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Hamblin R, Fountas A, Lithgow K, Loughrey PB, Bonanos E, Shinwari SK, Mitchell K, Shah S, Grixti L, Matheou M, Isand K, McLaren DS, Surya A, Ullah HZ, Klaucane K, Jayasuriya A, Bhatti S, Mavilakandy A, Ahsan M, Mathew S, Hussein Z, Jansz T, Wunna W, MacFarlane J, Ayuk J, Abraham P, Drake WM, Gurnell M, Brooke A, Baldeweg SE, Sam AH, Martin N, Higham C, Reddy N, Levy MJ, Ahluwalia R, Newell-Price J, Vamvakopoulos J, Krishnan A, Lansdown A, Murray RD, Pal A, Bradley K, Mamoojee Y, Purewal T, Panicker J, Freel EM, Hasan F, Kumar M, Jose B, Hunter SJ, Karavitaki N. Natural history of non-functioning pituitary microadenomas - results from the UK NFPA consortium. Eur J Endocrinol 2023:lvad070. [PMID: 37345849 DOI: 10.1093/ejendo/lvad070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE The optimal approach to the surveillance of non-functioning pituitary microadenomas (micro-NFPAs) is not clearly established. Our aim was to generate evidence on the natural history of micro-NFPAs to support patient care. DESIGN Multi-centre, retrospective, cohort study involving 23 endocrine departments (UK NFPA consortium). METHODS Clinical, imaging, and hormonal data of micro-NFPA cases between 1/1/2008 and 21/12/2021 were analysed. RESULTS Data for 459 patients were retrieved [median age at detection 44 years [interquartile range (IQR) 31-57) - 152 males/307 females]. 419 patients had more than two MRIs [median imaging monitoring 3.5 years (IQR 1.71-6.1)]. One case developed apoplexy. Cumulative probability of micro-NFPA growth was 7.8% (95%CI 4.9%-8.1%) and 14.5% (95%CI 10.2%-18.8%) at 3 and 5 years, respectively, and of reduction 14.1% (95%CI 10.4-17.8%) and 21.3% (95%CI 16.4-26.2%) at 3 and 5 years, respectively. Median tumour enlargement was 2 mm (IQR 1-3) and 49% of micro-NFPAs that grew became macroadenomas (nearly all >5 mm at detection). Eight (1.9%) patients received surgery (only one had visual compromise with surgery required >3 years after micro-NFPA detection). Sex, age, size at baseline were not predictors of enlargement/reduction. At time of detection, 7.2%, 1.7% and 1.5% patients had secondary hypogonadism, hypothyroidism and hypoadrenalism, respectively. Two (0.6%) developed hypopituitarism during follow-up (after progression to macroadenoma). CONCLUSIONS Probability of micro-NFPA growth is low and development of new hypopituitarism is rare. Delaying first follow-up MRI to three years and avoiding hormonal re-evaluation in absence of tumour growth or clinical manifestations is a safe approach for micro-NFPA surveillance.
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Affiliation(s)
- Ross Hamblin
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Athanasios Fountas
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kirstie Lithgow
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Benjamin Loughrey
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Efstathios Bonanos
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Shah Khalid Shinwari
- Department of Endocrinology and Metabolic Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Kirsten Mitchell
- Department of Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Syed Shah
- Department of Endocrinology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Lydia Grixti
- Department of Endocrinology and Metabolic Medicine, The Newcastle-Upon-Tyne NHS Foundation Trust, Newcastle, UK
| | - Mike Matheou
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kristina Isand
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David S McLaren
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ashutosh Surya
- Centre for Diabetes and Endocrinology, University Hospital of Wales, Cardiff, UK
| | - Hafiz Zubair Ullah
- Centre for Diabetes and Endocrinology, University Hospital of Wales, Cardiff, UK
| | - Katarina Klaucane
- Manx Centre for Endocrinology, Diabetes & Metabolism, Manx Care , Douglas, Isle of Man
| | - Anuradha Jayasuriya
- Department of Endocrinology and Metabolism, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sumbal Bhatti
- Department of Endocrinology, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK
| | - Akash Mavilakandy
- Department of Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Masato Ahsan
- Department of Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Susan Mathew
- Department of Endocrinology, The Christie NHS Foundation Trust, Manchester, UK
| | - Ziad Hussein
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Thijs Jansz
- Department of Endocrinology and Metabolism, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Wunna Wunna
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS trust, London, UK
| | - James MacFarlane
- Department of Endocrinology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Metabolic Research Laboratories, Wellcome MRC Institute of Metabolic Science, University of Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - John Ayuk
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Prakash Abraham
- Department of Diabetes and Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - William M Drake
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS trust, London, UK
| | - Mark Gurnell
- Department of Endocrinology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Metabolic Research Laboratories, Wellcome MRC Institute of Metabolic Science, University of Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Antonia Brooke
- Department of Endocrinology and Metabolism, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Amir H Sam
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Niamh Martin
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Claire Higham
- Department of Endocrinology, The Christie NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Narendra Reddy
- Department of Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Miles J Levy
- Department of Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rupa Ahluwalia
