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Santiago-Andres Y, Aquiles A, Taniguchi-Ponciano K, Salame L, Guinto G, Mercado M, Fiordelisio T. Association between Intracellular Calcium Signaling and Tumor Recurrence in Human Non-Functioning Pituitary Adenomas. Int J Mol Sci 2024; 25:3968. [PMID: 38612778 PMCID: PMC11011867 DOI: 10.3390/ijms25073968] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Clinically non-functioning pituitary adenomas (CNFPAs) are the second most frequent sellar tumor among studies on community-dwelling adults. They are characterized by the absence of hormonal hypersecretion syndrome, and patients present with compressive symptoms, such as a headache and visual field defects. Immunohistochemically, most CNFPAs are of gonadotrope differentiation, with only a few of them being truly null cell adenomas. Although these tumors express receptors for one or more hypothalamic releasing hormones, to what extent this has an impact on the biological and clinical behavior of these neoplasms remains to be defined. In this research, we evaluated the basal and hypothalamic secretagogue-stimulated intracellular calcium mobilization in 13 CNFPAs, trying to correlate this response to the phenotypic features of the patients. Our results indicate that the recurrence of a CNFPA correlates positively with cellular responsiveness, as measured by spontaneous intracellular calcium activity and the ability to respond to multiple hypothalamic secretagogues. We conclude that this finding may be a useful tool for predicting the clinicopathologic behavior of CNFPAs, by testing the variation of cellular responsiveness to hypothalamic secretagogues.
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Affiliation(s)
- Yorgui Santiago-Andres
- Laboratorio de Neuroendocrinología Comparada, Facultad de Ciencias, Universidad Nacional Autónoma de México, Ciudad Universitaria, Ciudad de Mexico 04510, Mexico;
- Posgrado en Ciencias Biológicas, Unidad de Posgrado, Edificio D, 1° Piso, Circuito de Posgrados, Ciudad Universitaria, Ciudad de Mexico 04510, Mexico
| | - Ana Aquiles
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Querétaro 76230, Mexico;
| | - Keiko Taniguchi-Ponciano
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (K.T.-P.); (L.S.)
| | - Latife Salame
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (K.T.-P.); (L.S.)
| | - Gerardo Guinto
- Centro Neurológico, Centro Médico ABC, Ciudad de México 05370, Mexico;
| | - Moises Mercado
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (K.T.-P.); (L.S.)
| | - Tatiana Fiordelisio
- Laboratorio de Neuroendocrinología Comparada, Facultad de Ciencias, Universidad Nacional Autónoma de México, Ciudad Universitaria, Ciudad de Mexico 04510, Mexico;
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Mondragón JD, Salame L, Kraus A, De Deyn PP. Clinical Considerations in Physician-Assisted Death for Probable Alzheimer's Disease: Decision-Making Capacity, Anosognosia, and Suffering. Dement Geriatr Cogn Dis Extra 2019; 9:217-226. [PMID: 31275347 PMCID: PMC6600029 DOI: 10.1159/000500183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/01/2019] [Indexed: 11/24/2022] Open
Abstract
Background Requests for physician-assisted death (PAD) in patients with cognitive impairment are complex and require careful consideration. Of particular difficulty is determination of whether the request is voluntary and well considered. Results Euthanasia and physician-assisted suicide (PAS) are both legal in The Netherlands, Luxemburg, Colombia, and Canada. Euthanasia is legal in Belgium, while PAS is legal in Switzerland and Oregon, Washington, Montana, Vermont, and California (USA). Upon a PAD request, evaluation of the capacity to consent medical treatment is relevant for the decision-making process, while evaluation of testamentary capacity is appropriate before an advance euthanasia directive is written. Anosognosia assessment throughout the Alzheimer's disease continuum provides essential and relevant information regarding the voluntary and well-considered nature of the PAD request; meanwhile, early assessment of hypernosognosia or subjective cognitive decline assists in formulation of a clinical prognosis. Furthermore, the assessment of physical and psychological suffering should incorporate verbal and nonverbal cues as well as consideration of the psychosocial factors that might affect due care criteria. Conclusion The clinical approach to a PAD request should consider the legal framework and the decision-making capacity, assess memory deficit awareness and the perception of suffering, and evaluate mental competency when considered pertinent.
