals exposed to a higher radiation dose (SIR = 1.78; 95% CI: 1.22-2.51 for ≥630 R vs SIR = 1.46; 95% CI: 1.31-1.62 for 325-475 R). In females, there was an excess cancer risk in all cancers with the higher radiation dose (SIR = 2.00; 95% CI: 1.21-3.13 for ≥630 R vs SIR = 1.30; 95% CI: 1.11-1.51 for 325-475 R) which was not observed in males, and for combined dose categories significantly raised SIRs for thyroid and head and neck cancer, suggesting a possible higher radiosensitivity of females. An increased risk was also observed for some cancers located far from the irradiated area. CONCLUSIONS The results suggest an association between radiation exposure and later increased cancer risk for cancers located near the radiation exposed area, mainly thyroid, and head and neck cancers. Further studies are necessary to disentangle possible non-radiation causes for distant cancers increased risk. ADVANCES IN KNOWLEDGE This paper shows a possible association between childhood X-ray epilation and increased risk of cancer which was not previously investigated in the Portuguese TC cohort.
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Affiliation(s)
- Luís Antunes
- North Region Cancer Registry of Portugal, Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Rua Dr. António Bernardino de Almeida North Region Cancer Registry of Portugal, 4200-072 Porto, Portugal
| | - Maria José Bento
- North Region Cancer Registry of Portugal, Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Rua Dr. António Bernardino de Almeida North Region Cancer Registry of Portugal, 4200-072 Porto, Portugal
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Boaventura P, Durães C, Mendes A, Costa NR, Chora I, Ferreira S, Araújo E, Lopes P, Rosa G, Marques P, Tavares S, Chaves V, Bettencourt P, Oliveira I, Costa F, Ramos I, Teles MJ, Guimarães JT, Sobrinho-Simões M, Soares P. Is Low-Dose Radiation Exposure a Risk Factor for Atherosclerotic Disease? Radiat Res 2018; 189:418-424. [PMID: 29461943 DOI: 10.1667/rr14942.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Nontargeted late effects of radiation include an increased risk of cardiovascular disease, although this is still debatable in the context of low-dose radiation. Tinea capitis patients treated in childhood with X rays to induce scalp epilation received a low dose of radiation to their carotids. To better clarify this issue, we evaluated carotid atherosclerosis in a cohort of such patients treated in 1950-1963 in Portugal. A group of 454 individuals randomly chosen from previously observed Portuguese tinea capitis patients and a control group mainly composed of their spouses (n = 280) were enrolled. Cardiovascular risk factors such as waist circumference, body mass index, blood pressure and tobacco consumption, as well as biochemical measurements were obtained. Ultrasound imaging of carotid arteries for intima media thickness and stenosis evaluation were performed according to a standardized protocol. In comparison to the control group, the irradiated cohort members were significantly older, more frequently never smokers, hypertensive, and presented higher glycated hemoglobin and alkaline phosphatase levels. In addition, the irradiated cohort showed a higher frequency of carotid stenosis ≥30% than the nonirradiated group (13.9% vs. 10.7%), although this was not significant ( P = 0.20). Stenosis was ≥50% in 2.9% of the irradiated group and 0.4% of the nonirradiated group ( P = 0.02). Likewise, the frequency of intima media thickness ≥1 mm was significantly higher in the irradiated group (16.8% vs. 10.7%; P = 0.02). Multivariate analysis, including other cardiovascular risk factors, showed that exposure to low-dose radiation increased the risk of carotid stenosis by ≥50% [odds ratio (OR) = 8.85; P = 0.04] and intima media thickness by ≥1 mm (OR = 1.82; P = 0.02). These findings confirm that low-dose exposure is a risk factor of carotid atherosclerotic disease.