- Department of Endocrinology, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK
| | - John Newell-Price
- Department of Endocrinology and Metabolism, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Joannis Vamvakopoulos
- Manx Centre for Endocrinology, Diabetes & Metabolism, Manx Care , Douglas, Isle of Man
| | - Amutha Krishnan
- Manx Centre for Endocrinology, Diabetes & Metabolism, Manx Care , Douglas, Isle of Man
| | - Andrew Lansdown
- Centre for Diabetes and Endocrinology, University Hospital of Wales, Cardiff, UK
| | - Robert D Murray
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Aparna Pal
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karin Bradley
- Department of Diabetes and Endocrinology, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Yaasir Mamoojee
- Department of Endocrinology and Metabolic Medicine, The Newcastle-Upon-Tyne NHS Foundation Trust, Newcastle, UK
| | - Tejpal Purewal
- Department of Endocrinology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Janki Panicker
- Department of Endocrinology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - E Marie Freel
- Department of Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Faisal Hasan
- Department of Diabetes and Endocrinology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Mohit Kumar
- Department of Endocrinology and Metabolic Medicine, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Biju Jose
- Department of Endocrinology and Metabolic Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Steven J Hunter
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Kaniuka-Jakubowska S, Levy MJ, Pal A, Abeyaratne D, Drake WM, Kyriakakis N, Murray RD, Orme SM, Gohil S, Brooke A, Leese GP, Korbonits M, Wass JA. A study of acromegaly-associated headache with somatostatin analgesia. Endocr Relat Cancer 2023; 30:e220138. [PMID: 36633458 DOI: 10.1530/erc-22-0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/11/2023] [Indexed: 01/13/2023]
Abstract
The aim of this study is to characterise somatostatin analogue-responsive headache in acromegaly, hitherto not systematically documented in a significant cohort. Using the UK pituitary network, we have clinically characterised a cohort of 18 patients suffering from acromegaly-related headache with a clear response to somatostatin analogues. The majority of patients had chronic migraine (78%) as defined by the International Headache Society diagnostic criteria. Headache was present at the time of acromegaly presentation and clearly associated temporally with disease activity in all cases. Short-acting somatostatin analogues uniquely resolved pain within minutes and the mean duration of analgesia was 1-6 h. Patients on long-acting analogues required less short-acting injections (mean: 3.7 vs 10.4 injections per day, P = 0.005). 94% used somatostatin analogues to control ongoing headache pain. All patients presented with macroadenoma, most had incomplete resection (94%) and headache was ipsilateral to remnant tissue (94%). Although biochemical control was achieved in 78% of patients, headache remained in 71% of them. Patients selected for this study had ongoing headache post-treatment (mean duration: 16 years after diagnosis); only four patients reached headache remission 26 years (mean range: 14-33) after the diagnosis. Headache in acromegaly patients can be persistent, severe, unrelieved by surgery, long-lasting and uncoupled from biochemical control. We show here that long-acting analogues allow a decrease in the number of short-acting analogue injections for headache relief. Further studies are needed to understand the mechanisms, markers and tumour tissue characteristics of acromegaly-related headache. Until then, this publication serves to provide the clinical characteristics as a reference point for further study.
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Affiliation(s)
- Sonia Kaniuka-Jakubowska
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
- Department of Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Miles J Levy
- Department of Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Aparna Pal
- Department of Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dayakshi Abeyaratne
- Department of Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - William M Drake
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Nikolaos Kyriakakis
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Robert D Murray
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Steve M Orme
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Shailesh Gohil
- Department of Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Antonia Brooke
- MacLeod Diabetes and Endocrinology Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | | | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - John Ah Wass
- Department of Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Seguna D, Akker S, Ahlquist J, Pal A, Brooke A, Lewis R, Plowman PN, Evanson J, Panday P, Drake WM. Efficacy and Safety of CyberKnife Stereotactic Radiosurgery in Acromegaly. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab195.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Objective: Active acromegaly is associated with increased mortality. While surgery is the mainstay of treatment, it is not always curative. In selected cases, CyberKnife stereotactic radiosurgery (CK SRS) can be used as adjuvant treatment in patients with persistent disease.
Method
Methodology: Biochemical response was measured using serum IGF-1 levels, calculated as a percentage of the upper limit of normal (% ULN). Levels were recorded prior to treatment, at 6-12 months post-treatment and at the most recent follow-up. Anterior pituitary hormone deficits were assessed before and after treatment. Tumour size was followed-up using MRI.
Results
10 patients (7 male, mean age 36 yrs [+/- 12.6, SD]) with acromegaly were treated with CK SRS. 9 were treated following failure to attain biochemical remission with TSS. 1 had primary CK SRS. 2 had previous conventional fractionated external beam radiotherapy.
