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Araujo-Castro M, Biagetti B, Menéndez Torre E, Novoa-Testa I, Cordido F, Pascual Corrales E, Rodríguez Berrocal V, Guerrero-Pérez F, Vicente A, Percovich JC, García Centeno R, González L, Ollero García MD, Irigaray Echarri A, Moure Rodríguez MD, Novo-Rodríguez C, Calatayud M, Villar R, Bernabéu I, Alvarez-Escola C, Benítez Valderrama P, Tenorio-Jimenéz C, Abellán Galiana P, Venegas Moreno E, González Molero I, Iglesias P, Blanco C, Vidal-Ostos De Lara F, de Miguel P, López Mezquita E, Hanzu F, Aldecoa I, Lamas C, Aznar S, Aulinas A, Calabrese A, Gracia P, Recio-Córdova JM, Aviles M, Asensio-Wandosel D, Sampedro M, Ruz-Caracuel I, Camara R, Paja M, Fajardo-Montañana C, Marazuela M, Puig-Domingo M. Differences between GH and PRL co-secreting and GH-secreting pituitary adenomas. A series of 604 cases. J Clin Endocrinol Metab 2024:dgae126. [PMID: 38436926 DOI: 10.1210/clinem/dgae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To evaluate differences in clinical presentation and in surgical outcomes between growth hormone-secreting pituitary adenomas (GH-PAs) and GH and prolactin co-secreting pituitary adenomas (GH&PRL-PAs). METHODS Multicenter retrospective study of 604 patients with acromegaly submitted to pituitary surgery. Patients were classified into two groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal and IHC for GH and PRL was positive or PRL levels were >100ng/and PRL IHC was not available (n=130) and b) GH-PAs who did not meet the previously mentioned criteria (n=474). RESULTS GH&PRL-PAs represented 21.5% (n=130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P<0.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs. 77.4%, P=0.001) and tended to be more invasive (33.6% vs. 24.7%, P=0.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (OR 2.8, 95% CI 1.83-4.38). IGF-1 upper limit of normality (ULN) levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [IQR 1.73-3.29] vs. 2.7 [IQR 1.91-3.67], P=0.023). There were no differences in the immediate (41.1% vs 43.3%, P=0.659) or long-term post-surgical acromegaly biochemical cure rate (53.5% vs. 53.1%, P=0.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs. 2.4%, P=0.011) in GH&PRL-PAs patients. CONCLUSIONS GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal. Madrid, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)
| | - Betina Biagetti
- Endocrinology & Nutrition Department. Hospital Universitario Vall de Hebrón. Barcelona, Spain
| | - Edelmiro Menéndez Torre
- Endocrinology & Nutrition Department. Hospital Universitario Central de Asturias. Asturias, Spain & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)
| | - Iría Novoa-Testa
- Endocrinology & Nutrition Department. Hospital Universitario de Coruña. Coruña, Spain
| | - Fernando Cordido
- Endocrinology & Nutrition Department. Hospital Universitario de Coruña. Coruña, Spain
| | - Eider Pascual Corrales
- Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal. Madrid, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)
| | | | - Fernando Guerrero-Pérez
- Endocrinology & Nutrition Department. Hospital Universitario de Bellvitge. Cataluña L'Hospitalet de Llobregat, Spain
| | - Almudena Vicente
- Endocrinology & Nutrition Department. Hospital Universitario de Toledo. Toledo, Spain
| | - Juan Carlos Percovich
- Endocrinology & Nutrition Department. Hospital Universitario Gregorio Marañón. Madrid. Spain
| | - Rogelio García Centeno
- Endocrinology & Nutrition Department. Hospital Universitario Gregorio Marañón. Madrid. Spain
| | - Laura González
- Endocrinology & Nutrition Department. Hospital Universitario Gregorio Marañón. Madrid. Spain
| | | | - Ana Irigaray Echarri
- Endocrinology & Nutrition Department. Hospital Universitario Navarra. Pamplona, Spain
| | | | - Cristina Novo-Rodríguez
- Endocrinology & Nutrition Department. Hospital Universitario Virgen de las Nieves. Granada, Spain
| | - María Calatayud
- Endocrinology & Nutrition Department. Hospital Universitario Doce de Octubre. Madrid, Spain
| | - Rocío Villar
- Endocrinology & Nutrition Department. Hospital Universitario de Santiago de Compostela. Madrid, Spain
| | - Ignacio Bernabéu
- Endocrinology & Nutrition Department. Hospital Universitario de Santiago de Compostela. Madrid, Spain
| | | | | | - Carmen Tenorio-Jimenéz
- Endocrinology & Nutrition Department. Hospital Universitario Virgen de las Nieves. Granada, Spain
| | - Pablo Abellán Galiana
- Endocrinology & Nutrition Department. Hospital Universitario de Castellón. Valencia, Spain
| | - Eva Venegas Moreno
- Endocrinology & Nutrition Department. Hospital Universitario Virgen del Rocío. Sevilla, Spain
| | | | - Pedro Iglesias
- Endocrinology & Nutrition Department. Hospital Universitario Puerta de Hierro. Madrid, Spain
| | - Concepción Blanco
- Endocrinology & Nutrition Department. Hospital Universitario Príncipe de Asturias. Madrid, Spain
| | | | - Paz de Miguel
- Endocrinology & Nutrition Department. Hospital Clínico San Carlos. Madrid, Spain
| | - Elena López Mezquita
- Endocrinology & Nutrition Department. Hospital Universitario Clínico San Cecilio. Granada, Spain
| | - Felicia Hanzu
- Endocrinology & Nutrition Department. Hospital Clinic de Barcelona. Barcelona, Spain
| | - Iban Aldecoa
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Barcelona. Neurological Tissue Bank of the Biobank, FCRB-IDIBAPS-Hospital Clinic Barcelona, Barcelona
| | - Cristina Lamas
- Endocrinology & Nutrition Department. Hospital Universitario De Albacete, Albacete, Spain
| | - Silvia Aznar
- Endocrinology & Nutrition Department. Hospital Universitario De Albacete, Albacete, Spain
| | - Anna Aulinas
- Endocrinology & Nutrition Department. Hospital de la Santa Creu i Sant Pau, IR-SANT PAU, CIBERER U747 (ISCIII), Barcelona, Spain
| | - Anna Calabrese
- Internal Medicine Department. Hospital San Luigi Gonzaga, Turín, Italia and IR-SANTPAU, Barcelona, Spain
| | - Paola Gracia
- Endocrinology & Nutrition Department. Hospital Royo Villanova. Zaragoza. Spain
| | | | - Mariola Aviles
- Endocrinology & Nutrition Department. Hospital Universitario Clínico San Cecilio. Granada, Spain
| | - Diego Asensio-Wandosel
- Endocrinology & Nutrition Department. Hospital Universitario Germans Trias i Pujol. Cataluña, Spain
| | - Miguel Sampedro
- Endocrinology & Nutrition Department. Hospital Universitario La Princesa Madrid, Spain
| | - Ignacio Ruz-Caracuel
- Anatomopathological Department. Hospital Universitario Ramón y Cajal. Madrid, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)
| | - Rosa Camara
- Endocrinology & Nutrition Department. Hospital La Fe. Valencia, Spain
| | - Miguel Paja
- Endocrinology & Nutrition Department. OSI Bilbao-Basurto. Hospital Universitario de Basurto. Bilbao, Spain & University of the Basque Country UPV/EHU
| | | | - Mónica Marazuela
- Endocrinology & Nutrition Department. Hospital Universitario La Princesa Madrid, Spain
| | - Manel Puig-Domingo
- Endocrinology & Nutrition Department. Hospital Universitario Germans Trias i Pujol. Cataluña, Spain
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Araujo-Castro M, García Sanz I, Mínguez Ojeda C, Hanzu F, Mora M, Vicente A, Blanco Carrera C, Miguel Novoa PD, López García MDC, Lamas C, Manjón-Miguélez L, Del Castillo Tous M, Rodríguez de Vera P, Barahona San Millán R, Recasens M, Fernández-Ladreda MT, Valdés N, Gracia Gimeno P, Robles Lazaro C, Michalopoulou T, Álvarez Escolá C, García Centeno R, Calatayud M. Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas. J Hypertens 2024; 42:252-259. [PMID: 37851004 DOI: 10.1097/hjh.0000000000003596] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
