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Januszewski AS, Niedzwiecki P, Sachithanandan N, Ward GM, O’Neal DN, Zozulinska‐Ziolkiewicz DA, Uruska AA, Jenkins AJ. Interactive calculator to estimate insulin sensitivity in type 1 diabetes. J Diabetes Investig 2024; 15:594-597. [PMID: 38366869 PMCID: PMC11060155 DOI: 10.1111/jdi.14161] [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: 12/06/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/18/2024] Open
Abstract
The gold standard for measuring insulin sensitivity (IS) is the hyperinsulinemic-euglycemic clamp, a time, costly, and labor-intensive research tool. A low insulin sensitivity is associated with a complication-risk in type 1 diabetes. Various formulae using clinical data have been developed and correlated with measured IS in type 1 diabetes. We consolidated multiple formulae into an online calculator (bit.ly/estimated-GDR), enabling comparison of IS and its probability of IS <4.45 mg/kg/min (low) or >6.50 mg/kg/min (high), as measured in a validation set of clamps in 104 adults with type 1 diabetes. Insulin sensitivity calculations using different formulae varied significantly, with correlations (R2) ranging 0.005-0.87 with agreement in detecting low and high glucose disposal rates in the range 49-93% and 89-100%, respectively. We demonstrate that although the calculated IS varies between formulae, their interpretation remains consistent. Our free online calculator offers a user-friendly tool for individual IS calculations and also offers efficient batch processing of data for research.
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Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNew South WalesAustralia
- Department of MedicineUniversity of MelbourneFitzroyVictoriaAustralia
- Sydney Pharmacy SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Pawel Niedzwiecki
- Department of Internal Medicine and DiabetologyPoznan University of Medical SciencesPoznanPoland
| | | | - Glenn M Ward
- Department of MedicineUniversity of MelbourneFitzroyVictoriaAustralia
| | - David N O’Neal
- Department of MedicineUniversity of MelbourneFitzroyVictoriaAustralia
| | | | - Aleksandra A Uruska
- Department of Internal Medicine and DiabetologyPoznan University of Medical SciencesPoznanPoland
| | - Alicia J Jenkins
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNew South WalesAustralia
- Department of MedicineUniversity of MelbourneFitzroyVictoriaAustralia
- Baker Heart and Diabetes InstituteMelbourneVictoriaAustralia
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Halim B, Yong EXZ, Egan M, MacIsaac RJ, O’Neal D, Sachithanandan N. Utility of Repeat Sampling in Bilateral Aldosterone Suppression During Adrenal Vein Sampling for Primary Aldosteronism. JCEM Case Rep 2024; 2:luae051. [PMID: 38601064 PMCID: PMC11005832 DOI: 10.1210/jcemcr/luae051] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Indexed: 04/12/2024]
Abstract
Primary aldosteronism (PA) is the most common form of secondary hypertension. Accurate subtyping of PA is essential to identify unilateral disease, as adrenalectomy improves outcomes. Subtyping PA requires adrenal vein sampling (AVS), which is technically challenging and results from AVS may not always be conclusive. We present a case of a 37-year-old man with PA whose AVS studies were inconclusive due to apparent bilateral aldosterone suppression (ABAS). As a result, our patient was misdiagnosed as having bilateral PA and medically managed until a repeat AVS showed lateralization to the right adrenal gland. ABAS is an underrecognized phenomenon that may confound the subtyping of PA. We recommend repeating AVS in such cases and discuss strategies to minimize ABAS.
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Affiliation(s)
- Bella Halim
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Medicine, The University of Melbourne, Fitzroy, Victoria 3065, Australia
| | - Eric X Z Yong
- Department of Radiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia
| | - Matthew Egan
- Department of Pathology, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Medicine, The University of Melbourne, Fitzroy, Victoria 3065, Australia
| | - David O’Neal
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Medicine, The University of Melbourne, Fitzroy, Victoria 3065, Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Medicine, The University of Melbourne, Fitzroy, Victoria 3065, Australia
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Martis WR, Sachithanandan N, Chiang C, Riedel B. Glucagon-like peptide-1 receptor agonists in the perioperative period: to cease or not to cease? ANZ J Surg 2024; 94:510-512. [PMID: 38012089 DOI: 10.1111/ans.18804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Walston Reginald Martis
- Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nirupa Sachithanandan
- Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Cherie Chiang
- Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Bernhard Riedel
- Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
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Stringer F, Sims NA, Sachithanandan N, Aleksova J. Severe Osteoporosis With Pathogenic LRP5 Variant. JCEM Case Rep 2024; 2:luae021. [PMID: 38404691 PMCID: PMC10888517 DOI: 10.1210/jcemcr/luae021] [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] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Indexed: 02/27/2024]
Abstract
A 24-year-old female patient was diagnosed with osteoporosis after presenting with numerous fractures throughout her childhood and adolescence. Risk factors included chronic constipation, severe vitamin D deficiency, and long-term high-dose steroid use for severe eczema. Metabolic bone disorder clinical exome screening (limited panel of metabolic bone disorders and gastrointestinal disorders) was undertaken and revealed a class 4 likely pathogenic variant in the LRP5 gene known to cause osteoporosis. Optimal treatment for patients with this variant is not well defined. A literature review of the condition and potential treatment options is discussed.
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Affiliation(s)
- Felicity Stringer
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Melbourne, VIC 3065, Australia
| | - Natalie A Sims
- St Vincent's Institute of Medical Research, Fitzroy, Melbourne, VIC 3065, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Melbourne, VIC 3065, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Jasna Aleksova
- Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Melbourne, VIC 3065, Australia
- Department of Medicine, Monash University, Clayton, VIC 3168, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
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Preston CA, Sachithanandan N, Sim IW, van Heerden J, Farrell S. Insulinoma: Metastatic Recurrence 38 Years Following Initial Diagnosis in Pregnancy. JCEM Case Rep 2024; 2:luad168. [PMID: 38196815 PMCID: PMC10773549 DOI: 10.1210/jcemcr/luad168] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Indexed: 01/11/2024]
Abstract
A case of recurrent insulinoma spanning 4 decades is described. Following a delayed diagnosis, hyperinsulinemic hypoglycemia was confirmed in a 24-year-old woman during early pregnancy. Initial surgery, culminating in subtotal pancreatectomy, was noncurative. A 1-cm insulinoma was subsequently resected from the head of the pancreas postpartum, with postoperative resolution of hypoglycemia. However, 32 years later, the patient experienced a recurrence of hypoglycemic symptoms. Eventually, a subcentimeter extrapancreatic lesion was identified anterior to the pancreatic head on gallium-68 DOTA-Exendin-4 positron emission tomography/computed tomography. In 2022, a third operation was performed, with excision of a 4 × 3 mm tumor adjacent to the pancreatic head, and histology confirming insulinoma. She was again cured of symptoms.