Median tumour diameter was 6 mm (IQR 5.2-10.5 mm), with cavernous sinus invasion in 2 cases. The dose was 20-24Gy/1#. 4 patients were on dopamine agonist, 4 on somatostatin analogue and 2 on pegvisomant. Mean follow-up 31.6 months (+/- 13.5 months, SD).
Median IGF-1 % ULN was 146% pre-treatment (IQR 126.5-208.5), 109% at 6-12 months (IQR 76.5-131%) and 71% (IQR 59-91%) at last follow-up. Mean radiological follow-up 16.6 months (+/- 15.9 months, SD). No cases showed tumour enlargement.
One patient developed secondary hypothyroidism. Side-effects: headache (7 patients), blurred vision (1 patient), fatigue/nausea (1 patient). No new visual fields defects, cranial nerve palsies, cerebrovascular events or secondary tumours.
Conclusion
Conclusions: CK SRS appears safe and effective in selected patients with acromegaly, when there is failure to attain biochemical cure with surgery and in patients intolerant or resistant to medical treatment.
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Lucas-Herald AK, Bryce J, Kyriakou A, Ljubicic ML, Arlt W, Audi L, Balsamo A, Baronio F, Bertelloni S, Bettendorf M, Brooke A, Claahsen van der Grinten HL, Davies JH, Hermann G, de Vries L, Hughes IA, Tadokoro-Cuccaro R, Darendeliler F, Poyrazoglu S, Ellaithi M, Evliyaoglu O, Fica S, Nedelea L, Gawlik A, Globa E, Zelinska N, Guran T, Güven A, Hannema SE, Hiort O, Holterhus PM, Iotova V, Mladenov V, Jain V, Sharma R, Jennane F, Johnston C, Guerra Junior G, Konrad D, Gaisl O, Krone N, Krone R, Lachlan K, Li D, Lichiardopol C, Lisa L, Markosyan R, Mazen I, Mohnike K, Niedziela M, Nordenstrom A, Rey R, Skaeil M, Tack LJW, Tomlinson J, Weintrob N, Cools M, Ahmed SF. Gonadectomy in conditions affecting sex development: a registry-based cohort study. Eur J Endocrinol 2021; 184:791-801. [PMID: 33780351 DOI: 10.1530/eje-20-1058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine trends in clinical practice for individuals with DSD requiring gonadectomy. DESIGN Retrospective cohort study. METHODS Information regarding age at gonadectomy according to diagnosis; reported sex; time of presentation to specialist centre; and location of centre from cases reported to the International DSD Registry and who were over 16 years old in January 2019. RESULTS Data regarding gonadectomy were available in 668 (88%) individuals from 44 centres. Of these, 248 (37%) (median age (range) 24 (17, 75) years) were male and 420 (63%) (median age (range) 26 (16, 86) years) were female. Gonadectomy was reported from 36 centres in 351/668 cases (53%). Females were more likely to undergo gonadectomy (n = 311, P < 0.0001). The indication for gonadectomy was reported in 268 (76%). The most common indication was mitigation of tumour risk in 172 (64%). Variations in the practice of gonadectomy were observed; of the 351 cases from 36 centres, 17 (5%) at 9 centres had undergone gonadectomy before their first presentation to the specialist centre. Median age at gonadectomy of cases from high-income countries and low-/middle-income countries (LMIC) was 13.0 years (0.1, 68) years and 16.5 years (1, 28), respectively (P < 0.0001) with the likelihood of long-term retention of gonads being higher in LMIC countries. CONCLUSIONS The likelihood of gonadectomy depends on the underlying diagnosis, sex of rearing and the geographical setting. Clinical benchmarks, which can be studied across all forms of DSD will allow a better understanding of the variation in the practice of gonadectomy.