PURPOSE To identify presurgical and surgical risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas (PGLs) (PPGLs). METHODS Retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. Intraoperative hypertensive crisis was defined as systolic blood pressure (SBP) greater than 200 mmHg lasting more than 1 min and postoperative hypertensive crisis as SBP greater than 180 mmHg or diastolic blood pressure (DBP) greater than 110 mmHg. RESULTS A total of 296 surgeries were included. Alpha presurgical blockade was employed in 93.2% of the cases and beta-adrenergic in 53.4%. Hypertensive crisis occurred in 20.3% ( n = 60) of the surgeries: intraoperative crisis in 56 and postoperative crisis in 6 cases (2 cases had both types of crises). We identified as risk factors of intraoperative hypertensive crisis, absence of presurgical glucocorticoid therapy (odds ratio [OR] 3.48; 95% confidence interval [CI] 1.19-10.12) higher presurgical SBP (OR 1.22 per each 10 mmHg, 95% CI 1.03-1.45), a larger tumor size (OR 1.09 per each 10 mm, 95% CI 1.00-1.19) and absence of oral sodium repletion (OR 2.59, 95% CI 1.25-5.35). Patients with hypertensive crisis had a higher rate of intraoperative bleeding ( P < 0.001), of intraoperative hemodynamic instability ( P < 0.001) and of intraoperative hypotensive episodes ( P < 0.001) than those without hypertensive crisis. CONCLUSION Intraoperative hypertensive crisis occurs in up to 20% of the PPGL resections. Patients not pretreated with glucocorticoid therapy before surgery, with larger tumors and higher presurgical SBP and who do not receive oral sodium repletion have a higher risk for developing hypertensive crisis during and after PPGL surgery.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid
- University of Alcalá
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa
| | | | - Felicia Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona
| | - Mireia Mora
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona
| | - Almudena Vicente
- Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo
| | | | | | | | - Cristina Lamas
- Endocrinology & Nutrition Department, Hospital Universitario de Albacete, Albacete
| | - Laura Manjón-Miguélez
- Endocrinology & Nutrition Department, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias. Oviedo
| | | | | | | | - Mónica Recasens
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona
| | | | - Nuria Valdés
- Endocrinology & Nutrition Department, Hospital Universitario de Cabueñes, Asturias
| | | | | | | | | | | | - María Calatayud
- Endocrinology & Nutrition Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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Araujo-Castro M, García Sanz I, Mínguez Ojeda C, Hanzu F, Mora M, Vicente A, Blanco Carrera C, de Miguel Novoa P, López García MDC, Lamas C, Manjón-Miguélez L, del Castillo Tous M, Rodríguez de Vera P, Barahona San Millán R, Recasens M, Tomé Fernández-Ladreda M, Valdés N, Gracia Gimeno P, Robles Lazaro C, Michalopoulou T, Álvarez Escolá C, García Centeno R, Barca-Tierno V, Herrera-Martínez AD, Calatayud M. Local recurrence and metastatic disease in pheochromocytomas and sympathetic paragangliomas. Front Endocrinol (Lausanne) 2023; 14:1279828. [PMID: 38155946 PMCID: PMC10753179 DOI: 10.3389/fendo.2023.1279828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/16/2023] [Indexed: 12/30/2023] Open
Abstract
Purpose To evaluate the rate of recurrence among patients with pheochromocytomas and sympathetic paragangliomas (PGLs; together PPGLs) and to identify predictors of recurrence (local recurrence and/or metastatic disease). Methods This retrospective multicenter study included information of 303 patients with PPGLs in follow-up in 19 Spanish tertiary hospitals. Recurrent disease was defined by the development of local recurrence and/or metastatic disease after initial complete surgical resection. Results A total of 303 patients with PPGLs that underwent 311 resections were included (288 pheochromocytomas and 15 sympathetic PGLs). After a median follow-up of 4.8 years (range 1-19), 24 patients (7.9%) had recurrent disease (3 local recurrence, 17 metastatic disease and 4 local recurrence followed by metastatic disease). The median time from the diagnosis of the PPGL to the recurrence was of 11.2 months (range 0.5-174) and recurrent disease cases distributed uniformly during the follow-up period. The presence of a pathogenic variant in SDHB gene (hazard ratio [HR] 13.3, 95% CI 4.20-41.92), higher urinary normetanephrine levels (HR 1.02 per each increase in standard deviation, 95% CI 1.01-1.03) and a larger tumor size (HR 1.01 per each increase in mm, 95% CI 1.00-1.02) were independently associated with disease recurrence. Conclusion The recurrence of PPGLs occurred more frequently in patients with SDHB mutations, with larger tumors and with higher urinary normetanephrine levels. Since PPGL recurrence may occur at any time after the initial PPGL diagnosis is performed, we recommend performing a strict follow-up in all patients with PPGLs, especially in those patients with a higher risk of recurrent disease.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Felicia Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Mireia Mora
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Almudena Vicente
- Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain
| | | | - Paz de Miguel Novoa
- Endocrinology & Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Cristina Lamas
- Endocrinology & Nutrition Department, Hospital Universitario de Albacete, Albacete, Spain
| | - Laura Manjón-Miguélez
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - María del Castillo Tous
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Pablo Rodríguez de Vera
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Mónica Recasens
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona, Spain
| | | | - Nuria Valdés
- Endocrinology & Nutrition Department, Hospital Universitario Cruces, Biobizkaia, Bizkaia, Spain
| | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanueva, Zaragoza, Spain
| | - Cristina Robles Lazaro
- Endocrinology & Nutrition Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - María Calatayud
- Endocrinology & Nutrition Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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Lamas C, Cámara R, Fajardo C, Remon-Ruiz P, Biagetti B, Guerrero-Pérez F, Araujo-Castro M, Mora M, Hanzu F, Iglesias P, García-Centeno R, Soto A. Efficacy and safety of temozolomide in the treatment of aggressive pituitary neuroendocrine tumours in Spain. Front Endocrinol (Lausanne) 2023; 14:1204206. [PMID: 37720528 PMCID: PMC10500829 DOI: 10.3389/fendo.2023.1204206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/03/2023] [Indexed: 09/19/2023] Open
Abstract
Current guidelines recommend temozolomide as the first-line chemotherapy for aggressive pituitary neuroendocrine tumours. However, no clinical trials have been conducted to date and clinical experience is quite limited. We retrospectively analyzed 28 patients (9 women and 19 men), aged 46.6 + 16.9, with aggressive pituitary tumours (4 pituitary carcinomas and 24 aggressive adenomas) treated with temozolomide in 10 Spanish pituitary reference centres. Four patients had Cushing's disease, 9 prolactinomas and 15 clinically non-functioning pituitary tumours (seven silent corticotroph, three silent somatotroph, one silent lactotroph, one silent gondotroph and three null-cell tumours). Median size at diagnosis was 10.5 cm3 (IQR 4.7-22.5), with cavernous sinus invasion in 88% and no metastases. Pre-temozolomide treatment, these data were 5.2 cm3 (IQR 1.9-12.3), 89.3% and 14.3% (2 intracranial and 2 spinal metastases). All patients had undergone surgery (1-5 surgeries), 25 (89.3%) had received radiotherapy (7 of them reirradiated) and 13(46.4%) had received cabergoline. One patient interrupted temozolomide prematurely. The remaining 27 patients received a median of 13 cycles (range 3-66) of 5 days every 28 days, with a mean initial dose of 265 ± 73 mg when administered alone and of 133 ± 15 mg when co-administered with radiotherapy. Eight patients (29.6%) had a significant reduction (>30%) in tumour volume and 14 (51.9%) attained tumour stabilization. After a median follow-up of 29 months (IQR 10-55), 8 out of these 22 showed disease progression. A longer progression-free survival was found in the five patients who received concomitant radiotherapy. Seven patients (25%) died (all of them because of tumour progression or complications of treatments) at 77 months (IQR 42-136) after diagnosis and 29 months (IQR 16-55) after the first dose of temozolomide. Adverse effects occurred in 18 patients (14 mild and 4 moderate or severe). In conclusion, temozolomide is an effective medical treatment for aggressive pitNET and pituitary carcinomas but is sometimes followed by tumour progression. Co-administration with radiotherapy may increase progression-free survival.