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Affiliation(s)
- Christopher A Preston
- Department of Endocrinology & Diabetes, St Vincent’s Hospital Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria 3021, Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology & Diabetes, St Vincent’s Hospital Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Medicine, The University of Melbourne, Fitzroy, Victoria 3065, Australia
| | - Ie-Wen Sim
- Department of Endocrinology & Diabetes, St Vincent’s Hospital Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria 3021, Australia
- Department of Medicine, The University of Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Endocrinology & Diabetes, Monash Health and Eastern Health, Melbourne, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Jon van Heerden
- Department of Surgery, Mayo Medical School, Rochester, MN 55905, USA
- Department of Surgery, Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA
| | - Stephen Farrell
- Department of Surgery, St Vincent’s Hospital Melbourne, Fitzroy, Victoria 3065, Australia
- Department of Surgery, Austin Health, Heidelberg, Victoria 3084, Australia
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Galligan A, Wallace R, Krishnamurthy B, Kay TWH, Sachithanandan N, Chiang C, Sandhu S, Hicks RJ, Iravani A. Increased Thyroidal Activity on Routine FDG-PET/CT after Combination Immune Checkpoint Inhibition: Temporal Associations with Clinical and Biochemical Thyroiditis. Cancers (Basel) 2023; 15:5803. [PMID: 38136348 PMCID: PMC10741830 DOI: 10.3390/cancers15245803] [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] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND FDG-PET/CT used for immune checkpoint inhibitor (ICI) response assessment can incidentally identify immune-related adverse events (irAEs), including thyroiditis. This study aimed to correlate the time course of FDG-PET/CT evidence of thyroiditis with clinical and biochemical evolution of thyroid dysfunction. METHODS A retrospective review was performed by two independent blinded nuclear medicine physicians (NMPs) of thyroidal FDG uptake in 127 patients who underwent PET/CT between January 2016 and January 2019 at baseline and during treatment monitoring of combination ICI therapy for advanced melanoma. Interobserver agreement was assessed and FDG-PET/CT performance defined by a receiver-operating characteristic (ROC) curve using thyroid function tests (TFTs) as the standard of truth. Thyroid maximum standardized uptake value (SUVmax) and its temporal changes with respect to the longitudinal biochemistry were serially recorded. RESULTS At a median of 3 weeks after commencing ICI, 43/127 (34%) had a diagnosis of thyroiditis established by abnormal TFTs. FDG-PET/CT was performed at baseline and at a median of 11 weeks (range 3-32) following the start of therapy. ROC analysis showed an area under the curve of 0.87 (95% CI 0.80, 0.94) for FDG-PET/CT for detection of thyroiditis with a positive predictive value of 93%. Among patients with biochemical evidence of thyroiditis, those with a positive FDG-PET/CT were more likely to develop overt hypothyroidism (77% versus 35%, p < 0.01). In the evaluation of the index test, there was an almost perfect interobserver agreement between NMPs of 93.7% (95% CI 89.4-98.0), kappa 0.83. CONCLUSION Increased metabolic activity of the thyroid on routine FDG-PET/CT performed for tumoral response of patients undergoing ICI therapy is generally detected well after routine biochemical diagnosis. Elevation of FDG uptake in the thyroid is predictive of overt clinical hypothyroidism and suggests that an ongoing robust inflammatory response beyond the initial thyrotoxic phase may be indicative of thyroid destruction.
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Affiliation(s)
- Anna Galligan
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia; (B.K.); (T.W.H.K.); (N.S.)
- Department of Medicine, St Vincent’s Hospital Medical School, University of Melbourne, Melbourne, VIC 3010, Australia;
- Immunology and Diabetes Unit, St. Vincent’s Institute of Medical Research, Fitzroy, VIC 3065, Australia
| | - Roslyn Wallace
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia; (R.W.); (S.S.)
| | - Balasubramanian Krishnamurthy
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia; (B.K.); (T.W.H.K.); (N.S.)
- Department of Medicine, St Vincent’s Hospital Medical School, University of Melbourne, Melbourne, VIC 3010, Australia;
- Immunology and Diabetes Unit, St. Vincent’s Institute of Medical Research, Fitzroy, VIC 3065, Australia
| | - Thomas W. H. Kay
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia; (B.K.); (T.W.H.K.); (N.S.)
- Department of Medicine, St Vincent’s Hospital Medical School, University of Melbourne, Melbourne, VIC 3010, Australia;
- Immunology and Diabetes Unit, St. Vincent’s Institute of Medical Research, Fitzroy, VIC 3065, Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia; (B.K.); (T.W.H.K.); (N.S.)
- Department of Medicine, St Vincent’s Hospital Medical School, University of Melbourne, Melbourne, VIC 3010, Australia;
- Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia;
| | - Cherie Chiang
- Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia;
- Department of Medicine, Royal Melbourne Hospital Medical School, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia; (R.W.); (S.S.)
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Rodney J. Hicks
- Department of Medicine, St Vincent’s Hospital Medical School, University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Amir Iravani
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
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Galligan A, Iravani A, Lasocki A, Wallace R, Weppler AM, Sachithanandan N, Chiang C, Colman PG, Wentworth J, Spain L, Au-Yeung G, Lee B, Kay TWH, Hicks RJ, Sandhu S, Krishnamurthy B. Imaging for assessment of cancer treatment response to immune checkpoint inhibitors can be complementary in identifying hypophysitis. Front Endocrinol (Lausanne) 2023; 14:1295865. [PMID: 38093958 PMCID: PMC10716424 DOI: 10.3389/fendo.2023.1295865] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Hypophysitis is reported in 8.5%-14% of patients receiving combination immune checkpoint inhibition (cICI) but can be a diagnostic challenge. This study aimed to assess the role of routine diagnostic imaging performed during therapeutic monitoring of combination anti-CTLA-4/anti-PD-1 treatment in the identification of hypophysitis and the relationship of imaging findings to clinical diagnostic criteria. Methods This retrospective cohort study identified patients treated with cICI between January 2016 and January 2019 at a quaternary melanoma service. Medical records were reviewed to identify patients with a documented diagnosis of hypophysitis based on clinical criteria. Available structural brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT) of the brain and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography with computed tomography (FDG-PET/CT) were assessed retrospectively. The main radiological outcome measures were a relative change in pituitary size or FDG uptake temporally attributed to cICI. Results There were 162 patients (median age 60 years, 30% female) included. A total of 100 and 134 had serial CT/MRI of the brain and FDG-PET/CT, respectively. There were 31 patients who had a documented diagnosis of hypophysitis and an additional 20 who had isolated pituitary imaging findings. The pituitary gland enlargement was mild, and the largest absolute gland size was 13 mm, with a relative increase of 7 mm from baseline. There were no cases of optic chiasm compression. Pituitary enlargement and increased FDG uptake were universally transient. High-dose glucocorticoid treatment for concurrent irAEs prevented assessment of the pituitary-adrenal axis in 90% of patients with isolated imaging findings. Conclusion Careful review of changes in pituitary characteristics on imaging performed for assessment of therapeutic response to iICI may lead to increased identification and more prompt management of cICI-induced hypophysitis.
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Affiliation(s)
- Anna Galligan
- Immunology and Diabetes Unit, St Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Amir Iravani
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Arian Lasocki
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Roslyn Wallace
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alison M. Weppler
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology and Diabetes, St Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Cherie Chiang
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Peter G. Colman
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - John Wentworth
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Lavinia Spain
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - George Au-Yeung
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Belinda Lee
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Thomas W. H. Kay
- Immunology and Diabetes Unit, St Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Rodney J. Hicks
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Shahneen Sandhu
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Balasubramanian Krishnamurthy
- Immunology and Diabetes Unit, St Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
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Januszewski AS, Niedzwiecki P, Sachithanandan N, Ward GM, Karschimkus CS, O'Neal DN, Zozulinska-Ziolkiewicz DA, Uruska AA, Jenkins AJ. Corrigendum to "Independent euglycaemic hyperinsulinaemic clamp studies validate clinically applicable formulae to estimate insulin sensitivity in people with type 1 diabetes" [Diabetes Metabol Syndr Clin Res Rev 17(1) (2023) 102691]. Diabetes Metab Syndr 2023; 17:102700. [PMID: 36586292 DOI: 10.1016/j.dsx.2022.102700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia.
| | - Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
| | | | - Glenn M Ward
- Department of Medicine, University of Melbourne, Australia
| | | | - David N O'Neal
- Department of Medicine, University of Melbourne, Australia
| | | | - Aleksandra A Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia
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Januszewski AS, Niedzwiecki P, Sachithanandan N, Ward GM, Karschimkus CS, O'Neal DN, Zozulinska-Ziolkiewicz DA, Uruska AA, Jenkins AJ. Independent euglycaemic hyperinsulinaemic clamp studies validate clinically applicable formulae to estimate insulin sensitivity in people with type 1 diabetes. Diabetes Metab Syndr 2023; 17:102691. [PMID: 36508938 DOI: 10.1016/j.dsx.2022.102691] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/10/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Low insulin sensitivity (IS) increases Type 1 diabetes (T1D) complication risk and can be estimated by simple formulae developed from complex euglycemic hyperinsulinaemic clamp studies. We aimed to validate these formulae using independent clamp data. METHODS Clamps were performed in 104 T1D adults. Measured glucose disposal rate (GDR) was correlated with eGDR and eLog10 M/I calculated by five IS formulae. RESULTS Correlations ranged between 0.23-0.40. Two IS formulae (by the authors), using age, sex, HDL-C, HbA1c, pulse pressure, BMI, and waist-hip-ratio had the highest correlation with measured GDR and the best performance in detecting low IS.