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Affiliation(s)
| | - Jillian Bryce
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Marie Lindhardt Ljubicic
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Audi
- Department of Pediatrics and Pediatric Endocrinology Unit, Vall d'Hebron Research Institute (VHIR), Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Balsamo
- Department of Pediatrics, University of Bologna Hospital of Bologna Sant Orsola-Malpighi, Bologna, Italy
| | - Federico Baronio
- Department of Pediatrics, University of Bologna Hospital of Bologna Sant Orsola-Malpighi, Bologna, Italy
| | | | - Markus Bettendorf
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Antonia Brooke
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | | | - Justin H Davies
- Department of Paediatric Endocrinology, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gloria Hermann
- Department of Pediatrics and Adolescent Medicine, University Medical Centre, Ulm, Germany
| | - Liat de Vries
- Paediatrics, Tel Aviv Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Centre of Israel, Petah Tikvah, Israel
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | | | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Mona Ellaithi
- Faculty of Medical Laboratory Sciences, Al-Neelain University, Khartoum, Sudan
| | - Olcay Evliyaoglu
- Department of Pediatric Endocrinology, Istanbul University - Cerrahpasa, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Simone Fica
- Endocrinologie, Universitatea de Medicina si Farmacie Carol Davila Facultatea de Medicine, Bucharest, Romania
| | - Lavinia Nedelea
- Endocrinologie, Universitatea de Medicina si Farmacie Carol Davila Facultatea de Medicine, Bucharest, Romania
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Evgenia Globa
- Ukrainian Research Center of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MOH of Ukraine, Kyiv, Ukraine
| | - Nataliya Zelinska
- Ukrainian Research Center of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MOH of Ukraine, Kyiv, Ukraine
| | - Tulay Guran
- Department of Pediatric Endocrinology, Marmara University, Istanbul, Turkey
| | - Ayla Güven
- Pediatric Endocrinology Clinic, Zeynep Kamil Women and Children Hospital, Istanbul, Turkey
| | - Sabine E Hannema
- Pediatric Endocrinology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf Hiort
- Division of Paediatrics, University of Lübeck, Lübeck, Germany
| | - Paul-Martin Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Hospital of Schleswig-Holstein Campus Kiel/Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Violeta Iotova
- UMHAT 'Sveta Marina', Medical University of Varna, Varna, Bulgaria
| | - Vilhelm Mladenov
- UMHAT 'Sveta Marina', Medical University of Varna, Varna, Bulgaria
| | - Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajni Sharma
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Farida Jennane
- Unité d'Endocrinologie/Diabétologie et Gynécologie de l'Enfant et de l'Adolescent, Hôpital d'Enfants, Casablanca, Morocco
| | - Colin Johnston
- Department of Endocrinology, St Albans City Hospital, West Hertfordshire Hospitals Trust, St Albans, UK
| | - Gil Guerra Junior
- Disciplina de Endocrinologia e Metabologia, Faculdade deo Ciencias Medicas da Universidade de Campinas, Departamento de Pediatria e Departamento de Clinica Medica, Sao Paolo, Brazil
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - Odile Gaisl
- Division of Pediatric Endocrinology and Diabetology and Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - Nils Krone
- Department of Oncology and Metabolism, Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - Ruth Krone
- Endocrinology, Birmingham Children's Hospital, Birmingham, UK
| | - Katherine Lachlan
- Department of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dejun Li
- Centre for Prenatal Diagnosis, Jilin University First Hospital, Jilin, China
| | - Corina Lichiardopol
- Endocrinology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Lidka Lisa
- Endocrinology, Institute of Prague, Czech Republic
| | - Renata Markosyan
- Endocrinology, Yerevan State Medical University Endocrinology Clinic, Yerevan, Armenia
| | - Inas Mazen
- Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Klaus Mohnike
- Department of Pediatrics, Otto-von-Guericke University, Magdeburg, Germany
| | - Marek Niedziela
- Department of Pediatric Endocrinology, Poznan University of Medical Sciences, Poznan, Wielkopolskie, Poland
| | - Anna Nordenstrom
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rodolfo Rey
- CONICET - FEI - División de Endocrinología, Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE), Buenos Aires, Argentina
| | - Mars Skaeil
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Lloyd J W Tack
- Pediatric Endocrinology Service, University Hospital Ghent, Ghent, Belgium
| | - Jeremy Tomlinson
- Oxford Centre for Diabetes, Endocrinology & Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK
| | - Naomi Weintrob
- Paediatrics, Tel Aviv Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology, Dana Dwek Children's Hospital, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Martine Cools
- Pediatric Endocrinology Service, University Hospital Ghent, Ghent, Belgium
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
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Brooke A, Ahmed R, Hodson J, Rooney S, Oelofse T, Singh H, Shah T, Steeds R. Carcinoid heart disease: the role of echocardiography in predicting post-surgical outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Carcinoid heart disease (CHD) often complicates neuroendocrine tumours (NET). The prognosis of CHD without intervention is poor; 3 year survival is estimated at 31%. Surgical valve replacement is the only treatment for CHD, but is associated with high 30-day mortality (10–15%).
Purpose
The aim is to identify pre-operative transthoracic echocardiogram (PTTE) findings that could determine which patients have a high likelihood of post-surgical mortality at 1 year.
Methods
This retrospective observational cohort study recruited 88 patients with a confirmed diagnosis of CHD between 2005–19 at University Hospital Birmingham; 49 (56%) of these were treated surgically. Indications for surgery: stable NET, symptomatic severe valvular dysfunction, progressive RV dilatation or RV dysfunction, no significant comorbidities. All patients underwent a standard PTTE. PTTE parameters assessed: right ventricular (RV) size, RV function (qualitative), TAPSE, RV fractional area change, RV S wave velocity, left ventricular (LV) size, LV ejection fraction and valve velocities. Surgery was performed by a single surgical team with bioprosthetic valve replacements.
Results
Patients were followed up for a median of 15 months (IQR: 6–59) after surgery, during which time there were 33 deaths, giving a median survival time of 30 months (IQR: 7–85). Increasingly severe RV dilatation was significantly associated with shorter survival (p=0.032). The estimated survival rate at three years was 67% in those with normal RV size, compared to 24% in the severe RV group (Figure 1). RV basal diameter was assessed used ROC curve analysis for the outcome of one year survival and returned an area under the curve of 0.66 (SE=0.10). Youden's index identified RV diameter >4.8cm to be the optimal cut-off for identifying high-risk patients. One year mortality rates were 26% (7/27) vs. 75% (9/12) in those with RV basal diameter of ≤4.8 vs. >4.8cm (p=0.006).