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Affiliation(s)
- Cristina Lamas
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Rosa Cámara
- Endocrinology and Nutrition Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carmen Fajardo
- Endocrinology and Nutrition Department, Hospital Universitario de La Ribera, Alzira, Spain
| | - Pablo Remon-Ruiz
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Betina Biagetti
- Endocrinology and Nutrition Department, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Fernando Guerrero-Pérez
- Endocrinology and Nutrition Department, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Marta Araujo-Castro
- Endocrinology and Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mireia Mora
- Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Felicia Hanzu
- Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Pedro Iglesias
- Endocrinology and Nutrition Department, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Rogelio García-Centeno
- Endocrinology and Nutrition Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alfonso Soto
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Araujo-Castro M, Paja Fano M, Pla Peris B, González Boillos M, Pascual-Corrales E, García-Cano AM, Parra Ramírez P, Rojas-Marcos PM, Ruiz-Sanchez JG, Vicente A, Gómez-Hoyos E, Ferreira R, García Sanz I, Recasens M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, Perdomo C, Manjón L, García-Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales M, Calatayud M, Collao SAF, Meneses D, Sampedro Nuñez MA, Escudero Quesada V, Ribas EM, Sanmartín Sánchez A, Diaz CG, Lamas C, Guerrero-Vázquez R, del Castillo Tous M, Serrano J, Michalopoulou T, Moya Mateo EM, Hanzu F. Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes. Endocr Connect 2023; 12:e230043. [PMID: 37410097 PMCID: PMC10448600 DOI: 10.1530/ec-23-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/04/2023] [Indexed: 07/07/2023]
Abstract
Purpose The aim of this study was to evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes. Methods This is a retrospective multicenter study of PA patients who underwent 1 mg dexamethasone-suppression test (DST) during diagnostic workup in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8 µg/dL (confirmed ACS if >5 µg/dL and possible ACS if 1.8-5 µg/dL) in the absence of specific clinical features of hypercortisolism. The cardiometabolic profile was compared with a control group with ACS without PA (ACS group) matched for age and DST levels. Results The prevalence of ACS in the global cohort of patients with PA (n = 176) was 29% (ACS-PA; n = 51). Ten patients had confirmed ACS and 41 possible ACS. The cardiometabolic profile of ACS-PA and PA-only patients was similar, except for older age and larger tumor size of the adrenal lesion in the ACS-PA group. When comparing the ACS-PA group (n = 51) and the ACS group (n = 78), the prevalence of hypertension (OR 7.7 (2.64-22.32)) and cardiovascular events (OR 5.0 (2.29-11.07)) was higher in ACS-PA patients than in ACS patients. The coexistence of ACS in patients with PA did not affect the surgical outcomes, the proportion of biochemical cure and clinical cure being similar between ACS-PA and PA-only groups. Conclusion Co-secretion of cortisol and aldosterone affects almost one-third of patients with PA. Its occurrence is more frequent in patients with larger tumors and advanced age. However, the cardiometabolic and surgical outcomes of patients with ACS-PA and PA-only are similar.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
- University of Alcalá, Madrid, Spain
| | - Miguel Paja Fano
- Department of Endocrinology & Nutrition, OSI Bilbao-Basurto, Hospital Universitario de Basurton & Basque Country University, Medicine Department, Bilbao, Spain
| | - Begoña Pla Peris
- Department of Endocrinology & Nutrition, Hospital Universitario de Castellón, Castellón, Spain
| | - Marga González Boillos
- Department of Endocrinology & Nutrition, Hospital Universitario de Castellón, Castellón, Spain
| | - Eider Pascual-Corrales
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Paola Parra Ramírez
- Department of Endocrinology & Nutrition, Hospital Universitario La Paz Madrid, Spain
| | | | | | - Almudena Vicente
- Department of Endocrinology & Nutrition, Hospital Universitario de Toledo, Toledo, Spain
| | - Emilia Gómez-Hoyos
- Department of Endocrinology & Nutrition, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Rui Ferreira
- Department of Endocrinology & Nutrition, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Iñigo García Sanz
- Department of General & Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mónica Recasens
- Department of Endocrinology & Nutrition, Institut Català de la Salut Girona, Girona, Spain
| | | | - María José Picón César
- Department of Endocrinology & Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA Malaga, Spain CIBEROBN, Madrid, Spain
| | - Patricia Díaz Guardiola
- Department of Endocrinology & Nutrition, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Carolina Perdomo
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Laura Manjón
- Department of Endocrinology & Nutrition, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Rogelio García-Centeno
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Percovich
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Rebollo Román
- Department of Endocrinology & Nutrition, Hospital Reina Sofía, Córdoba, Spain
| | - Paola Gracia Gimeno
- Department of Endocrinology & Nutrition, Hospital Rollo Villanova, Zaragoza, Spain
| | - Cristina Robles Lázaro
- Department of Endocrinology & Nutrition, Complejo Universitario de Salamanca, Salamanca, Spain
| | - Manuel Morales
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - María Calatayud
- Department of Endocrinology & Nutrition, Hospital Doce de Octubre, Madrid, Spain
| | | | - Diego Meneses
- Department of Endocrinology & Nutrition, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Elena Mena Ribas
- Department of Endocrinology & Nutrition, Hospital Universitario Son Espases, Islas Baleares, Spain
| | - Alicia Sanmartín Sánchez
- Department of Endocrinology & Nutrition, Hospital Universitario Son Espases, Islas Baleares, Spain
| | - Cesar Gonzalvo Diaz
- Department of Endocrinology & Nutrition, Hospital Universitario De Albacete, Albacete, Spain
| | - Cristina Lamas
- Department of Endocrinology & Nutrition, Hospital Universitario De Albacete, Albacete, Spain
| | | | | | - Joaquín Serrano
- Department of Endocrinology & Nutrition, Hospital General Universitario de Alicante, Alicante, Spain
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Felicia Hanzu
- Department of Endocrinology & Nutrition, Hospital Clinic, IDIPAS, Barcelona, Spain
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Santamaria J, Bretón I, Fernández A, Hanzu F, Luque R, Pinés P, Tejera C, Zugasti A, Del Prado N, Elola J, Escalada J. RECALSEEN 2021. Resources and quality in the Endocrinology and Nutrition units of the National Health System of Spain. ENDOCRINOL DIAB NUTR 2023; 70:459-467. [PMID: 37516609 DOI: 10.1016/j.endien.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/24/2022] [Accepted: 03/19/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES RECALSEEN project aims to analyze the structure, activity, and outcomes of the departments of endocrinology and nutrition (S-U_EyN) of the Spanish National Health System (SNHS). Based on the results obtained, the challenges for the specialty are analyzed and proposals for improvement policies are made. In this paper 2021 survey data and activity data from the 2007-2019 from the Minimum Basic Data Set (MBDS) are presented. MATERIAL AND METHODS Cross-sectional descriptive study of the S-U_EyN of acute general hospitals of the NHS in 2020. Data were obtained through: 1. an "ad hoc" survey answered by the S-U_EyN' consultants; and 2. analysing the acute general hospital discharges from S-U_EyN and discharges with endocrine-metabolic comorbidities registered in the minimum basis data set (MBDS) of the SNHS. RESULTS 112 responses from S-U_EyN were obtained from a total of 154 general acute hospitals of the NHS (73%). The 2021 S-U_EyN sample includes 24 more centers than in 2017. 54% of the S-U_EyN were endocrinology departments. The median number of endocrinologists per S-U_EyN was 7. The estimated rate of endocrinologists was 2.5 per 100,000 inhabitants. S-U_EyN showed a high level of collaboration with primary care teams and other hospital units. Use of telemedicine by S-U_EyN experienced a high increase in 2020. Notable differences in resources and activity have been found between hospitals and Autonomous Communities. There was a wide margin for improvement in quality management. CONCLUSIONS RECALSEEN is a useful project for the analysis of S-U_EyN. The remarkable variability found in the indicators of structure, activity and management probably indicates a wide margin for improvement.