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Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia.
| | - Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
| | | | - Glenn M Ward
- Department of Medicine, University of Melbourne, Australia
| | | | - David N O'Neal
- Department of Medicine, University of Melbourne, Australia
| | | | - Aleksandra A Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia
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Srougi V, Bancos I, Daher M, Lee JE, Graham PH, Karam JA, Henriquez A, Mckenzie TJ, Sada A, Bourdeau I, Poirier J, Vaidya A, Abbondanza T, Kiernan CM, Rao SN, Hamidi O, Sachithanandan N, Hoff AO, Chambo JL, Almeida MQ, Habra MA, Fragoso MCBV. Cytoreductive Surgery of the Primary Tumor in Metastatic Adrenocortical Carcinoma: Impact on Patients' Survival. J Clin Endocrinol Metab 2022; 107:964-971. [PMID: 34850915 PMCID: PMC9122637 DOI: 10.1210/clinem/dgab865] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 08/16/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The role of cytoreduction of adrenocortical carcinoma (ACC) remains poorly understood. OBJECTIVE To analyze the impact of cytoreductive surgery of the primary tumor in patients with metastatic ACC. DESIGN AND SETTING We performed a multicentric, retrospective paired cohort study comparing the overall survival (OS) in patients with metastatic ACC who were treated either with cytoreductive surgery (CR group) or without cytoreductive surgery (no-CR group) of the primary tumor. Data were retrieved from 9 referral centers in the American-Australian-Asian Adrenal Alliance collaborative research group. PATIENTS Patients aged ≥18 years with metastatic ACC at initial presentation who were treated between January 1, 1995, and May 31, 2019. INTERVENTION Performance (or not) of cytoreductive surgery of the primary tumor. MAIN OUTCOME AND MEASURES A propensity score match was done using age and the number of organs with metastasis (≤2 or >2). The main outcome was OS, determined from the date of diagnosis until death or until last follow-up for living patients. RESULTS Of 339 patients pooled, 239 were paired and included: 128 in the CR group and 111 in the no-CR group. The mean follow-up was 67 months. Patients in the no-CR group had greater risk of death than did patients in the CR group (hazard ratio [HR] = 3.18; 95% CI, 2.34-4.32). Independent predictors of survival included age (HR = 1.02; 95% CI, 1.00-1.03), hormone excess (HR = 2.56; 95% CI, 1.66-3.92), and local metastasis therapy (HR = 0.41; 95% CI, 0.47-0.65). CONCLUSION Cytoreductive surgery of the primary tumor in patients with metastatic ACC is associated with prolonged survival.
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Affiliation(s)
- Victor Srougi
- Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Division of Urology, Hospital Moriah, São Paulo, Brazil
| | - Irina Bancos
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Marilyne Daher
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose A Karam
- Department of Urology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Travis J Mckenzie
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Alaa Sada
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Isabelle Bourdeau
- Division of Endocrinology and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Jonathan Poirier
- Division of Endocrinology and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tiffany Abbondanza
- Center for Adrenal Disorders, Division of Endocrinology Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Colleen M Kiernan
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarika N Rao
- Division of Endocrinology, Mayo Clinic, Jacksonville, FL, USA
| | - Oksana Hamidi
- Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nirupa Sachithanandan
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Melbourne, Australia
| | - Ana O Hoff
- Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jose L Chambo
- Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Madson Q Almeida
- Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria C B V Fragoso
- Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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11
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Wang R, Solomon B, Luen SJ, Prall OW, Khoo C, Gill AJ, Lewin J, Sachithanandan N. Pitfalls and progress in adrenocortical carcinoma diagnosis: the utility of a multidisciplinary approach, immunohistochemistry and genomics. Endocrinol Diabetes Metab Case Rep 2022; 2022:EDM210081. [PMID: 35023475 PMCID: PMC8789009 DOI: 10.1530/edm-21-0081] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Adrenocortical carcinoma is a rare disease with poor prognosis whose clinical heterogeneity can at times present a challenge to accurate and timely diagnosis. We present the case of a patient who presented with extensive pulmonary lesions, mediastinal and hilar lymphadenopathy and an adrenal mass in whom the oncological diagnosis was initially uncertain. Through the use of immunohistochemistry, biochemistry and genomic testing, an accurate diagnosis of adrenocortical carcinoma was ultimately made which resulted in more directed treatment being administered. The use of multidisciplinary input and genomics to aid in diagnosis and prognosis of adrenocortical carcinoma is discussed. LEARNING POINTS Adrenocortical carcinomas can present a diagnostic challenge to clinicians given it is a rare malignancy with significant clinical heterogeneity. Specialist multidisciplinary team input is vital in the diagnosis and management of adrenocortical carcinomas. Hormonal testing is recommended in the diagnostic workup of adrenal masses, even in the absence of overt clinical signs/symptoms of hormone excess. Immunostaining for the highly sensitive and specific steroidogenic factor-1 is vital for accurate diagnosis. Genomics can provide prognostic utility in management of adrenocortical carcinoma.
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Affiliation(s)
- Ray Wang
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Stephen J Luen
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Owen W.J. Prall
- Department of Pathology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Christine Khoo
- Department of Pathology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Anthony J Gill
- University of Sydney, Sydney, New South Wales, Australia
| | - Jeremy Lewin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Nirupa Sachithanandan
- Department of Internal Medicine, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
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12
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Koneshamoorthy A, Seniveratne-Epa D, Calder G, Sawyer M, Kay TWH, Farrell S, Loudovaris T, Mariana L, McCarthy D, Lyu R, Liu X, Thorn P, Tong J, Chin LK, Zacharin M, Trainer A, Taylor S, MacIsaac RJ, Sachithanandan N, Thomas HE, Krishnamurthy B. Case Report: Hypoglycemia Due to a Novel Activating Glucokinase Variant in an Adult - a Molecular Approach. Front Endocrinol (Lausanne) 2022; 13:842937. [PMID: 35370948 PMCID: PMC8969599 DOI: 10.3389/fendo.2022.842937] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
We present a case of an obese 22-year-old man with activating GCK variant who had neonatal hypoglycemia, re-emerging with hypoglycemia later in life. We investigated him for asymptomatic hypoglycemia with a family history of hypoglycemia. Genetic testing yielded a novel GCK missense class 3 variant that was subsequently found in his mother, sister and nephew and reclassified as a class 4 likely pathogenic variant. Glucokinase enables phosphorylation of glucose, the rate-limiting step of glycolysis in the liver and pancreatic β cells. It plays a crucial role in the regulation of insulin secretion. Inactivating variants in GCK cause hyperglycemia and activating variants cause hypoglycemia. Spleen-preserving distal pancreatectomy revealed diffuse hyperplastic islets, nuclear pleomorphism and periductular islets. Glucose stimulated insulin secretion revealed increased insulin secretion in response to glucose. Cytoplasmic calcium, which triggers exocytosis of insulin-containing granules, revealed normal basal but increased glucose-stimulated level. Unbiased gene expression analysis using 10X single cell sequencing revealed upregulated INS and CKB genes and downregulated DLK1 and NPY genes in β-cells. Further studies are required to see if alteration in expression of these genes plays a role in the metabolic and histological phenotype associated with glucokinase pathogenic variant. There were more large islets in the patient's pancreas than in control subjects but there was no difference in the proportion of β cells in the islets. His hypoglycemia was persistent after pancreatectomy, was refractory to diazoxide and improved with pasireotide. This case highlights the variable phenotype of GCK mutations. In-depth molecular analyses in the islets have revealed possible mechanisms for hyperplastic islets and insulin hypersecretion.