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Affiliation(s)
- Jaime D Mondragón
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Alzheimer Research Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Latife Salame
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Department of Internal Medicine, The American British Cowdray Medical Center, Mexico City, Mexico
| | - Arnoldo Kraus
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Department of Internal Medicine, The American British Cowdray Medical Center, Mexico City, Mexico
| | - Peter Paul De Deyn
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Alzheimer Research Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
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Espinosa E, Salame L, Marrero-Rodriguez D, Romero-Nieves AM, Cuenca D, Castelan-Martínez OD, Mendoza V, Ponce-Navarrete G, Salcedo M, Luque-Leòn E, Rodriguez-Gonzalez A, Mercado M. Expression of the growth hormone receptor isoforms and its correlation with the metabolic profile in morbidly obese subjects. Endocrine 2019; 63:573-581. [PMID: 30361972 DOI: 10.1007/s12020-018-1794-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Given the lipolytic effect of GH and its potential role in determining adipose tissue distribution, we evaluated the expression of the GH hormone receptor (GHR) isoforms in patients with morbid obesity seeking associations with metabolic parameters. METHODS 262 morbidly obese subjects (mean age 42.5 ± 11 years, 75% women) underwent PCR-genotyping of the exon 3 GHR polymorphism. In 17 of these subjects, who proved to be heterozygous for the exon 3 genotype (+3/-3), subcutaneous and visceral adipose tissue was obtained during bariatric surgery; total RNA was extracted, reversely transcribed, and the different isoforms of the GHR (exon 3 containing and lacking flGHR as well as the trGHR) were PCR-amplified using specific primers. RESULTS 27% were +3/+3 homozygous, 20% -3/-3 homozygous and 53% were +3/-3 heterozygous. Compared to subjects homozygous for the +3 genotype, homozygous and heterozygous carriers of the -3 genotype were significantly heavier and tended to have a higher HOMA 2-IR. Expression of the flGHR and trGHR mRNA was demonstrated in all evaluated samples of subcutaneous and visceral adipose tissue from the 17 patients. The exon 3+ isoform was expressed in all adipose tissue samples, whereas only six subjects expressed the 3- isoform as well. The only distinctive feature of these six patients was a higher HbA1c. CONCLUSIONS The heterozygous GHR +3/-3 genotype is more prevalent in subjects with morbid obesity. Patients expressing the exon +3 and exon -3 isoforms in adipose tissue had a higher HbA1c, than those expressing only the exon -3 isoform.
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Affiliation(s)
- Etual Espinosa
- Endocrinology Service/Experimental Endocrinology Unit and Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Juárez, Mexico
| | - Latife Salame
- Endocrinology Service/Experimental Endocrinology Unit and Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Juárez, Mexico
| | - Daniel Marrero-Rodriguez
- Obesity Clinic Hospital de Especialidades and Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Juárez, Mexico
| | - Andy-Michel Romero-Nieves
- Oncology Research Unit, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Juárez, Mexico
| | - Dalia Cuenca
- Endocrinology Service/Experimental Endocrinology Unit and Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Juárez, Mexico
| | | | - Victoria Mendoza
- Endocrinology Service/Experimental Endocrinology Unit and Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Juárez, Mexico
| | - Gustavo Ponce-Navarrete
- Obesity Clinic Hospital de Especialidades and Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Juárez, Mexico
| | - Mauricio Salcedo
- Obesity Clinic Hospital de Especialidades and Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Juárez, Mexico
| | | | | | - Moisés Mercado
- Endocrinology Service/Experimental Endocrinology Unit and Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Juárez, Mexico.