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Affiliation(s)
- Javier Santamaria
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Hospital Universitario de Cruces, Barakaldo, Bizcaia, Spain
| | - Irene Bretón
- Presidenta de la Fundación de la Sociedad Española de Endocrinología y Nutrición, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Fernández
- Secretario de la Sociedad Española de Endocrinología y Nutrición, Hospital Universitario de Móstoles, Madrid, Spain
| | - Felicia Hanzu
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Raúl Luque
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Universidad de Córdoba/Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Pedro Pinés
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Cristina Tejera
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, El Ferrol, Spain
| | - Ana Zugasti
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain.
| | - Javier Escalada
- Presidente de la Sociedad Española de Endocrinología y Nutrición, Clínica Universidad de Navarra, Pamplona, Spain
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7
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Araujo-Castro M, García Sanz I, Mínguez Ojeda C, Calatayud M, Hanzu F, Mora M, Vicente A, Blanco Carrera C, De Miguel Novoa P, López García MDC, Manjón-Miguélez L, Rodríguez de Vera P, Del Castillo Tous M, Barahona San Millán R, Recasens M, Tomé Fernández-Ladreda M, Valdés N, Gracia Gimeno P, Robles Lazaro C, Michalopoulou T, Álvarez Escolá C, García Centeno R, Lamas C. Differences in intraoperative and surgical outcomes between normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs) and hypertensive PPGLs: results from the PHEO-RISK STUDY. J Endocrinol Invest 2023; 46:805-814. [PMID: 36323983 DOI: 10.1007/s40618-022-01954-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/27/2022] [Accepted: 10/25/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare the intraoperative and surgical outcomes of normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs), hypertensive PPGLs and non-PPGL adrenal lesions. METHODS This a retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. A control group of histologically confirmed adrenocortical adenomas (non-PPGL group) was selected to compare intraoperative and surgical outcomes with of the normotensive PPGLs. RESULTS Two hundred and ninety-six surgeries performed in 289 patients with PPGLs were included. Before surgery, 209 patients were classified as hypertensive PPGLs (70.6%) and 87 as normotensive PPGLs. A higher proportion of normotensive PPGLs than hypertensive PPGLs did not receive alpha presurgical blockade (P = 0.009). When we only considered those patients who received presurgical alpha blockers (200 hypertensive PPGLs and 76 normotensive PPGLs), hypertensive PPGLs had a threefold higher risk of intraoperative hypertensive crisis (OR 3.0 [95% 1.3-7.0]) and of hypotensive episodes (OR 2.9 [95% CI 1.2-6.7]) than normotensive PPGLs. When we compared normotensive PPGLs (n = 76) and non-PPGLs (n = 58), normotensive PPGLs had a fivefold higher risk of intraoperative complications (OR 5.3 [95% CI 1.9-14.9]) and a six times higher risk of postoperative complications (OR 6.1 [95% CI 1.7-21.6]) than non-PPGLs. CONCLUSION Although the risk of intraoperative hypertensive and hypotensive episodes in normotensive PPGLs is significantly lower than in hypertensive PPGLs, normotensive PPGLs have a greater risk of intraoperative and postoperative complications than non-PPGL adrenal lesions. Therefore, it is recommended to follow the standard of care for presurgical and anesthetic management of PPGLs also in normotensive PPGLs.
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Affiliation(s)
- M Araujo-Castro
- Endocrinology and Nutrition Department, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Colmenar Viejo Street Km 9, 28034, Madrid, Spain.
- University of Alcalá, Madrid, Spain.
| | - I García Sanz
- General and Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - C Mínguez Ojeda
- Urology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Calatayud
- Endocrinology and Nutrition Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - F Hanzu
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - M Mora
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - A Vicente
- Endocrinology and Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain
| | - C Blanco Carrera
- Endocrinology and Nutrition Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - P De Miguel Novoa
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - L Manjón-Miguélez
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - P Rodríguez de Vera
- Endocrinology and Nutrition Department, Hospital Universitario Virgen de La Macarena, Seville, Spain
| | - M Del Castillo Tous
- Endocrinology and Nutrition Department, Hospital Universitario Virgen de La Macarena, Seville, Spain
| | - R Barahona San Millán
- Endocrinology and Nutrition Department, Institut Català de la Salut Girona, Girona, Spain
| | - M Recasens
- Endocrinology and Nutrition Department, Institut Català de la Salut Girona, Girona, Spain
| | | | - N Valdés
- Endocrinology and Nutrition Department, Hospital Universitario de Cabueñes, Asturias, Spain
| | - P Gracia Gimeno
- Endocrinology and Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain
| | - C Robles Lazaro
- Endocrinology and Nutrition Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - T Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - C Álvarez Escolá
- Endocrinology and Nutrition Department, Hospital Universitario La Paz, Madrid, Spain
| | - R García Centeno
- Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - C Lamas
- Endocrinology and Nutrition Department, Hospital Universitario de Albacete, Albacete, Spain
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García Blasco L, Pinés Corrales PJ, Hanzu F, Fernández Martínez A, Bretón Lesmes I, Escalada San Martín J. A survey on the perception of the specialty of Endocrinology and Nutrition among students preparing for the entrance exam for medical specialty training in Spain. ENDOCRINOL DIAB NUTR 2023; 70:240-244. [PMID: 37116969 DOI: 10.1016/j.endien.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/12/2022] [Accepted: 01/08/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION AND AIMS Previous studies have shown that there is decreasing interest in E&N among medical students. The aim of our study was to evaluate the perception of E&N among a sample of medical students. MATERIAL AND METHODS We surveyed 2252 students prior to taking the exam that allows access to specialised training in Spain. RESULTS Overall, 9.9% (222 participants) would probably choose E&N. The most positive aspects in includes of the specialty are its logical pathophysiological basis (54%) and that the work is dynamic and varied (27%), while the least attractive aspects are the few interventional techniques. The parts of the specialty that most attract students are hypothalamic-pituitary disease and diabetes mellitus. CONCLUSIONS The proportion of candidates who want to study E&N as their first choice is adequate in relation to the number of places available.