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Affiliation(s)
- Anojian Koneshamoorthy
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Dilan Seniveratne-Epa
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Genevieve Calder
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Matthew Sawyer
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Thomas W. H. Kay
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Melbourne, VIC, Australia
- St. Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medicine, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Stephen Farrell
- Department of Surgery, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Thomas Loudovaris
- St. Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
| | - Lina Mariana
- St. Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
| | - Davis McCarthy
- St. Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
- Melbourne Integrative Genomics, Faculty of Science, University of Melbourne, Melbourne, VIC, Australia
| | - Ruqian Lyu
- St. Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
| | - Xin Liu
- St. Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
- Melbourne Integrative Genomics, Faculty of Science, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Thorn
- Charles Perkins Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Jason Tong
- Charles Perkins Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Lit Kim Chin
- Department of Diabetes and Endocrinology, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Margaret Zacharin
- Department of Diabetes and Endocrinology, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Alison Trainer
- Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Shelby Taylor
- Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Richard J. MacIsaac
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Medicine, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Medicine, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Helen E. Thomas
- St. Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medicine, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Balasubramanian Krishnamurthy
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Melbourne, VIC, Australia
- St. Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medicine, St. Vincent’s Hospital, Melbourne, VIC, Australia
- *Correspondence: Balasubramanian Krishnamurthy,
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13
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Sawyer MP, Yong EXZ, Marginson B, Farrell SG, Derbyshire MM, MacIsaac RJ, Sachithanandan N. Utility of semi-quantitative quick cortisol assay with low-dose adrenocorticotropic hormone infusion adrenal vein sampling. ANZ J Surg 2021; 92:437-442. [PMID: 34806293 DOI: 10.1111/ans.17352] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adrenal vein sampling (AVS) is integral to identifying surgically remediable unilateral primary aldosteronism (PA). However, right adrenal vein (AV) cannulation can be challenging, limiting its success. Intra-procedural cortisol assays can improve the reliability of AVS. The aim of this study was to validate the use of semi-quantitative cortisol estimates obtained utilizing a quick cortisol assay (QCA) during AVS procedures at our institution. METHODS Retrospective review of results of AVS procedures before and after the introduction of the QCA. Twenty-three AVS procedures were performed with the provisional success determined by intra-procedural QCA. Successful AV cannulation was defined by an AV to peripheral vein cortisol ratio ≥ 4.0 (the selectivity index) from laboratory measurements. The control cohort consisted of 23 consecutive procedures prior to introduction of the QCA. RESULTS QCA correctly predicted all AV cannulation attempts. Successful bilateral AV cannulation increased from 52% to 91% of procedures when performed with the QCA (P = 0.01) and adequate cannulation of the right AV increased from 61% to 91% (P = 0.03). There was no increase in procedural time, number of AV cannulation or sampling attempts. CONCLUSIONS Point-of-care, semi-quantitative cortisol estimates can be performed accurately during AVS with QCA, facilitating improvements in AVS success rates without increasing procedural time.
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Affiliation(s)
- Matthew P Sawyer
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Eric X Z Yong
- Department of Radiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Benjamin Marginson
- Department of Radiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Stephen G Farrell
- Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Maresa M Derbyshire
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Department of Medicine, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Department of Medicine, The University of Melbourne, Fitzroy, Victoria, Australia
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14
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Gogna R, Jung C, McLachlan K, Krishnamurthy B, Hong A, Derbyshire M, Kiburg KV, Zacharin M, MacIsaac RJ, Sachithanandan N, Caputo C. Reducing adverse events associated with the glucagon stimulation test for the assessment of growth hormone deficiency in adults with a high prevalence of pituitary hormone deficiencies. Clin Endocrinol (Oxf) 2021; 95:125-133. [PMID: 33728673 DOI: 10.1111/cen.14464] [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: 12/19/2020] [Revised: 03/04/2021] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
DESIGN A retrospective review of the adverse events (AEs) in 78 patients during the glucagon stimulation test (GST) for the assessment of growth hormone deficiency (GHD) before and after protocol amendments which aimed to reduce AEs in a group of patients with a high prevalence of pituitary hormone deficiencies. PATIENTS Based on our observations of frequent AEs during the standard GST protocol in an initial 25 patients (cohort 1), a modified protocol was introduced to include the routine administration of 20 mg of hydrocortisone pre-GST in a subsequent 53 patients (cohort 2). Post hoc analysis of the effect of glucocorticoid dosing pre-GST on AEs was examined in those receiving <20 mg hydrocortisone (group A, n = 19) vs ≥20 mg hydrocortisone (group B, n = 59). MEASUREMENTS AEs including hypotension, hypoglycaemia and nausea/vomiting. RESULTS Of the 78 patients undergoing the GST, 79% had ≥2 hormone deficiencies. Rates of AEs were 41% vs 30% for hypotension, 60% vs 28% for hypoglycaemia (p < .05) and 20% vs 13% for nausea/vomiting in cohort 1 compared with cohort 2, respectively. Post hoc analysis revealed lower rates of AEs in those receiving ≥20 mg hydrocortisone (group B) compared to those receiving <20 mg due to a reduction in hypoglycaemic events (82% vs 26%, p < .001) and hypotension (50% vs 27%, p = .05). Similar numbers of patients in group A and group B met criteria for GHD. CONCLUSIONS In patients with a high prevalence of pituitary deficiencies, a modified GST protocol of additional stress dose glucocorticoid attenuated the frequency of AEs without appearing to compromise the performance of the GST.
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Affiliation(s)
- Reetu Gogna
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | - Caroline Jung
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Vic., Australia
| | - Kylie McLachlan
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | - Balasubramanian Krishnamurthy
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Vic., Australia
- St. Vincent's Institute, Fitzroy, Vic., Australia
| | - Alice Hong
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | - Maresa Derbyshire
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | - Katerina V Kiburg
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Vic., Australia
- St. Vincent's Institute, Fitzroy, Vic., Australia
| | - Margaret Zacharin
- Hormone Research, Murdoch Children's Research Institute, Parkville, Vic., Australia
- Department of Endocrinology, Royal Children's Hospital, Parkville, Vic., Australia
- Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Vic., Australia
- St. Vincent's Institute, Fitzroy, Vic., Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Vic., Australia
| | - Carmela Caputo
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Vic., Australia
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15
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Januszewski AS, Sachithanandan N, Ward G, Karschimkus CS, O'Neal DN, Jenkins AJ. Estimated insulin sensitivity in Type 1 diabetes adults using clinical and research biomarkers. Diabetes Res Clin Pract 2020; 167:108359. [PMID: 32745699 DOI: 10.1016/j.diabres.2020.108359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/24/2020] [Revised: 07/04/2020] [Accepted: 07/28/2020] [Indexed: 01/09/2023]
Abstract
AIMS Insulin resistance in people with type 1 diabetes (T1D) is associated with increased risk of chronic complications and death. The gold standard to quantify insulin sensitivity, a euglycaemic hyperinsulinaemic clamp, is not applicable to clinical practice. We have employed clamp studies to develop a panel of formulae to estimate insulin sensitivity in adults with T1D for use in clinical practice and trials. METHODS Clamps were conducted in 28 adults with T1D, who were also characterised with 38 clinical and research biomarkers. Exhaustive search analysis was used to derive equations correlating with clamp-quantified glucose disposal rate (GDR), GDR/plasma insulin (M/I) and log10M/I. RESULTS Measured insulin sensitivity correlated with BMI, WHR, HDL-C, adipokines and inflammation markers on univariate analysis. Exhaustive search analysis derived three formulae correlating with clamp-derived GDR and logM/I (p < 0.0001), accounting for ≈62% of their variability. A formula using gender, age, HDL-C, pulse pressure and WHR performed as well as those containing inflammation and adipokine measures. CONCLUSIONS The performance of formulae using routinely available parameters with/without research biomarkers in clinical studies and trials, particularly related to future complications, relevant lifestyle interventions, insulin delivery modes and insulin sensitisers is merited.