Conclusion
A pre-operative right ventricular basal diameter >4.8cm is associated with a near three-fold increase in post-operative mortality at one year. These findings highlight the importance of regular imaging in order to optimise the timing of surgery in patients with CHD.
Figure 1. Kaplan-Meier curve of post-op survival
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Brooke
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - R Ahmed
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - J Hodson
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S Rooney
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Oelofse
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - H Singh
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Shah
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - R.P Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Ali UM, Judge A, Foster C, Brooke A, James K, Marriott T, Lamb SE. Do portable nursing stations within bays of hospital wards reduce the rate of inpatient falls? An interrupted time-series analysis. Age Ageing 2018; 47:818-824. [PMID: 30010697 PMCID: PMC6201822 DOI: 10.1093/ageing/afy097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/14/2018] [Indexed: 11/13/2022] Open
Abstract
Background falls can negatively affect patients, resulting in loss of independence and functional decline and have substantial healthcare costs. Hospitals are a high-risk falls environment and regularly introduce, but seldom evaluate, policies to reduce inpatient falls. This study evaluated whether introducing portable nursing stations in ward bays to maximise nurse-patient contact time reduced inpatient falls. Methods inpatient falls data from local hospital incident reporting software (Datix) were collected monthly (April 2014-December 2017) from 17 wards in Stoke Mandeville and Wycombe General Hospitals, the UK. Portable nursing stations were introduced in bays on these wards from April 2016. We used a natural experimental study design and interrupted time series analysis to evaluate changes in fall rates, measured by the monthly rate of falls per 1000 occupied bed days (OBDs). Results the wards reported 2875 falls (April 2014-December 2017). The fallers' mean age was 78 (SD = 13) and 58% (1624/2817) were men. Most falls, 99.41% (2858/2875), resulted in none, low or moderate harm, 0.45% (13/2875) in severe harm and 0.14% (4/2875) in death. The monthly falls rate increased by 0.119 per 1000 OBDs (95% CI: 0.045, 0.194; P = 0.002) before April 2016, then decreased by 0.222 per 1000 OBDs (95% CI: -0.350, -0.093; P = 0.001) until December 2017. At 12 months post-intervention, the absolute difference between the estimated post-intervention trend and pre-intervention projected estimate was 2.84 falls per 1000 OBDs, a relative reduction of 26.71%. Conclusion portable nursing stations were associated with lower monthly falls rates and could reduce inpatient falls across the NHS.
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Affiliation(s)
- U M Ali
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research in Oxford, University of Oxford, Oxford, UK
| | - A Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - C Foster
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - A Brooke
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - K James
- Oxford Academic Health Sciences Network, Oxford, UK
| | - T Marriott
- Oxford Academic Health Sciences Network, Oxford, UK
| | - S E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research in Oxford, University of Oxford, Oxford, UK
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Baldeweg SE, Ball S, Brooke A, Gleeson HK, Levy MJ, Prentice M, Wass J. SOCIETY FOR ENDOCRINOLOGY CLINICAL GUIDANCE: Inpatient management of cranial diabetes insipidus. Endocr Connect 2018; 7:G8-G11. [PMID: 29930026 PMCID: PMC6013691 DOI: 10.1530/ec-18-0154] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/08/2018] [Indexed: 11/10/2022]
Abstract
Cranial diabetes insipidus (CDI) is a treatable chronic condition that can potentially develop into a life-threatening medical emergency. CDI is due to the relative or absolute lack of the posterior pituitary hormone vasopressin (AVP), also known as anti-diuretic hormone. AVP deficiency results in uncontrolled diuresis. Complete deficiency can lead to polyuria exceeding 10 L/24 h. Given a functioning thirst mechanism and free access to water, patients with CDI can normally maintain adequate fluid balance through increased drinking. Desmopressin (DDAVP, a synthetic AVP analogue) reduces uncontrolled water excretion in CDI and is commonly used in treatment. Critically, loss of thirst perception (through primary pathology or reduced consciousness) or limited access to water (through non-availability, disability or inter-current illness) in a patient with CDI can lead to life-threatening dehydration. This position can be further exacerbated through the omission of DDAVP. Recent data have highlighted serious adverse events (including deaths) in patients with CDI. These adverse outcomes and deaths have occurred through a combination of lack of knowledge and treatment failures by health professionals. Here, with our guideline, we recommend treatment pathways for patients with known CDI admitted to hospital. Following these guidelines is essential for the safe management of patients with CDI.