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Affiliation(s)
- Lourdes García Blasco
- Complejo Hospitalario Universitario de Albacete [University Hospital Complex of Albacete], Spain.
| | - Pedro J Pinés Corrales
- Complejo Hospitalario Universitario de Albacete [University Hospital Complex of Albacete], Spain
| | - Felicia Hanzu
- Hospital Universitari Clínic de Barcelona [Clinical University Hospital of Barcelona], Spain
| | | | - Irene Bretón Lesmes
- Hospital General Universitario Gregorio Marañón [Gregorio Marañón General University Hospital], Spain
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9
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Araujo-Castro M, Mínguez Ojeda C, García Sanz I, Calatayud M, Hanzu F, Mora M, Vicente A, Blanco Carrera C, De Miguel Novoa P, López García MDC, Lamas C, Manjón-Miguélez L, Del Castillo Tous M, Rodríguez de Vera P, Barahona San Millán R, Recasens M, Tomé Fernández-Ladreda M, Valdés N, Gracia Gimeno P, Robles Lazaro C, Michalopoulou T, Parra Ramírez P, Marazuela M, Álvarez Escolá C, García Centeno R. Genetic study in pheochromocytoma ¿is it possible to stratify the risk of hereditary pheochromocytoma? Neuroendocrinology 2023:000529319. [PMID: 36693324 DOI: 10.1159/000529319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION It is estimated that 30-40% of patients with apparently sporadic pheochromocytomas (PHEOs) have an inherited predisposition syndrome. The aim of our study was to develop a predictive model of hereditary pheochromocytoma (PHEO) based on the clinical, hormonal, and radiological features present at the diagnosis of patients with PHEOs. METHODS A retrospective multicenter cohort study of patients with PHEOs with available genetic study from 18 tertiary hospitals. Clinical, biochemical, and radiological features were used to build a multivariate logistic regression model. The estimation of all possible equations was used to select the model with the best diagnostic accuracy (lower Akaike index (AIC)). RESULTS A total of 245 patients were included: 169 (69.0%) patients with sporadic PHEOs and 76 (31%) with hereditary PHEOs. The parsimonious predictive model with the highest diagnostic accuracy for the prediction of hereditary PHEO combined the variables age, non-cardiovascular disease, urinary norepinephrine levels and tumor size. The area under the ROC curve of this model was of 0.800 (0.705-0.887). Based on the predictive model, the probability of hereditary PHEO in patients older than 60 years with cardiovascular disease, high levels of urinary norepinephrine and unilateral PHEOs >60 mm was <2%. And if the age was above 80 years, lower than 1%. The probability of sporadic PHEO linearly increased with age (MH Test for linear Trend: Chi2(1) = 30.05; P<0.001) Conclusion: In certain populations such as old patients with cardiovascular disease, with high levels of urinary norepinephrine and large tumors in which the probability of hereditary PHEO is very low, genetic testing could be avoided in the absence of specific suspicion.
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Parra Ramírez P, Rojas-Marcos PM, Paja Fano M, González Boillos M, Pascual-Corrales E, García-Cano A, Ruiz-Sanchez JG, Vicente A, Gómez-Hoyos E, Ferreira R, García Sanz I, Recasens M, Pla Peris B, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, Jesús García González J, Perdomo C, Manjón L, García-Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales M, Hanzu F, Araujo-Castro M. Differences in the presentation and evolution of primary aldosteronism in elderly (≥65 years) and young patients (<65 years). Endocr Connect 2022; 11:EC-22-0169. [PMID: 35583179 PMCID: PMC9254285 DOI: 10.1530/ec-22-0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To compare the presentation and evolution of primary aldosteronism (PA) in the elderly (≥65 years) and young patients (<65 years). METHODS A retrospective multicenter study was performed in 20 Spanish hospitals of PA patients in follow-up between 2018 and 2021. RESULTS Three hundred fifty-two patients with PA <65 years and 88 patients ≥65 years were included. Older PA patients had a two-fold higher prevalence of type 2 diabetes, dyslipidemia, and cerebrovascular disease, but these differences disappeared after adjusting for hypertension duration. At diagnosis, diastolic blood pressure was lower than in young patients (83.3 ± 11.54 vs 91.6 ± 14.46 mmHg, P < 0.0001). No differences in the rate of overall correct cannulation (56.5% vs 42.3%, P = 0.206) or the diagnosis of unilaterality (76.9% vs 62.5%, P = 0.325) in the adrenal venous sampling (AVS) was observed between the elderly and young groups. However, there was a lower proportion of PA patients who underwent adrenalectomy in the elderly group than in the younger group (22.7% (n = 20) vs 37.5% (n = 132), P = 0.009). Nevertheless, no differences in the rate of postsurgical biochemical (100% (n = 14) vs 92.8% (n = 90), P = 0.299) and hypertension cure (38.6% (n = 51) vs 25.0% (n = 5), P = 0.239) were observed between both groups. CONCLUSION Older patients with PA have a worse cardiometabolic profile than young patients with PA that it is related to a longer duration of hypertension. However, the results of the AVS, and adrenalectomy are similar in both groups. Therefore, the management of elderly patients with PA should be based not only on age, but rather on the overall medical, physical, social, and mental characteristics of the patients.
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Affiliation(s)
- Paola Parra Ramírez
- Endocrinology & Nutrition Department, La Paz University Hospital, Madrid, Spain
- Correspondence should be addressed to P Parra Ramírez or M Araujo-Castro: or
| | | | - Miguel Paja Fano
- Endocrinology & Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain
- Medicine Department, Basque Country University, Bilbao, Spain
| | - Marga González Boillos
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - Eider Pascual-Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Ana García-Cano
- Biochemistry Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Almudena Vicente
- Endocrinology & Nutrition Department, Complejo Universitario de Toledo, Toledo, Spain
| | - Emilia Gómez-Hoyos
- Endocrinology & Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Rui Ferreira
- Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mònica Recasens
- Endocrinology & Nutrition Department, Hospital Josep Trueta, Servei d’Endocrinologia, Girona, Spain
| | - Begoña Pla Peris
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | | | - María José Picón César
- Endocrinology & Nutrition Department, Complejo Hospitalario Málaga (Hospital Virgen de la Victoria), IBIMA Malaga, Malaga, Spain
- CIBEROBN, Madrid, Spain
| | | | | | - Carolina Perdomo
- Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Laura Manjón
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Rogelio García-Centeno
- Endocrinology & Nutrition Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Percovich
- Endocrinology & Nutrition Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain
| | - Cristina Robles Lázaro
- Endocrinology & Nutrition Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Manuel Morales
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Felicia Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
- University of Alcalá, Madrid, Spain
- Correspondence should be addressed to P Parra Ramírez or M Araujo-Castro: or
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11
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Araujo-Castro M, García Centeno R, Robles Lázaro C, Parra Ramírez P, Gracia Gimeno P, Rojas-Marcos PM, Fernández-Ladreda MT, Percovich Hualpa JC, Sampedro Núñez M, López-García MC, Lamas C, Álvarez Escolá C, Calatayud Gutiérrez M, Blanco Carrera C, de Miguel Novoa P, Valdés Gallego N, Hanzu F, Marazuela M, Mora Porta M, Mínguez Ojeda C, García Gómez Muriel I, Escobar-Morreale HF, Valderrabano P. Predictive model of pheochromocytoma based on the imaging features of the adrenal tumours. Sci Rep 2022; 12:2671. [PMID: 35177692 PMCID: PMC8854552 DOI: 10.1038/s41598-022-06655-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/28/2021] [Accepted: 02/03/2022] [Indexed: 12/18/2022] Open