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Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Australia; University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia.
| | - Nirupa Sachithanandan
- University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Australia
| | - Glenn Ward
- University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Australia
| | - Connie S Karschimkus
- University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia
| | - David N O'Neal
- University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Australia; University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Australia
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16
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Galligan A, Iravani A, Lasocki A, Wallace R, Weppler A, Au-Yeung G, Sachithanandan N, Chiang CY, Wentworth J, Colman PG, Kay TW, Krishnamurthy B, Sandhu S. OR32-06 Opportunistic Assessment of Pituitary Gland with Routine MRI and PET/CT Can Guide in Earlier and Increased Identification of Hypophysitis in Patients Treated with Combination Checkpoint Inhibitors. J Endocr Soc 2020. [PMCID: PMC7208878 DOI: 10.1210/jendso/bvaa046.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Hypophysitis is one of the commonly reported adverse events related to immune checkpoint inhibitors (ICI), and the incidence is expected to rise with increased use of combined programmed cell death protein 1 (PD1) and cytotoxic T lymphocyte associated protein 4 (CTLA4) blockade. The clinical diagnosis can be delayed due to non-specific symptoms. At our centre, subjects undergo periodic imaging to assess tumour response to ICI. We reviewed whether neuroimaging studies can guide us in the diagnosis of hypophysitis and whether early changes can be detected before the onset of the clinical syndrome. Methods: We retrospectively reviewed the medical charts, biochemistry, structural brain imaging and whole-body positron emission tomography (PET) with specific reference to hypophysitis in 162 patients treated with combination ICI at a tertiary melanoma referral centre. Suspected cases were identified based on meeting one or more of the following criteria: 1) A documented diagnosis of hypophysitis or pituitary dysfunction found on chart review, 2) A relative change in pituitary size or appearance from baseline on neuroimaging studies, or 3) An increase in pituitary maximum standardized uptake value (SUVmax) greater than 25% from baseline on 18F-FDG PET. Results: 58/162 patients (36%) met criteria for suspected hypophysitis. Only 4 patients were identified on routine screening of early morning cortisol. 14 patients presented with symptoms leading to biochemical work up. A further 40 patients were found to have suspicious imaging changes, 13 of which went on to receive a formal diagnosis of hypophysitis. Of the remaining 27 patients, 23 were receiving high dose glucocorticoids for concomitant immune related adverse events at the time of the abnormal imaging study.Conclusion: We report the highest incidence to date of suspected hypophysitis in cohort of patients treated with combination ICI. This study highlights the important role of structural and functional neuroimaging in the early recognition of hypophysitis. Imaging may also play a role when the clinical syndrome is masked by concurrent glucocorticoid use.
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Affiliation(s)
- Anna Galligan
- ST VINCENT’S INST OF MED RSRCH, Fitzroy Vic, Australia
| | - Amir Iravani
- Peter MacCallum Cancer Centre, Melbourne, Australia
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17
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Galligan A, Iravani A, Lasocki A, Wallace R, Weppler A, Au-Yeung G, Sachithanandan N, Chiang CY, Wentworth J, Colman PG, Kay TW, Krishnamurthy B, Sandhu S. SUN-127 Diagnostic Challenges Associated with the Rising Incidence of Endocrine Toxicity in the Era of Combination Immunotherapy. J Endocr Soc 2020. [PMCID: PMC7209434 DOI: 10.1210/jendso/bvaa046.1693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Immune checkpoint blockade is now established as standard of care in several malignancies. Trials involving combined cytotoxic T lymphocyte associated protein 4 (CTLA4) and programmed cell death protein 1 (PD1) blockade demonstrate improved tumour responses in melanoma but at the cost of severe grade 3-4 immune related adverse events (irAEs) in 55%, and endocrine irAEs in up to 10% [1]. Immune-mediated damage to endocrine glands can be a diagnostic and management challenge. We aimed to review the incidence, biochemical evolution and imaging findings of endocrine toxicity related to combined anti CTLA-4 and anti-PD-1 therapy. Methods: We undertook a retrospective chart review of patients who received combined ipilimumab and nivolumab for metastatic melanoma at a tertiary referral centre between 2016-2019. We recorded onset and duration of abnormal biochemistry in endocrine irAEs, reviewed all available MRI images for pituitary size (mm) and appearance and 18-F FDG PET images for features of hypophysitis, thyroiditis and pancreatitis. Results: 162 patients received combination therapy. At least one irAE was recorded in 135 patients (83%), 100 (62%) required glucocorticoids, and 84 (52%) had an unplanned hospital presentation due to irAEs. Thyroiditis occurred in 50 (30.9%), with median time to onset of 30.9 days (range 1-234 days). 35 cases were identified with routine biochemistry performed every 4-6 weeks. TSH receptor antibody was measured in 13 patients and all were negative. 29 (58%) developed permanent hypothyroidism. Central cortisol deficiency was documented in 31 (19%) with a median time to diagnosis of 67.5 days (range 5-286). 4 cases were diagnosed on routine biochemistry and 14 presented with symptoms prompting investigation. 13 were diagnosed after routine neuroimaging demonstrated a pituitary abnormality, and a further 27 patients without the clinical syndrome had features of hypophysitis on neuroimaging. New onset diabetes occurred in 3 people, in which pancreatic inflammation on imaging was found in 2. A further 3/5 patients with an asymptomatic elevated lipase were found to have abnormal pancreatic imaging. In one patient with no features of endocrine or exocrine failure, there was a significant increase in FDG uptake and a subsequent loss of pancreatic volume. Conclusion: We report real world incidence of endocrine irAEs with combination immunotherapy. Routine biochemistry leads to the detection of some but not all cases. Early recognition and avoidance of unplanned presentations remains a challenge. Opportunistic assessment of endocrine gland appearance on routine imaging studies may provide useful early diagnostic information. Reference: Larkin J, Chiarion-Sileni V, Gonzalez R, Grob JJ, Cowey CL, Lao CD, et al. Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med. (2015) 1:23-34. 10.1056/NEJMoa1504030
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Affiliation(s)
- Anna Galligan
- ST VINCENT’S INST OF MED RSRCH, Fitzroy Vic, Australia
| | - Amir Iravani
- Peter MacCallum Cancer Centre, Melbourne, Australia
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18
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Graf A, Sarlos S, Farrell SG, MacIsaac RJ, Inder WJ, Sachithanandan N. Selective intra‐arterial calcium stimulation test for the localization of insulinomas: an Australian hospital experience. ANZ J Surg 2020; 90:E172-E176. [DOI: 10.1111/ans.15913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Anneke Graf
- Department of Diabetes and Endocrinology St Vincent's Hospital Melbourne Fitzroy Victoria Australia
| | - Stella Sarlos
- Department of Endocrinology Monash Health Clayton Victoria Australia
- Department of Medicine Monash University Clayton Victoria Australia
| | - Stephen G. Farrell
- Department of Surgery St Vincent's Hospital Melbourne Fitzroy Victoria Australia
| | - Richard J. MacIsaac
- Department of Diabetes and Endocrinology St Vincent's Hospital Melbourne Fitzroy Victoria Australia
- Department of Medicine St Vincent's Hospital Melbourne University of Melbourne Fitzroy Victoria Australia
| | - Warrick J. Inder
- Department of Diabetes and Endocrinology Princess Alexandra Hospital Brisbane Queensland Australia
- Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Nirupa Sachithanandan
- Department of Diabetes and Endocrinology St Vincent's Hospital Melbourne Fitzroy Victoria Australia
- Department of Medicine St Vincent's Hospital Melbourne University of Melbourne Fitzroy Victoria Australia
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19
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Calder GL, Ward GM, Sachithanandan N, MacIsaac RJ. Insulin Autoimmune Syndrome: A Case of Clopidogrel-induced Autoimmune Hypoglycemia. J Clin Endocrinol Metab 2020; 105:5809264. [PMID: 32182368 DOI: 10.1210/clinem/dgz301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/08/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Insulin autoimmune syndrome (IAS) is characterized by hyperinsulinemic hypoglycemia with elevated anti-insulin antibodies. Most commonly observed in the Japanese population, elsewhere it is rare and associated with autoimmune diseases, plasma cell dyscrasias, or sulfhydryl group medications. The active metabolite of clopidogrel has a sulfhydryl group and here we report a case of clopidogrel-induced IAS. CASE DESCRIPTION A 67-year-old man was admitted with severe hyperinsulinemic hypoglycemia requiring continuous intravenous infusion of 10% dextrose to sustain euglycemia. His symptoms of hypoglycemia had started after commencing dual antiplatelet therapy (including clopidogrel) for ischemic heart disease 9 months earlier. The hypoglycemia was associated with elevated insulin, proinsulin, c-peptide, and anti-insulin antibody titers as well as the HLA-DRB1*04 haplotype. Multiple localizing studies were negative for an insulinoma. A diagnosis of IAS was thus made. Clopidogrel cessation, oral dexamethasone, and diazoxide therapy were not sufficient to safely wean the dextrose infusion. Plasma exchange was ultimately effective. CONCLUSIONS This case highlights a case of severe IAS. Given the ubiquity of clopidogrel, IAS should be remembered as a rare adverse effect.