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Affiliation(s)
- Paula Boaventura
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S)
| | - Cecília Durães
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S)
| | - Adélia Mendes
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S)
| | - Natália Rios Costa
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S)
| | | | | | | | | | | | | | | | | | - Paulo Bettencourt
- c S. João Hospital, Porto.,d Department of Pathology, Faculty of Medicine of the University of Porto
| | | | | | - Isabel Ramos
- c S. João Hospital, Porto.,e Faculty of Medicine of the University of Porto
| | - Maria José Teles
- c S. João Hospital, Porto.,e Faculty of Medicine of the University of Porto
| | | | - Manuel Sobrinho-Simões
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S).,c S. João Hospital, Porto.,d Department of Pathology, Faculty of Medicine of the University of Porto.,e Faculty of Medicine of the University of Porto
| | - Paula Soares
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S).,c S. João Hospital, Porto.,e Faculty of Medicine of the University of Porto
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Boaventura P, Batista R, Pestana A, Reis M, Mendes A, Eloy C, Sobrinho-Simões M, Soares P. TERT promoter mutations: a genetic signature of benign and malignant thyroid tumours occurring in the context of tinea capitis irradiation. Eur J Endocrinol 2017; 176:49-55. [PMID: 27760791 DOI: 10.1530/eje-16-0740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/15/2016] [Accepted: 10/19/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the frequency and molecular characteristics of TERTp mutations in thyroid adenomas and carcinomas occurring in the low-dose radiation exposure tinea capitis setting. DESIGN AND METHODS Twenty-seven patients with 34 well-differentiated thyroid carcinomas and 28 patients with 29 follicular adenomas diagnosed in a Portuguese tinea capitis cohort were studied. Blood samples were obtained from all the patients. Screening for TERTp mutations was performed by PCR amplification followed by Sanger sequencing. A series of 33 sporadic thyroid adenomas was used as control. RESULTS TERTp mutations were detected in six of the 28 patients with adenoma (21.4%) and in four of the 27 patients with carcinoma (14.8%). Three tumours (two carcinomas and one adenoma) had the tandem mutation -124/-125 GG>AA (30.0%), whereas the remaining seven had the -124G > A. The 20.7% frequency of TERTp mutations in adenomas contrasts with the absence of mutations in the adenomas from the control group and from most series on record, whereas the one found in carcinomas (11.8%) is similar to those reported in the literature for sporadic carcinomas. CONCLUSION TERTp mutations, including the tandem mutation -124/-125 GG>AA not described previously in thyroid tumours, appear to represent a genetic signature for thyroid tumours in patients submitted to low-dose X-ray irradiation. The high frequency of TERTp mutations in the adenomas of our cohort contrasts with their absence in sporadically occurring, as well as in adenomas of the Chernobyl series.
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Affiliation(s)
- Paula Boaventura
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of PortoPorto, Portugal
- i3S - Instituto de Investigação e Inovação em SaúdeUniversidade do Porto, Porto, Portugal
| | - Rui Batista
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of PortoPorto, Portugal
- i3S - Instituto de Investigação e Inovação em SaúdeUniversidade do Porto, Porto, Portugal
| | - Ana Pestana
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of PortoPorto, Portugal
- i3S - Instituto de Investigação e Inovação em SaúdeUniversidade do Porto, Porto, Portugal
| | - Marta Reis
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of PortoPorto, Portugal
- i3S - Instituto de Investigação e Inovação em SaúdeUniversidade do Porto, Porto, Portugal
| | - Adélia Mendes
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of PortoPorto, Portugal
- i3S - Instituto de Investigação e Inovação em SaúdeUniversidade do Porto, Porto, Portugal
| | - Catarina Eloy
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of PortoPorto, Portugal
- i3S - Instituto de Investigação e Inovação em SaúdeUniversidade do Porto, Porto, Portugal
| | - Manuel Sobrinho-Simões
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of PortoPorto, Portugal
- i3S - Instituto de Investigação e Inovação em SaúdeUniversidade do Porto, Porto, Portugal
- Faculty of MedicineUniversity of Porto, Porto, Portugal
- Department of PathologyCentro Hospitalar de S. João, Porto, Portugal
| | - Paula Soares
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of PortoPorto, Portugal
- i3S - Instituto de Investigação e Inovação em SaúdeUniversidade do Porto, Porto, Portugal
- Faculty of MedicineUniversity of Porto, Porto, Portugal
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Boaventura P, Durães C, Mendes A, Costa NR, Chora I, Ferreira S, Araújo E, Lopes P, Rosa G, Marques P, Bettencourt P, Oliveira I, Costa F, Ramos I, Teles MJ, Guimarães JT, Sobrinho-Simões M, Soares P. IL6-174 G>C Polymorphism (rs1800795) Association with Late Effects of Low Dose Radiation Exposure in the Portuguese Tinea Capitis Cohort. PLoS One 2016; 11:e0163474. [PMID: 27662210 PMCID: PMC5035001 DOI: 10.1371/journal.pone.0163474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/09/2016] [Indexed: 02/06/2023] Open