Abstract
The purpose of our study was to develop a predictive model to rule out pheochromocytoma among adrenal tumours, based on unenhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) features. We performed a retrospective multicentre study of 1131 patients presenting with adrenal lesions including 163 subjects with histological confirmation of pheochromocytoma (PHEO), and 968 patients showing no clinical suspicion of pheochromocytoma in whom plasma and/or urinary metanephrines and/or catecholamines were within reference ranges (non-PHEO). We found that tumour size was significantly larger in PHEO than non-PHEO lesions (44.3 ± 33.2 versus 20.6 ± 9.2 mm respectively; P < 0.001). Mean unenhanced CT attenuation was higher in PHEO (52.4 ± 43.1 versus 4.7 ± 17.9HU; P < 0.001). High lipid content in CT was more frequent among non-PHEO (83.6% versus 3.8% respectively; P < 0.001); and this feature alone had 83.6% sensitivity and 96.2% specificity to rule out pheochromocytoma with an area under the receiver operating characteristics curve (AUC-ROC) of 0.899. The combination of high lipid content and tumour size improved the diagnostic accuracy (AUC-ROC 0.961, sensitivity 88.1% and specificity 92.3%). The probability of having a pheochromocytoma was 0.1% for adrenal lesions smaller than 20 mm showing high lipid content in CT. Ninety percent of non-PHEO presented loss of signal in the “out of phase” MRI sequence compared to 39.0% of PHEO (P < 0.001), but the specificity of this feature for the diagnosis of non-PHEO lesions low. In conclusion, our study suggests that sparing biochemical screening for pheochromocytoma might be reasonable in patients with adrenal lesions smaller than 20 mm showing high lipid content in the CT scan, if there are no typical signs and symptoms of pheochromocytoma.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
| | - Rogelio García Centeno
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Robles Lázaro
- Department of Endocrinology & Nutrition, Hospital Universitario Virgen de La Concha, Zamora, Spain
| | - Paola Parra Ramírez
- Department of Endocrinology & Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Paola Gracia Gimeno
- Department of Endocrinology & Nutrition, Hospital Universitario Rollo Villanova, Zaragoza, Spain
| | | | | | | | - Miguel Sampedro Núñez
- Department of Endocrinology & Nutrition, Hospital Universitario La Princesa, Madrid, Spain
| | - María-Carmen López-García
- Department of Endocrinology & Nutrition, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Cristina Lamas
- Department of Endocrinology & Nutrition, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | - Paz de Miguel Novoa
- Department of Endocrinology & Nutrition, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Nuria Valdés Gallego
- Department of Endocrinology & Nutrition, Hospital Universitario de Cabueñes, Asturias, Spain
| | - Felicia Hanzu
- Department of Endocrinology & Nutrition, Hospital Clinic, Barcelona, Spain
| | - Mónica Marazuela
- Department of Endocrinology & Nutrition, Hospital Universitario La Princesa, Madrid, Spain
| | - Mireia Mora Porta
- Department of Endocrinology & Nutrition, Hospital Clinic, Barcelona, Spain
| | | | | | - Héctor F Escobar-Morreale
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Pablo Valderrabano
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
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12
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Haydar S, Paillot T, Fagot C, Cogne Y, Fountas A, Tutuncu Y, Vintila M, Tsatsoulis A, Thanh Chi P, Garandeau P, Chetea D, Badiu C, Gheorghiu M, Ylli D, Lautier C, Jarec M, Monnier L, Normand C, Šarac J, Barakat A, Missoni S, Pugeat M, Poucheret P, Hanzu F, Gomis R, Macias JM, Litvinov S, Khusnutdinova E, Poiana C, Pasquali R, Lauro D, Sesti G, Trischitta V, Abdelhak S, Zenati A, Ylli A, Satman I, Kanninen T, Rinato Y, Grigorescu F. Branched-Chain Amino Acid Database Integrated in MEDIPAD Software as a Tool for Nutritional Investigation of Mediterranean Populations. Nutrients 2018; 10:E1392. [PMID: 30275383 PMCID: PMC6213539 DOI: 10.3390/nu10101392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/24/2022] Open
Abstract
Branched-chained amino acids (BCAA) are essential dietary components for humans and can act as potential biomarkers for diabetes development. To efficiently estimate dietary intake, we developed a BCAA database for 1331 food items found in the French Centre d'Information sur la Qualité des Aliments (CIQUAL) food table by compiling BCAA content from international tables, published measurements, or by food similarity as well as by calculating 267 items from Greek, Turkish, Romanian, and Moroccan mixed dishes. The database embedded in MEDIPAD software capable of registering 24 h of dietary recalls (24HDR) with clinical and genetic data was evaluated based on archived 24HDR of the Saint Pierre Institute (France) from 2957 subjects, which indicated a BCAA content up to 4.2 g/100 g of food and differences among normal weight and obese subjects across BCAA quartiles. We also evaluated the database of 119 interviews of Romanians, Turkish and Albanians in Greece (27⁻65 years) during the MEDIGENE program, which indicated mean BCAA intake of 13.84 and 12.91 g/day in males and females, respectively, comparable to other studies. The MEDIPAD is user-friendly, multilingual, and secure software and with the BCAA database is suitable for conducting nutritional assessment in the Mediterranean area with particular facilities for food administration.
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Affiliation(s)
- Sara Haydar
- Unité Mixte de Recherche (UMR)204 NUTRIPASS (Nutrition et Alimentation des Populations aux Suds, IRD, UM, SupAgro), Molecular Endocrinology, Institut Universitaire de Recherche Clinique (IURC), Faculty of Medicine, University of Montpellier, 34093 Montpellier, France.
| | | | | | - Yannick Cogne
- Unité Mixte de Recherche (UMR)204 NUTRIPASS (Nutrition et Alimentation des Populations aux Suds, IRD, UM, SupAgro), Molecular Endocrinology, Institut Universitaire de Recherche Clinique (IURC), Faculty of Medicine, University of Montpellier, 34093 Montpellier, France.
| | - Athanasios Fountas
- Department of Endocrinology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece.
| | - Yildiz Tutuncu
- Department of Internal Medicine, Istanbul University, 34093 Istanbul, Turkey.
| | - Madalina Vintila
- Department of Endocrinology, Universitatea de Medicina si Farmacie Carol Davila, 011863 Bucharest, Romania.
| | - Agathocles Tsatsoulis
- Department of Endocrinology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece.
| | - Pham Thanh Chi
- Unité Mixte de Recherche (UMR)204 NUTRIPASS (Nutrition et Alimentation des Populations aux Suds, IRD, UM, SupAgro), Molecular Endocrinology, Institut Universitaire de Recherche Clinique (IURC), Faculty of Medicine, University of Montpellier, 34093 Montpellier, France.
| | - Patrick Garandeau
- Unité Mixte de Recherche (UMR)204 NUTRIPASS (Nutrition et Alimentation des Populations aux Suds, IRD, UM, SupAgro), Molecular Endocrinology, Institut Universitaire de Recherche Clinique (IURC), Faculty of Medicine, University of Montpellier, 34093 Montpellier, France.
| | - Dan Chetea
- Nicolae Paulescu National Institute, 020475 Bucharest, Romania.
| | - Corin Badiu
- Department of Endocrinology, Universitatea de Medicina si Farmacie Carol Davila, 011863 Bucharest, Romania.
| | - Monica Gheorghiu
- Department of Endocrinology, Universitatea de Medicina si Farmacie Carol Davila, 011863 Bucharest, Romania.
| | - Dorina Ylli
- Faculty of Medicine, Mjekesise University of Tirana, 1005 Tirana, Albania.
| | - Corinne Lautier
- Unité Mixte de Recherche (UMR)204 NUTRIPASS (Nutrition et Alimentation des Populations aux Suds, IRD, UM, SupAgro), Molecular Endocrinology, Institut Universitaire de Recherche Clinique (IURC), Faculty of Medicine, University of Montpellier, 34093 Montpellier, France.