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Affiliation(s)
- Genevieve L Calder
- Department of Diabetes & Endocrinology, St Vincent's Hospital, Melbourne, Australia
| | - Glenn M Ward
- Department of Diabetes & Endocrinology, St Vincent's Hospital, Melbourne, Australia
| | | | - Richard J MacIsaac
- Department of Diabetes & Endocrinology, St Vincent's Hospital, Melbourne, Australia
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Kong G, Schenberg T, Yates CJ, Trainer A, Sachithanandan N, Iravani A, Ravi Kumar A, Hofman MS, Akhurst T, Michael M, Hicks RJ. The Role of 68Ga-DOTA-Octreotate PET/CT in Follow-Up of SDH-Associated Pheochromocytoma and Paraganglioma. J Clin Endocrinol Metab 2019; 104:5091-5099. [PMID: 30977831 DOI: 10.1210/jc.2019-00018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/05/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Germline succinate dehydrogenase (SDHx) mutation carriers, especially SDHB, are at increased risk for malignancy and require life-long surveillance. Current guidelines recommend periodic whole-body MRI imaging. We assessed the incremental value of 68Ga-DOTA-octreotate (GaTate) positron emission tomography (PET)/CT compared with conventional imaging in such patients. METHODS SDHx mutation carriers who had GaTate PET/CT were retrospectively reviewed. Detection of lesions were compared with MRI or CT on a per-patient and per-lesion basis. Proof of lesions were based on histopathology or clinical/imaging follow-up. RESULTS Twenty consecutive patients (median age, 46 years; 10 males) were reviewed. Fourteen patients had SDHB, four, SDHD, one SDHC, and one SDHA mutation. Fifteen had prior surgery and/or radiotherapy. Indications for PET/CT were as follows: 7 patients for surveillance for previously treated disease, 9 residual disease, 2 asymptomatic mutation carriers, and 2 for elevated catecholamines. Median time between modalities was 1.5 months.GaTate PET/CT had higher sensitivity and specificity than conventional imaging. On a per-patient basis: PET/CT sensitivity 100%, specificity 100%; MRI/CT 85% and 50%. Per-lesion basis: PET/CT sensitivity 100%, specificity 75%; MRI/CT 80% and 25%. PET/CT correctly identified additional small nodal and osseous lesions. MRI/CT had more false-positive findings. Change of management resulted in 40% (8/20 patients): 3 received localized treatment instead of observation, 1 changed to observation given extra disease detected, 4 with metastases had radionuclide therapy. CONCLUSIONS GaTate PET/CT provided incremental diagnostic information with consequent management impact in SDHx-pheochromocytoma and paraganglioma. Incorporating this modality as part of a surveillance program seems prudent. Further research is needed to define the optimal surveillance strategy including use of MRI.
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Affiliation(s)
- Grace Kong
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Victoria, Australia
- Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Tess Schenberg
- Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Familial Cancer Service, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Christopher J Yates
- Endocrinology, The Royal Melbourne Hospital, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Alison Trainer
- Familial Cancer Service, Peter MacCallum Cancer Centre, Victoria, Australia
| | | | - Amir Iravani
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Victoria, Australia
- Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Aravind Ravi Kumar
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Victoria, Australia
- Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael S Hofman
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Victoria, Australia
- Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Tim Akhurst
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Victoria, Australia
- Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Michael
- Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Rodney J Hicks
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Victoria, Australia
- Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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Hong A, Shanahan M, Schenberg T, Inder W, MacIsaac R, James P, Sachithanandan N. Higher risk of phaeochromocytoma/paraganglioma (Phaeo‐Pgl) in SDHD than SDHB carriers: an Australian cohort study. Intern Med J 2019; 49:529-532. [DOI: 10.1111/imj.14250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/14/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Alice Hong
- Department of Endocrinology and DiabetesSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Mary Shanahan
- Familial Cancer ClinicPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Tess Schenberg
- Familial Cancer ClinicPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Warrick Inder
- Department of Endocrinology and DiabetesPrincess Alexandra Hospital Brisbane Queensland Australia
| | - Richard MacIsaac
- Department of Endocrinology and DiabetesSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Paul James
- Familial Cancer ClinicPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology and DiabetesSt Vincent's Hospital Melbourne Melbourne Victoria Australia
- Familial Cancer ClinicPeter MacCallum Cancer Centre Melbourne Victoria Australia
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Bongetti E, Lee MH, Pattison DA, Hicks RJ, Norris R, Sachithanandan N, MacIsaac RJ. Diagnostic challenges in a patient with an occult insulinoma: 68 Ga-DOTA-exendin-4 PET/CT and 68Ga-DOTATATE PET/CT. Clin Case Rep 2018; 6:719-722. [PMID: 29636947 PMCID: PMC5889260 DOI: 10.1002/ccr3.1448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/06/2018] [Accepted: 01/21/2018] [Indexed: 12/13/2022] Open
Abstract
Despite growing evidence for GLP-1R molecular-based imaging, successful localization of insulinomas may require the use of multiple imaging modalities. Not all benign insulinomas express the GLP-1R as expected. Our case demonstrates that there is a still an important role for traditional methods for the anatomical localization of an insulinoma.