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Mercado M, Melgar V, Salame L, Cuenca D. Clinically non-functioning pituitary adenomas: Pathogenic, diagnostic and therapeutic aspects. ACTA ACUST UNITED AC 2017; 64:384-395. [PMID: 28745610 DOI: 10.1016/j.endinu.2017.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 04/06/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/15/2022]
Abstract
Clinically non-functioning pituitary adenomas (NFPAs) are among the most common tumors in the sellar region. These lesions do not cause a hormonal hypersecretion syndrome, and are therefore found incidentally (particularly microadenomas) or diagnosed based on compressive symptoms such as headache and visual field defects, as well as clinical signs of pituitary hormone deficiencies. Immunohistochemically, more than 45% of these adenomas stain for gonadotropins or their subunits and are therefore called gonadotropinomas, while 30% of them show no immunostaining for any hormone and are known as null cell adenomas. The diagnostic approach to NFPAs should include visual field examination, an assessment of the integrity of all anterior pituitary hormone systems, and magnetic resonance imaging of the sellar region to define tumor size and extension. The treatment of choice is transsphenoidal resection of the adenoma, which in many instances cannot be completely accomplished. The recurrence rate after surgery may be up to 30%. Persistent or recurrent adenomas are usually treated with radiation therapy. In a small proportion of these cases, drug treatment with dopamine agonists and, to a lesser extent, somatostatin analogs may achieve reduction or at least stabilization of the tumor.
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Affiliation(s)
- Moises Mercado
- Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico; Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico.
| | - Virgilio Melgar
- Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico
| | - Latife Salame
- Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico
| | - Dalia Cuenca
- Department of Medicine, American British Cowdray Medical Center, Mexico City, Mexico
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Molina L, Sutton R, Gandoy W, Reyes N, Lara S, Limón F, Gómez S, Orihuela C, Salame L, Moreno G. Medium-term effects of septal and apical pacing in pacemaker-dependent patients: a double-blind prospective randomized study. Pacing Clin Electrophysiol 2013; 37:207-14. [PMID: 23998710 PMCID: PMC4265201 DOI: 10.1111/pace.12257] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/15/2013] [Accepted: 07/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pacing the right ventricle is established practice, but there remains controversy as to the optimal site to preserve hemodynamic function. AIMS To evaluate clinical and hemodynamic differences between apical and septal pacing in pacemaker-dependent patients. METHODS Patients receiving their first pacemaker for advanced atrioventricular block, with the atria in sinus rhythm, were randomized to receive apical (Group A) or septal (Group S) ventricular leads. After implant, with the device programmed VVI 70 beats/min fixed rate, patients underwent a 6-minute walk test and a transthoracic echocardiogram. Then, DDDR was programmed at nominal settings. The same tests were performed at 6 months and 12 months follow-up. If ventricular pacing was less than 98%, the patient was excluded. RESULTS A total of 142 patients were included in the study. During the study year, 71 (50%) were excluded for not fulfilling the condition of 98% ventricular pacing. Groups A and S had 34 and 37 patients, respectively. Age and gender were similar in the groups. At implant, QRS duration was significantly greater in Group A (158 ms) than Group S (146 ms; P = 0.018), and the QRS axis was different: -74.5° in Group A and 1° in Group S (P < 0.001). At 1 year, the 6-minute walk improved significantly in both groups: Group A 15% (P = 0.048) and Group S 24% (P = 0.001). Left ventricular ejection fraction (LVEF) increased from 0.57 to 0.61 (P = 0.008) in Group S, without significant change in Group A. CONCLUSIONS After 1 year, pacemaker-dependent patients with septal ventricular leads have better clinical and functional (LVEF) outcome.
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Affiliation(s)
- Luis Molina
- Arrhythmia Laboratory of the Universidad Nacional Autónoma de México (UNAM) en Hospital General de México, Mexico City, Medico
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