Abstract
Head and neck cancers, and cardiovascular disease have been described as late effects of low dose radiation (LDR) exposure, namely in tinea capitis cohorts. In addition to radiation dose, gender and younger age at exposure, the genetic background might be involved in the susceptibility to LDR late effects. The -174 G>C (rs1800795) SNP in IL6 has been associated with cancer and cardiovascular disease, nevertheless this association is still controversial. We assessed the association of the IL6-174 G>C SNP with LDR effects such as thyroid carcinoma, basal cell carcinoma and carotid atherosclerosis in the Portuguese tinea capitis cohort. The IL6-174 G>C SNP was genotyped in 1269 individuals formerly irradiated for tinea capitis. This sampling group included thyroid cancer (n = 36), basal cell carcinoma (n = 113) and cases without thyroid or basal cell carcinoma (1120). A subgroup was assessed for atherosclerosis by ultrasonography (n = 379) and included matched controls (n = 222). Genotypes were discriminated by real-time PCR using a TaqMan SNP genotyping assay. In the irradiated group, we observed that the CC genotype was significantly associated with carotid plaque risk, both in the genotypic (OR = 3.57, CI = 1.60–7.95, p-value = 0.002) and in the recessive (OR = 3.02, CI = 1.42–6.42, p-value = 0.004) models. Irradiation alone was not a risk factor for carotid atherosclerosis. We did not find a significant association of the IL6-174 C allele with thyroid carcinoma or basal cell carcinoma risk. The IL6-174 CC genotype confers a three-fold risk for carotid atherosclerotic disease suggesting it may represent a genetic susceptibility factor in the LDR context.
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Affiliation(s)
- Paula Boaventura
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, Rua Júlio Amaral de Carvalho 45, 4200–135 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Rua Alfredo Allen 208, 4200–135 Porto, Portugal
- * E-mail:
| | - Cecília Durães
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, Rua Júlio Amaral de Carvalho 45, 4200–135 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Rua Alfredo Allen 208, 4200–135 Porto, Portugal
| | - Adélia Mendes
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, Rua Júlio Amaral de Carvalho 45, 4200–135 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Rua Alfredo Allen 208, 4200–135 Porto, Portugal
| | - Natália Rios Costa
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, Rua Júlio Amaral de Carvalho 45, 4200–135 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Rua Alfredo Allen 208, 4200–135 Porto, Portugal
| | - Inês Chora
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Sara Ferreira
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Emanuel Araújo
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Pedro Lopes
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Gilberto Rosa
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Pedro Marques
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Paulo Bettencourt
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Inês Oliveira
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Francisco Costa
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Isabel Ramos
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Maria José Teles
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - João Tiago Guimarães
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Manuel Sobrinho-Simões
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, Rua Júlio Amaral de Carvalho 45, 4200–135 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Rua Alfredo Allen 208, 4200–135 Porto, Portugal
- Hospital of S. João, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
| | - Paula Soares
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, Rua Júlio Amaral de Carvalho 45, 4200–135 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Rua Alfredo Allen 208, 4200–135 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200–319 Porto, Portugal
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Liebelt BD, Haider AS, Steele WJ, Krishna C, Blacklock JB. Spinal Schwannoma and Meningioma Mimicking a Single Mass at the Craniocervical Junction Subsequent to Remote Radiation Therapy for Acne Vulgaris. World Neurosurg 2016; 93:484.e13-6. [PMID: 27450976 DOI: 10.1016/j.wneu.2016.07.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Schwannomas and meningiomas are relatively common tumors of the nervous system. They have been reported in the literature as existing concurrently as a single mass, but very rarely have they been shown to present at the craniocervical junction. CASE DESCRIPTION We present a rare and interesting case of a patient previously treated with radiation therapy for acne vulgaris and who presented to us with a concurrent schwannoma and meningioma of the craniocervical junction mimicking a single mass. CONCLUSIONS These tumors can be solitary or mixed masses, and are known to be associated with certain disease processes such as long-term sequelae of radiation therapy and neurofibromatosis type 2. The precise mechanism behind the formation of these tumors is unknown; however, molecular cues in the tumor microenvironment may play a role.