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Affiliation(s)
- Elisa Bongetti
- Department of Endocrinology & Diabetes St Vincent's Hospital Melbourne Victoria Australia
| | - Melissa H Lee
- Department of Endocrinology & Diabetes St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - David A Pattison
- Centre for Cancer Imaging Peter MacCallum Cancer Centre Melbourne Victoria Australia.,Department of Nuclear Medicine & Specialised PET Services Royal Brisbane & Women's Hospital Brisbane Queensland Australia
| | - Rodney J Hicks
- Centre for Cancer Imaging Peter MacCallum Cancer Centre Melbourne Victoria Australia.,Neuroendocrine Service Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Richard Norris
- Department of Pathology St Vincent's Hospital Melbourne Victoria Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology & Diabetes St Vincent's Hospital Melbourne Victoria Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
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Lee MH, Calder GL, MacIsaac RJ, Sachithanandan N. Hyponatraemia and hypopituitarism: an easily missed entity. Med J Aust 2017; 207:282-283. [DOI: 10.5694/mja16.00921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 02/23/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Richard J MacIsaac
- St Vincent's Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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Calder GL, Lee MH, Sachithanandan N, Bell S, Zeimer H, MacIsaac RJ. Aceruloplasminaemia: a disorder of diabetes and neurodegeneration. Intern Med J 2017; 47:115-118. [PMID: 28076908 DOI: 10.1111/imj.13309] [Citation(s) in RCA: 12] [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: 04/22/2016] [Revised: 08/14/2016] [Accepted: 09/05/2016] [Indexed: 12/01/2022]
Abstract
Aceruloplasminaemia is an autosomal recessive disorder of iron metabolism which is characterised by diabetes, neurodegeneration and anaemia. It should be considered in the differential diagnosis of adult onset, antibody-negative diabetes associated with persistent mild anaemia and hyperferritinaemia and/or progressive neuropsychiatric impairments.
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Affiliation(s)
- Genevieve L Calder
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Melissa H Lee
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sally Bell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Howard Zeimer
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Richard J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Aleksova J, Ward G, Taubman K, Tan J, Farrell S, Galloway S, MacIsaac RJ, Sachithanandan N. Cushing's conundrum: an unusual case of primary pigmented nodular adrenal disease in a 60-year-old woman. Lancet Diabetes Endocrinol 2016; 4:630. [PMID: 26527509 DOI: 10.1016/s2213-8587(15)00262-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/28/2015] [Accepted: 07/06/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Jasna Aleksova
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne Fitzroy, Melbourne, Australia.
| | - Glenn Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne Fitzroy, Melbourne, Australia
| | - Kim Taubman
- Department of Nuclear Medicine, St Vincent's Hospital Melbourne Fitzroy, Melbourne, Australia
| | - Jason Tan
- Department of Surgery, St Vincent's Hospital Melbourne Fitzroy, Melbourne, Australia
| | - Stephen Farrell
- Department of Surgery, St Vincent's Hospital Melbourne Fitzroy, Melbourne, Australia
| | - Stuart Galloway
- Department of Pathology, St Vincent's Hospital Melbourne Fitzroy, Melbourne, Australia
| | - Richard J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne Fitzroy, Melbourne, Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne Fitzroy, Melbourne, Australia
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Lee MH, Moxey JE, Derbyshire MM, Ward GM, MacIsaac RJ, Sachithanandan N. Decrease in serum potassium levels post saline suppression test in primary aldosteronism: an under-recognised phenomenon? J Hum Hypertens 2016; 30:664-665. [PMID: 26888603 DOI: 10.1038/jhh.2016.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M H Lee
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, VIC, Australia
| | - J E Moxey
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, VIC, Australia
| | - M M Derbyshire
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, VIC, Australia
| | - G M Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Pathology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - R J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - N Sachithanandan
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
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Affiliation(s)
- Jurstine Daruwalla
- Department of Surgery; University of Melbourne, Austin Health; Victoria Australia
| | | | - David Andrews
- Department of Anesthesia and Pain Management; Royal Melbourne Hospital; Parkville Australia
- Department of Anesthesia; Perioperative and Pain Medicine Unit, The University of Melbourne; Parkville Australia
| | - Julie A. Miller
- Endocrine Surgery Unit; Royal Melbourne Hospital; Victoria Australia
- Epworth Freemasons Hospital; Victoria Australia
- University of Melbourne Department of Surgery; Victoria Australia
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Abell SK, Teng J, Dowling A, Hofman MS, MacIsaac RJ, Sachithanandan N. Prolonged life-threatening hypoglycaemia following dose escalation of octreotide LAR in a patient with malignant polysecreting pancreatic neuroendocrine tumour. Endocrinol Diabetes Metab Case Rep 2015; 2015:140097. [PMID: 25755880 PMCID: PMC4313612 DOI: 10.1530/edm-14-0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 12/11/2022] Open
Abstract
This paper details the case of a 77-year-old male with refractory hypoglycaemia due to inoperable metastatic pancreatic neuroendocrine tumour (pNET) co-secreting insulin and gastrin. Multiple medical therapies were trialled with limited success, and we describe the complications experienced by our patient. Somatostatin analogues can ameliorate hypoglycaemia and may have tumour-stabilising effects; however, in our case resulted in paradoxical worsening of hypoglycaemia. This rendered our patient hospital dependent for glycaemic support including continuous dextrose infusion. Although this is a reported adverse effect with initiation of therapy, we describe successful initiation of short-acting octreotide as an inpatient followed by commencement of long-acting octreotide. Hypoglycaemic collapse occurred only after dose titration of long-acting octreotide. We outline the pitfalls of somatostatin analogue therapy and the mechanisms that may contribute to worsening hypoglycaemia. This rare side effect cannot be reliably predicted, necessitating close supervision and glucose monitoring during therapy. Our patient achieved disease stabilisation and gradual resolution of hypoglycaemia with peptide receptor radionuclide therapy (PRRT), an emerging therapeutic option for metastatic neuroendocrine tumours with high efficacy and low toxicity. We present a brief but comprehensive discussion of currently available and novel therapies for insulin secreting pNETs.
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Affiliation(s)
- Sally K Abell
- Department of Endocrinology and Diabetes , St Vincent's Hospital , PO Box 2900, Fitzroy, Melbourne, 3065 Victoria , Australia
| | - Jessie Teng
- Department of Endocrinology and Diabetes , St Vincent's Hospital , PO Box 2900, Fitzroy, Melbourne, 3065 Victoria , Australia
| | - Anthony Dowling
- Department of Oncology , St Vincent's Hospital , PO Box 2900, Fitzroy, Melbourne, 3065 Victoria , Australia
| | - Michael S Hofman
- Department of Medicine , University of Melbourne , Parkville, Melbourne, Victoria , Australia ; Molecular Imaging, Centre for Cancer Imaging, Peter MacCallum Cancer Centre , East Melbourne, Melbourne, Victoria , Australia
| | - Richard J MacIsaac
- Department of Endocrinology and Diabetes , St Vincent's Hospital , PO Box 2900, Fitzroy, Melbourne, 3065 Victoria , Australia ; Department of Medicine , University of Melbourne , Parkville, Melbourne, Victoria , Australia
| | - Nirupa Sachithanandan
- Department of Endocrinology and Diabetes , St Vincent's Hospital , PO Box 2900, Fitzroy, Melbourne, 3065 Victoria , Australia
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Teng J, Abell S, Hicks RJ, Hofman MS, Sachithanandan N, McKelvie P, MacIsaac RJ. Protracted hypocalcaemia following a single dose of denosumab in humoral hypercalcaemia of malignancy due to PTHrP-secreting neuroendocrine tumour. Clin Endocrinol (Oxf) 2014; 81:940-2. [PMID: 24890549 DOI: 10.1111/cen.12519] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jessie Teng
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Vic., Australia.