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Affiliation(s)
- S E Baldeweg
- Department of Diabetes and EndocrinologyUniversity College London NHS Foundation Trust and Univeristy College London, London, UK
| | - S Ball
- Department of Medicine and EndocrinologyManchester University Foundation Trust & Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - A Brooke
- Royal Devon and Exeter NHS Foundation TrustExeter, UK
| | - H K Gleeson
- Department of EndocrinologyQueen Elizabeth Hospital, Birmingham, UK
| | - M J Levy
- University of Leicester and University of Leicester Hospitals TrustLeicester, UK
| | - M Prentice
- Croydon Health Services NHS TrustCroydon, UK
| | - J Wass
- Department of EndocrinologyOxford Centre for Diabetes, Endocrinology & Metabolism, Oxford, UK
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Thomas N, Glod J, Derse-Anthony C, Baple EL, Obsborne N, Sturley R, Vaidya B, Newbold K, Brooke A. Pregnancy on vandetanib in metastatic medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2B. Clin Endocrinol (Oxf) 2018; 88:754-756. [PMID: 29457255 PMCID: PMC5903939 DOI: 10.1111/cen.13577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nicholas Thomas
- Department of Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - John Glod
- Paediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Claudia Derse-Anthony
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702
| | - Emma L Baple
- Department of Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter Medical School, Exeter, UK
| | - Nigel Obsborne
- Department of Neonatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Rachel Sturley
- Department of Obstetrics, Royal Devon and Exeter NHS Foundation Trust Exeter, UK
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Kate Newbold
- Head and Neck Oncology Unit, the Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Antonia Brooke
- Department of Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Babiker T, Kyrodimou E, Berney DM, Gurnell M, Drake WM, Brooke A. Acromegaly and Cushing's syndrome caused by a neuroendocrine tumor arising within a sacrococcygeal teratoma. Clin Case Rep 2017; 5:1768-1771. [PMID: 29152267 PMCID: PMC5676263 DOI: 10.1002/ccr3.1148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/27/2017] [Accepted: 07/20/2017] [Indexed: 11/05/2022] Open
Abstract
A 60-year-old man with a pre-existing stable sacrococcygeal teratoma developed acromegaly, ectopic Cushing's syndrome, and 5HIAA secretion. To our knowledge, this represents the first reported case of ACTH and serotonin secretion, and likely GHRH or GH cosecretion, from a sacrococcygeal teratoma in an adult.
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Affiliation(s)
- Tarig Babiker
- Departments of Endocrinology and Histopathology Royal Devon and Exeter Hospital Barrack Road Exeter EX2 5DW UK
| | - Efstathia Kyrodimou
- Departments of Endocrinology and Histopathology Royal Devon and Exeter Hospital Barrack Road Exeter EX2 5DW UK
| | - Daniel M Berney
- Department of Histopathology Barts Cancer Institute Queen Mary, University of London London EC1A7BE UK
| | - Mark Gurnell
- Metabolic Research Laboratories Wellcome Trust-MRC Institute of Metabolic Science National Institute for Health Research Cambridge Biomedical Research Centre Addenbrooke's Hospital University of Cambridge Cambridge CB2 0QQ UK
| | - William M Drake
- Department of Endocrinology St Bartholomew's Hospital London EC1A7BE UK
| | - Antonia Brooke
- Departments of Endocrinology and Histopathology Royal Devon and Exeter Hospital Barrack Road Exeter EX2 5DW UK
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Patel KA, Warren R, Brooke A, Aziz A, Avades T, Poyner R, Vaidya B. Interpretation of thyroid scintigraphy is inconsistent among endocrinologists. J Endocrinol Invest 2017; 40:1155-1157. [PMID: 28836164 DOI: 10.1007/s40618-017-0750-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/19/2017] [Indexed: 10/19/2022]
Affiliation(s)
- K A Patel
- University of Exeter Medical School, Exeter, UK.
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK.