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Affiliation(s)
- Brandon D Liebelt
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA.
| | - Ali S Haider
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA
| | - William J Steele
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA
| | - Chandan Krishna
- Department of Neurosurgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - J Bob Blacklock
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA
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Nenoff P, Krüger C, Paasch U, Ginter-Hanselmayer G. Mycology - an update Part 3: Dermatomycoses: topical and systemic therapy. J Dtsch Dermatol Ges 2016; 13:387-410; quiz 411. [PMID: 25918080 DOI: 10.1111/ddg.12689] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Treatment of dermatophyte infections is based on the clinical picture and mycological detection of the causative pathogen. Based on the appropriate indication, onychomycosis can be treated topically using an antimycotic nail lacquer. Atraumatic nail abrasion with 40 % urea ointment has a beneficial effect on healing. Continuous treatment of onychomycosis with terbinafine represents the most effective systemic therapy. Terbinafine or itraconazole are the safest and most effective antimycotic agents for the treatment of onychomycosis in children. For laser therapy of onychomycosis, only a few studies on clinical efficacy are available. Regarding tinea capitis, targeted species-specific therapy of dermatophytosis of the scalp is currently recommended. Terbinafine, yet also itraconazole and fluconazole, are effective in tinea capitis caused by Trichophyton species. Microsporum infections of the scalp are preferably treated with griseofulvin, alternatively with itraconazole or fluconazole. Terbinafine is less effective. Candidal intertrigo are topically treated with nystatin, but azoles or ciclopirox olamine are also suitable candidates. Systemically, fluconazole or itraconazole are used. Topical and systemic antimycotics are equivalent forms of therapy in acute vulvovaginal mycosis. Fluconazole is the drug of choice in chronic recurrent vulvovaginal mycosis caused by Candida albicans. Ketoconazole shows very good efficacy in tinea versicolor. With respect to systemic treatment of severe and widespread tinea versicolor, itraconazole is the drug of choice.
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Barczyński M, Bränström R, Dionigi G, Mihai R. Sporadic multiple parathyroid gland disease--a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 2015; 400:887-905. [PMID: 26542689 PMCID: PMC4747992 DOI: 10.1007/s00423-015-1348-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/05/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Sporadic multiglandular disease (MGD) has been reported in literature in 8-33 % of patients with primary hyperparathyroidism (pHPT). This paper aimed to review controversies in the pathogenesis and management of sporadic MGD. METHODS A literature search and review was made to evaluate the level of evidence concerning diagnosis and management of sporadic MGD according to criteria proposed by Sackett, with recommendation grading by Heinrich et al. and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled 'Hyperparathyroidism due to multiple gland disease: An evidence-based perspective'. RESULTS Literature reports no prospective randomised studies; thus, a relatively low level of evidence was achieved. Appropriate surgical therapy of sporadic MGD should consist of a bilateral approach in most patients. Unilateral neck exploration guided by preoperative imaging should be reserved for selected patients, performed by an experienced endocrine surgeon and monitored by intraoperative parathormone assay (levels of evidence III-V, grade C recommendation). There is conflicting or equally weighted levels IV-V evidence supporting that cure rates can be similar or worse for sporadic MGD than for single adenomas (no recommendation). Best outcomes can be expected if surgery is performed by an experienced parathyroid surgeon working in a high-volume centre (grade C recommendation). Levels IV-V evidence supports that recurrent/persistence pHPT occurs more frequently in patients with double adenomas hence in situations where a double adenoma has been identified, the surgeon should have a high index of suspicion during surgery and postoperatively for the possibility of a four-gland disease (grade C recommendation). CONCLUSIONS Identifying preoperatively patients at risk for MGD remains challenging, intraoperative decisions are important for achieving acceptable cure rates and long-term follow-up is mandatory in such patients.
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Affiliation(s)
- Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Kraków, Poland.
| | - Robert Bränström
- Endocrine and Sarcoma Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Gianlorenzo Dionigi
- First Division of Surgery, Research Center for Endocrine Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Radu Mihai
- Department of Endocrine Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
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Nenoff P, Krüger C, Paasch U, Ginter-Hanselmayer G. Mykologie - ein Update Teil 3: Dermatomykosen: Topische und systemische Behandlung. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12689_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Pietro Nenoff
- Labor für medizinische Mikrobiologie; Mölbis Deutschland
| | | | - Uwe Paasch
- Klinik und Poliklinik für Dermatologie; Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig; Deutschland
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