| | - Morana Jarec
- Institute for Anthropological Research, 10000 Zagreb, Croatia.
| | - Louis Monnier
- Unité Mixte de Recherche (UMR)204 NUTRIPASS (Nutrition et Alimentation des Populations aux Suds, IRD, UM, SupAgro), Molecular Endocrinology, Institut Universitaire de Recherche Clinique (IURC), Faculty of Medicine, University of Montpellier, 34093 Montpellier, France.
| | - Christophe Normand
- Unité Mixte de Recherche (UMR)204 NUTRIPASS (Nutrition et Alimentation des Populations aux Suds, IRD, UM, SupAgro), Molecular Endocrinology, Institut Universitaire de Recherche Clinique (IURC), Faculty of Medicine, University of Montpellier, 34093 Montpellier, France.
| | - Jelena Šarac
- Institute for Anthropological Research, 10000 Zagreb, Croatia.
| | | | - Sasa Missoni
- Institute for Anthropological Research, 10000 Zagreb, Croatia.
| | - Michel Pugeat
- Fédération d'Endocrinologie, Cardio-Neuro Hospital, University Claude Bernard de Lyon 1, 69677 Lyon-Bron, France.
| | - Patrick Poucheret
- Faculty of Pharmacy, UMR 95 Qualisud, University of Montpellier, 34398 Montpellier, France.
| | - Felicia Hanzu
- Institut d'Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain.
| | - Ramon Gomis
- Institut d'Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain.
| | | | | | | | - Catalina Poiana
- Department of Endocrinology, Universitatea de Medicina si Farmacie Carol Davila, 011863 Bucharest, Romania.
| | - Renato Pasquali
- Division of Endocrinology, University Alma Mater Studiorum, 40138 Bologna, Italy.
| | - Davide Lauro
- Department of Internal Medicine, Universita degli Studi di Roma Tor Vergata, 00173 Roma, Italy.
| | - Giorgio Sesti
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy.
| | | | - Sonia Abdelhak
- Institut Pasteur de Tunis, Laboratory of Biomedical Genomics and Oncogenetics, 1002 Tunis, Tunisia.
| | - Akila Zenati
- Laboratoire de Biochimie Génétique, CHU Bab-El-Oued, Université d'Alger, Alger 16000, Algeria.
| | - Agron Ylli
- Faculty of Medicine, Mjekesise University of Tirana, 1005 Tirana, Albania.
| | - Ilhan Satman
- Department of Internal Medicine, Istanbul University, 34093 Istanbul, Turkey.
| | | | - Yves Rinato
- Intactile Design SA, 34000 Montpellier, France.
| | - Florin Grigorescu
- Unité Mixte de Recherche (UMR)204 NUTRIPASS (Nutrition et Alimentation des Populations aux Suds, IRD, UM, SupAgro), Molecular Endocrinology, Institut Universitaire de Recherche Clinique (IURC), Faculty of Medicine, University of Montpellier, 34093 Montpellier, France.
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Vidal Ó, Delgado-Oliver E, Díaz Del Gobbo R, Hanzu F, Squarcia M, Martínez D, Fuster D, Fondevila C. Functional adrenal cortex preservation: A good reason for posterior retroperitoneal endoscopic approach. Cir Esp 2018; 96:488-493. [PMID: 29804624 DOI: 10.1016/j.ciresp.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Cortical-sparing adrenalectomy is a suitable treatment for hereditary and sporadic bilateral pheochromocytoma, in cases of low risk of malignancy, to reduce the possibility of adrenal insufficiency assuming the chance of local recurrence. The aim of the study is to analyze the functional results of partial adrenalectomy by retroperitoneal endoscopic approach in single-adrenal patients or patients requiring bilateral adrenalectomy. METHODS Prospective study between January 2015 and February 2016 including pheochromocytoma patients diagnosed with low risk of malignant mutations. All patients agreed to be included in the study. Experienced endocrine surgeons who have been trained in minimally invasive endocrine surgery performed the procedure using the same surgical technique. Demographic variables and clinical characteristics were collected, subsequently carrying out the descriptive analysis of the data. RESULTS A total of 6 patients were registered, four associated with MEN type 2 syndrome and two in the context of VHL syndrome. Retroperitoneoscopic resection was performed without laparoscopic or open conversion and no postoperative complications; the average hospital stay was 2.5 days. Preservation of the functional cortex without corticosteroids was achieved in 5 (83%) of out 6 cases with a follow-up of 26.2 ± 6 months. Today, these 5 patients have a preserved adrenal function without hormone replacement. CONCLUSIONS Cortical-sparing adrenalectomy by the retroperitoneal endoscopic approach, in expert hands, is safe and feasible for the treatment of hereditary and sporadic pheochromocytoma in a context of low malignancy, making it possible to avoid the need for corticoid replacement in most cases.
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Affiliation(s)
- Óscar Vidal
- Servicio de Cirugía General y Digestivo, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, Universidad de Barcelona, Barcelona, España.
| | - Eduardo Delgado-Oliver
- Servicio de Cirugía General y Digestivo, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Rafael Díaz Del Gobbo
- Servicio de Cirugía General y Digestivo, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Felicia Hanzu
- Servicio de Endocrinología y Nutrición, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERDEM; IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Mattia Squarcia
- Servicio de Radiodiagnóstico, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic, Barcelona, España
| | - Daniel Martínez
- Servicio de Anatomía patológica, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, IDIBAPS, Barcelona, España
| | - David Fuster
- Servicio de Medicina Nuclear, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic; IDIBAPS, Barcelona, España
| | - Constantino Fondevila
- Servicio de Cirugía General y Digestivo, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, Universidad de Barcelona, Barcelona, España
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Reyes L, García S, Torales J, Halperín I, Alobid I, Hanzu F, Mora M, Valero R, Enseñat J. [Endoscopic endonasal surgery for sellar region pathology. An analysis of our first 200 patients. What we have learned]. Neurocirugia (Astur) 2016; 27:229-36. [PMID: 27012678 DOI: 10.1016/j.neucir.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 01/25/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Pituitary and sellar region tumours account for 10-15% of intracranial benign tumours, with pituitary adenoma being the most common one. In this article, a review is presented on 9 years of experience in surgical treatment using an endoscopic approach of sellar region lesions. The main features of our surgical technique will be explained, as well as the results in clinical and hormonal terms. MATERIAL AND METHODS A retrospective analysis was conducted on 200 patients operated on due to sellar lesions by the same neurosurgeon (J.E.) using an endoscopic endonasal transsphenoidal approach between February 2006 and February 2015. The cases excluded were, those requiring extended approaches of the skull base, as well as craniopharyngiomas, inflammatory, metastatic, or malignant lesions. RESULTS Of the 200 patients treated (59.5% women, mean age of 51.7 years, range: 18-82 years old), there were: 7 Rathke cysts and 193 adenomas (26 micro-adenomas and 165 macro-adenomas). All of them sub-classified according to the degree of invasion of the cavernous sinus (Knosp 0, 1, and 2: 129 cases and Knosp 3 and 4: 71 cases). Total resection was achieved in 143 patients (71.5%), subtotal resection in 39 (19.5%), and partial resection in 18 (9%). In the group of higher occupancy of the cavernous sinus (Knosp 3 and 4) complete resection was achieved in 55.5% (40 of 71 patients). Hormonal remission was achieved in 34 patients with acromegaly (85%), 23 patients with prolactinomas (76%), and 30 patients with Cushing's disease (86%). CONCLUSION The results obtained in our series, due to the centralisation of pathology and experience, are comparable to those achieved in pituitary surgery reference centres. Early surgical exploration of cerebrospinal fluid leaks reduces the risk of post-surgical meningitis.