| | - R Warren
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - A Brooke
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - A Aziz
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - T Avades
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - R Poyner
- Department of Nuclear Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - B Vaidya
- University of Exeter Medical School, Exeter, UK
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
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Koulouri O, Kandasamy N, Hoole AC, Gillett D, Heard S, Powlson AS, O'Donovan DG, Annamalai AK, Simpson HL, Akker SA, Aylwin SJB, Brooke A, Buch H, Levy MJ, Martin N, Morris D, Parkinson C, Tysome JR, Santarius T, Donnelly N, Buscombe J, Boros I, Smith R, Aigbirhio F, Antoun NM, Burnet NG, Cheow H, Mannion RJ, Pickard JD, Gurnell M. Successful treatment of residual pituitary adenoma in persistent acromegaly following localisation by 11C-methionine PET co-registered with MRI. Eur J Endocrinol 2016; 175:485-498. [PMID: 27562400 DOI: 10.1530/eje-16-0639] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/24/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine if functional imaging using 11C-methionine positron emission tomography co-registered with 3D gradient echo MRI (Met-PET/MRI), can identify sites of residual active tumour in treated acromegaly, and discriminate these from post-treatment change, to allow further targeted treatment. DESIGN/METHODS Twenty-six patients with persistent acromegaly after previous treatment, in whom MRI appearances were considered indeterminate, were referred to our centre for further evaluation over a 4.5-year period. Met-PET/MRI was performed in each case, and findings were used to decide regarding adjunctive therapy. Four patients with clinical and biochemical remission after transsphenoidal surgery (TSS), but in whom residual tumour was suspected on post-operative MRI, were also studied. RESULTS Met-PET/MRI demonstrated tracer uptake only within the normal gland in the four patients who had achieved complete remission after primary surgery. In contrast, in 26 patients with active acromegaly, Met-PET/MRI localised sites of abnormal tracer uptake in all but one case. Based on these findings, fourteen subjects underwent endoscopic TSS, leading to a marked improvement in (n = 7), or complete resolution of (n = 7), residual acromegaly. One patient received stereotactic radiosurgery and two patients with cavernous sinus invasion were treated with image-guided fractionated radiotherapy, with good disease control. Three subjects await further intervention. Five patients chose to receive adjunctive medical therapy. Only one patient developed additional pituitary deficits after Met-PET/MRI-guided TSS. CONCLUSIONS In patients with persistent acromegaly after primary therapy, Met-PET/MRI can help identify the site(s) of residual pituitary adenoma when MRI appearances are inconclusive and direct further targeted intervention (surgery or radiotherapy).
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Affiliation(s)
- Olympia Koulouri
- Metabolic Research LaboratoriesWellcome Trust-MRC Institute of Metabolic Science
| | - Narayanan Kandasamy
- Metabolic Research LaboratoriesWellcome Trust-MRC Institute of Metabolic Science
| | | | | | | | - Andrew S Powlson
- Metabolic Research LaboratoriesWellcome Trust-MRC Institute of Metabolic Science
| | | | - Anand K Annamalai
- Metabolic Research LaboratoriesWellcome Trust-MRC Institute of Metabolic Science
| | - Helen L Simpson
- Metabolic Research LaboratoriesWellcome Trust-MRC Institute of Metabolic Science
| | - Scott A Akker
- Department of EndocrinologySt Bartholomew's Hospital, London, UK
| | | | - Antonia Brooke
- Macleod Diabetes and Endocrine CentreRoyal Devon and Exeter Hospital, Exeter, UK
| | - Harit Buch
- Department of Diabetes and EndocrinologyNew Cross Hospital, Wolverhampton, UK
| | - Miles J Levy
- Department of EndocrinologyLeicester Royal Infirmary, Leicester, UK
| | - Niamh Martin
- Department of EndocrinologyImperial College Healthcare NHS Trust, London, UK
| | - Damian Morris
- Diabetes and Endocrine CentreIpswich Hospital, Ipswich, UK
| | | | | | | | | | | | - Istvan Boros
- Wolfson Brain Imaging CentreUniversity of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Rob Smith
- Wolfson Brain Imaging CentreUniversity of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Franklin Aigbirhio
- Wolfson Brain Imaging CentreUniversity of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | - John D Pickard
- Department of Neurosurgery Wolfson Brain Imaging CentreUniversity of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Mark Gurnell
- Metabolic Research LaboratoriesWellcome Trust-MRC Institute of Metabolic Science
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Spenzer JG, Mackenzie JE, Brooke A, Bronnert Ε. III. Mittheilungen aus dem mineralogischen und petrographiscken Institut der Universität Strassburg. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1895.24.1.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wilson J, Brooke A, Dunn J, Goodman A, Hamilton-Wood C, Vaidya B. Recurrent phaeochromocytoma along the laparoscopic portal sites. Intern Med J 2015; 45:359-61. [PMID: 25735583 DOI: 10.1111/imj.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J Wilson
- Department of Endocrinology, Royal Devon and Exeter Hospital, Exeter, UK
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Vaidya B, Wright A, Shuttleworth J, Donohoe M, Warren R, Brooke A, Gericke CA, Ukoumunne OC. Block & replace regime versus titration regime of antithyroid drugs for the treatment of Graves' disease: a retrospective observational study. Clin Endocrinol (Oxf) 2014; 81:610-3. [PMID: 24801484 DOI: 10.1111/cen.12478] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 03/19/2014] [Accepted: 04/16/2014] [Indexed: 11/29/2022]
Abstract
CONTEXT Two widely used antithyroid drug (ATD) regimes for Graves' disease (GD) include the 'block & replace' (B&R) regime (a fixed high-dose of ATD combined with levothyroxine) and the 'titration' regime (a titrating dose of ATD). Anecdotally, it is believed that B&R is less prone to fluctuating thyroid function. OBJECTIVE To study whether, in routine clinical practice, the B&R regime, compared with the titration regime, is associated with more stable thyroid function. METHODS We retrospectively analysed case-records for 450 patients treated with ATDs for GD at a secondary care hospital. Exclusion criteria included treatment with ATDs for <6 months, thyrotoxicosis due to other causes, treatment with radioiodine or thyroidectomy and pregnancy. RESULTS Two hundred and twenty three patients were treated with the B&R regime ('B&R group'), 149 with the titration regime ('titration group') and 78 with both regimes. The number of thyroid function tests (TFTs) performed per year (mean(SD): 3·2(1·2) vs 3·4(1·5); adjusted mean difference = -0·4; 95% CI: -0·7 to -0·1; and P = 0·008) and the number of hospital clinic visits per year (mean (SD): 2·9 (1·0) vs 3·2 (1·3); adjusted mean difference = -0·4; 95% CI: -0·7 to -0·2; and P = 0·002) were lower in the B&R group than the titration group. The number of abnormal TFT results per year was similar in the two groups (mean(SD): 1·8(1·3) vs 1·8(1·4); adjusted mean difference = 0·05; 95%CI: -0·3 to 0·4; and P = 0·74). CONCLUSIONS In this retrospective study, there was little evidence that patients under B&R have more stable thyroid function. Further data from prospective studies, however, are needed to confirm this finding.
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Affiliation(s)
- Bijay Vaidya
- Department of Endocrinology, Royal Devon & Exeter Hospital, Exeter, UK; NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
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Napolitano A, Miller SR, Murgatroyd PR, Delafont B, Brooke A, Elkhawad M, Tan CY, Virtue S, Vidal-Puig A, Nunez DJ. Prediction of weight loss and regain following dietary, lifestyle, and pharmacologic intervention. Clin Pharmacol Ther 2012; 91:1027-34. [PMID: 22336590 DOI: 10.1038/clpt.2011.333] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To develop statistical models for predicting weight loss and regain, we analyzed the phenotypic responses in an outpatient study of 60 obese subjects randomized to one of three 12-week interventions, diet (-600 kcal) alone, diet with exercise, and diet with sibutramine. This was followed by 12 weeks of observation. The best of the "baseline covariates" models was one that incorporated intervention group and baseline homeostasis model assessment-estimated insulin resistance (HOMA(IR)). It predicted week 12 weight change with R(2) of 0.38 and root mean square error (√MSE) of 2.92 kg. An alternative model incorporating baseline fat mass plus change in weight and HOMA(IR) at week 4 improved the prediction (R(2), 0.67, √MSE, 2.19 kg). We could not identify a satisfactory model to predict weight regain. We conclude that prediction of weight loss over 12 weeks is significantly improved when short-term weight change is incorporated into the model. This information could be utilized to forecast the success of a weight-loss program and to motivate and contribute to innovative designing of obesity trials.
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Affiliation(s)
- A Napolitano
- Clinical Unit in Cambridge, GlaxoSmithKline, Cambridge University Hospital NHS Trust, Cambridge, UK
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Abstract
A 14-year-old female patient attended Bristol Dental Hospital for an oral screening prior to undergoing a bone marrow transplant as treatment for her acute lymphoblastic leukaemia. Maxillofacial radiographs revealed multiple, well-defined, non-corticated radiolucent lesions throughout the vault of her skull and mandible. These radiological features (coupled with the patient's age) would have correlated with a diagnosis of Langerhans cell histiocytosis. However, a previous bone marrow biopsy confirmed that the patient did indeed have acute lymphoblastic leukaemia. The lytic lesions were present throughout her entire skeletal frame and had previously led to episodes of leg and abdominal pain. We feel that this radiological presentation of leukaemia needs to be reported as these features could easily have been confused with other haematological or even malignant conditions.
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Affiliation(s)
- R Ali
- Department of Oral and Dental Science, Bristol Dental Hospital, Bristol, BS1 2LY, UK.
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Hinson JP, Brooke A, Raven PW. Therapeutic uses of dehydroepiandrosterone. Curr Opin Investig Drugs 2003; 4:1205-8. [PMID: 14649212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Over recent years, increased attention has been paid to the possibility that dehydroepiandrosterone (DHEA) may have therapeutic benefits. Several clinical trials of DHEA have been conducted, investigating the use of this steroid in the treatment of conditions ranging from chronic inflammatory disease to psychiatric disorders. Possible replacement therapy with DHEA in adrenal insufficiency and in old age has also been investigated. This review evaluates our current understanding of the possible therapeutic value of DHEA. Evidence of beneficial effects is discussed and areas where further research is needed are highlighted. Possible adverse effects of long-term DHEA therapy are also considered.
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Affiliation(s)
- Joy P Hinson
- Department of Endocrinology, Barts and the London, Queen Mary's School of Medicine and Dentistry, Suite 12, Dominion House, Bartholomew Close, London, EC1A 7BE, UK.
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Brooke A, Mukherjee SK. Drug treatment in the elderly in South Nottinghamshire. A community audit. Br J Clin Pract 1988; 42:17-20. [PMID: 3196636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Brooke A, Bruni N. How different are college-trained nurses? Aust Nurses J 1980; 10:11-6. [PMID: 6906195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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