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Affiliation(s)
- Luis Reyes
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
| | - Sergio García
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Jorge Torales
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Irene Halperín
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Isam Alobid
- Servicio de Otorrinolaringología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Felicia Hanzu
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Mireia Mora
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Ricard Valero
- Servicio de Anestesiología y Reanimación, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Joaquim Enseñat
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
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Torales J, Halperin I, Hanzu F, Mora M, Alobid I, De Notaris M, Ferrer E, Enseñat J. Endoscopic endonasal surgery for pituitary tumors. Results in a series of 121 patients operated at the same center and by the same neurosurgeon. ACTA ACUST UNITED AC 2014; 61:410-6. [PMID: 24857341 DOI: 10.1016/j.endonu.2014.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/12/2014] [Accepted: 03/18/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pituitary adenomas account for approximately 15% of intracranial benign tumors. The neurosurgical results achieved since the endoscopic endonasal transsphenoidal (EET) approach was introduced in our center in 2005 are reported here. PATIENTS AND METHODS A retrospective analysis of 121 patients with sellar lesions (58% females, age 55.7 ± 16 years, range 18-82) who underwent EET surgery from February 2005 to January 2012 and were followed up for a mean time of 4.58 years (range 1.08-8.58). RESULTS Six Rathke cleft cysts (3 intra-suprasellar, 1 intrasellar, 2 suprasellar); 114 pituitary adenomas (16 microadenomas, 98 macroadenomas), and 1 case of normal MRI were included. Baseline findings included hormonal changes in 59 patients (48,7%) and visual field changes in 38 patients (31%); in 7 patients (5.8%), clinical presentation was pituitary apoplexy. Complete resection was achieved in 77 patients (63.6%), subtotal resection in 29 (23.9%), and partial resection in 15 (12.3%). In patients with Grade 3 and 4 cavernous sinus invasion, resection was subtotal in 30% (12/39) and complete in 46% (18/39). Hormonal remission was achieved in 16 patients with Cushing disease (84%), 18 patients with prolactinoma (78.2%), and 18 patients with acromegaly (85,7%). There were 12 cases (9%) of cerebrospinal fluid leak, 4 cases of diabetes insipidus, and 3 cases with transient SIADH/hyponatremia. Seven patients developed panhypopituitarism. Postoperative mortality rate was 2.4%. One hundred and three patients (85.3%) were discharged from the hospital less than 48 hours after surgery. CONCLUSION Our results are similar to those reported by renowned pituitary units. Results achieved using an endoscopic approach in pituitary neurosurgery are better than those of microneurosurgery for cavernous sinus invasion.
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Affiliation(s)
- Jorge Torales
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Irene Halperin
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Felicia Hanzu
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Mireia Mora
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Isam Alobid
- Servicio de Otorrinolaringología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Mateo De Notaris
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Enrique Ferrer
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Joaquim Enseñat
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
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Canivell S, Ruano EG, Sisó-Almirall A, Kostov B, González-de Paz L, Fernandez-Rebollo E, Hanzu F, Párrizas M, Novials A, Gomis R. Gastric inhibitory polypeptide receptor methylation in newly diagnosed, drug-naïve patients with type 2 diabetes: a case-control study. PLoS One 2013; 8:e75474. [PMID: 24086540 PMCID: PMC3781044 DOI: 10.1371/journal.pone.0075474] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/15/2013] [Indexed: 11/18/2022] Open
Abstract
GIP action in type 2 diabetic (T2D) patients is altered. We hypothesized that methylation changes could be present in GIP receptor of T2D patients. This study aimed to assess the differences in DNA methylation profile of GIPR promoter between T2D patients and age- and Body Mass Index (BMI)-matched controls. We included 93 T2D patients (cases) that were uniquely on diet (without any anti-diabetic pharmacological treatment). We matched one control (with oral glucose tolerance test negative, non diabetic), by age and BMI, for every case. Cytokines and hormones were determined by ELISA. DNA was extracted from whole blood and DNA methylation was assessed using the Sequenom EpiTYPER system. Our results showed that T2D patients were more insulin resistant and had a poorer β cell function than their controls. Fasting adiponectin was lower in T2D patients as compared to controls (7.0±3.8 µgr/mL vs. 10.0±4.2 µgr/mL). Levels of IL 12 in serum were almost double in T2D patients (52.8±58.3 pg/mL vs. 29.7±37.4 pg/mL). We found that GIPR promoter was hypomethylated in T2D patients as compared to controls. In addition, HOMA-IR and fasting glucose correlated negatively with mean methylation of GIPR promoter, especially in T2D patients. This case-control study confirms that newly diagnosed, drug-naïve T2D patients are more insulin resistant and have worse β cell function than age- and BMI-matched controls, which is partly related to changes in the insulin-sensitizing metabolites (adiponectin), in the proinflammatory profile (IL12) and we suggest in the methylation pattern of GIPR. Our study provides novel findings on GIPR promoter methylation profile which may improve our ability to understand type 2 diabetes pathogenesis.
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Affiliation(s)
- Silvia Canivell
- Department of Endocrinology and Nutrition, Hospital Clinic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Les Corts Primary Health Care Centre, Transverse group for research in primary care-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Diabetes and Obesity Laboratory-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Elena G. Ruano
- Diabetes and Obesity Laboratory-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain
| | - Antoni Sisó-Almirall
- Les Corts Primary Health Care Centre, Transverse group for research in primary care-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Belchin Kostov
- Les Corts Primary Health Care Centre, Transverse group for research in primary care-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Luis González-de Paz
- Les Corts Primary Health Care Centre, Transverse group for research in primary care-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Eduardo Fernandez-Rebollo
- Diabetes and Obesity Laboratory-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain
| | - Felicia Hanzu
- Department of Endocrinology and Nutrition, Hospital Clinic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Diabetes and Obesity Laboratory-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Marcelina Párrizas
- Diabetes and Obesity Laboratory-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Anna Novials
- Department of Endocrinology and Nutrition, Hospital Clinic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Diabetes and Obesity Laboratory-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain
| | - Ramon Gomis
- Department of Endocrinology and Nutrition, Hospital Clinic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Diabetes and Obesity Laboratory-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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Abstract
AIM Considering the poor long-term success of current dietary and pharmacological interventions, we aimed to evaluate the potential effect of sodium tungstate in the treatment of grade I and II obesity (ClinicalTrials.gov identifier: NCT00555074). METHODS Prospective, randomized, placebo-controlled, double-blind, proof-of-concept study was carried out. Following a 2-week lead-in period, 30 obese (body mass index, BMI 30.0-39.9 kg/m(2)), non-diabetic subjects were randomized to receive either sodium tungstate (100 mg bid) or placebo for 6 weeks. The primary study endpoint was the absolute change in body weight relative to the time of randomization. RESULTS Treatment with sodium tungstate [-0.135 ± 0.268 kg (95% CI -0.686 to +0.416 kg)] was not associated with a significant weight loss compared to placebo [-0.063 ± 0.277 kg (95% CI -0.632 to +0.507 kg)] (p = 0.854). Likewise, treatment with sodium tungstate was not associated with significant changes in fat mass (DEXA), resting energy expenditure (indirect calorimetry) or caloric consumption (3-day food records). CONCLUSION Our data do not support sodium tungstate as a pharmacological agent in the treatment of human obesity.
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Affiliation(s)
- F Hanzu
- Endocrinology and Nutrition Department, Hospital Clínic, IDIBAPS, Barcelona University, Barcelona, Spain
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