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Januszewski AS, Sachithanandan N, Karschimkus C, O'Neal DN, Yeung CK, Alkatib N, Jenkins AJ. Non-invasive measures of tissue autofluorescence are increased in Type 1 diabetes complications and correlate with a non-invasive measure of vascular dysfunction. Diabet Med 2012; 29:726-33. [PMID: 22211881 DOI: 10.1111/j.1464-5491.2011.03562.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if ocular and skin autofluorescence, reflecting advanced glycation end-products, and vascular stiffness correlate in non-diabetic and Type 1 diabetic subjects and if levels differ by diabetes status. RESEARCH DESIGN AND METHODS Patients with Type 1 diabetes (n = 69, 19 with and 50 without vascular complications) and 60 subjects without diabetes (control) had ocular and skin autofluorescence and pulse-wave analysis performed in the fasted state. Correlations between measures within groups used the Pearson or Spearman correlation-coefficient and measures between groups were compared by ANOVA. RESULTS Lens and skin autofluorescence correlated in control (r = 0.58, P = 0.0001) and in Type 1 diabetes (r = 0.53, P = 0.001). Corneal autofluorescence correlated with lens (r = 0.53, r = 0.52, P = 0.0001) and skin autofluorescence (r = 0.34, P = 0.01 and r = 0.49, P = 0.00001) in control and Type 1 diabetes respectively. In Type 1 diabetes, small and large artery elasticity correlated inversely and systemic vascular resistance correlated positively with skin autofluorescence (all P = 0.001), and with lens and corneal autofluorescence (all P < 0.03). In Type 1 diabetes tissue advanced glycation end-products correlated with C-reactive protein and inversely with the estimated glucose disposal rate and with circulating advanced glycation end-product levels. Relative to non-diabetic subjects, lens, corneal and skin fluorescence were increased (all P < 0.001) and small artery elasticity was decreased in diabetes (P = 0.04). Lens, corneal and skin autofluorescence were greater (all P = 0.0001) in patients with Type 1 diabetes with complications compared to those without complications, but small artery elasticity did not differ significantly. CONCLUSIONS Ocular and skin autofluorescence and vascular stiffness correlate in non-diabetic and Type 1 diabetes subjects and are increased in Type 1 diabetes. Tissue advanced glycation end-products correlate with vascular risk factors, including circulating advanced glycation end-products.
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Affiliation(s)
- A S Januszewski
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, Australia.
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Sachithanandan N, Graham KL, Galic S, Honeyman JE, Fynch SL, Hewitt KA, Steinberg GR, Kay TW. Macrophage deletion of SOCS1 increases sensitivity to LPS and palmitic acid and results in systemic inflammation and hepatic insulin resistance. Diabetes 2011; 60:2023-31. [PMID: 21646388 PMCID: PMC3142066 DOI: 10.2337/db11-0259] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Macrophage secretion of proinflammatory cytokines contributes to the pathogenesis of obesity-related insulin resistance. An important regulator of inflammation is the suppressor of cytokine signaling-1 (SOCS1), which inhibits the JAK-STAT and toll-like receptor-4 (TLR4) pathways. Despite the reported role of SOCS1 in inhibiting insulin signaling, it is surprising that a SOCS1 polymorphism that increases SOCS1 promoter activity is associated with enhanced insulin sensitivity despite obesity. In the current study, we investigated the physiological role of myeloid and lymphoid cell SOCS1 in regulating inflammation and insulin sensitivity. RESEARCH DESIGN AND METHODS We used mice generated by crossing SOCS1 floxed mice with mice expressing Cre recombinase under the control of the LysM-Cre promoter (SOCS1 LysM-Cre). These mice have deletion of SOCS1 in macrophages and lymphocytes. We assessed macrophage inflammation using flow cytometry and serum cytokine levels using Bioplex assays. We then measured insulin sensitivity using glucose tolerance tests and the euglycemic-hyperinsulinemic clamp. Using bone marrow-derived macrophages, we tested the effects of SOCS1 deletion in regulating responses to the TLR4 ligands: lipopolysaccharide (LPS) and palmitic acid. RESULTS SOCS1 LysM-Cre mice had increased macrophage expression of CD11c, enhanced sensitivity to LPS, and palmitic acid and increased serum concentrations of tumor necrosis factor-α, interleukin-6, and monocyte chemoattractant protein. Increased inflammation was associated with impaired glucose tolerance and hyperinsulinemia as a result of reduced hepatic but not skeletal muscle insulin sensitivity. CONCLUSIONS The expression of SOCS1 in hematopoietic cells protects mice against systemic inflammation and hepatic insulin resistance potentially by inhibiting LPS and palmitate-induced TLR4 signaling in macrophages.
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Affiliation(s)
- Nirupa Sachithanandan
- St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Kate L. Graham
- St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Sandra Galic
- St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Jane E. Honeyman
- St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Stacey L. Fynch
- St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Kimberly A. Hewitt
- St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Gregory R. Steinberg
- St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
- McMaster University, Division of Endocrinology and Metabolism, Department of Medicine, Hamilton, Ontario, Canada
| | - Thomas W. Kay
- St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
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Sachithanandan N, Fam BC, Fynch S, Dzamko N, Watt MJ, Wormald S, Honeyman J, Galic S, Proietto J, Andrikopoulos S, Hevener AL, Kay TWH, Steinberg GR. Liver-specific suppressor of cytokine signaling-3 deletion in mice enhances hepatic insulin sensitivity and lipogenesis resulting in fatty liver and obesity. Hepatology 2010; 52:1632-42. [PMID: 20799351 DOI: 10.1002/hep.23861] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED Obesity is associated with chronic inflammation and contributes to the development of insulin resistance and nonalcoholic fatty liver disease. The suppressor of cytokine signaling-3 (SOCS3) protein is increased in inflammation and is thought to contribute to the pathogenesis of insulin resistance by inhibiting insulin and leptin signaling. Therefore, we studied the metabolic effects of liver-specific SOCS3 deletion in vivo. We fed wild-type (WT) and liver-specific SOCS3 knockout (SOCS3 LKO) mice either a control diet or a high-fat diet (HFD) for 6 weeks and examined their metabolic phenotype. We isolated hepatocytes from WT and SOCS3 LKO mice and examined the effects of tumor necrosis factor α and insulin on Akt phosphorylation and fatty acid metabolism and lipogenic gene expression. Hepatocytes from control-fed SOCS3 LKO mice were protected from developing tumor necrosis factor α-induced insulin resistance but also had increased lipogenesis and expression of sterol response element-binding protein-1c target genes. Lean SOCS3 LKO mice fed a control diet had enhanced hepatic insulin sensitivity; however, when fed an HFD, SOCS3 LKO mice had increased liver fat, inflammation, and whole-body insulin resistance. SOCS3 LKO mice fed an HFD also had elevated hypothalamic SOCS3 and fatty acid synthase expression and developed greater obesity due to increased food intake and reduced energy expenditure. CONCLUSION Deletion of SOCS3 in the liver increases liver insulin sensitivity in mice fed a control diet but paradoxically promotes lipogenesis, leading to the development of nonalcoholic fatty liver disease, inflammation, and obesity.
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Affiliation(s)
- Nirupa Sachithanandan
- St. Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
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Abstract
BACKGROUND Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal-dominant syndrome associated with neoplasia of pituitary, pancreas, parathyroid, and foregut lineage neuroendocrine tissue. Although enteropancreatic carcinoid has been well described in patients with MEN 1, it was believed that bronchopulmonary carcinoid was relatively uncommon, occurring in approximately 5% of patients. It is unclear whether the increased screening of asymptomatic patients with MEN 1 will facilitate early diagnosis of this tumor and improve patient prognosis. METHODS The authors reviewed the patient records and, when available, thoracic computed tomographic (CT) images of 129 MEN 1-affected adult members of a single family to determine the prevalence and prognosis of bronchopulmonary nodules and carcinoid. RESULTS Among 129 patients, a diagnosis of bronchopulmonary carcinoid was noted in the records for 6 individuals (1 male and 5 females; 5%). Thoracic CT scans also were available for review from 32 of those patients. Twelve patients (38%) had pulmonary nodules evident on CT scans. Only hypergastrinemia was significantly more common in patients with pulmonary nodules; otherwise, the spectrum of neoplasia was similar between individuals with and without pulmonary lesions. Histologic diagnoses were available in four patients (three female) with abnormal CT images, and carcinoid was confirmed in each patient. No deaths or distant metastases occurred among the patients despite long-term follow-up (mean, 127 months). CONCLUSIONS The findings suggested that bronchopulmonary carcinoid is more prevalent in patients with MEN 1 than was recognized previously. Furthermore, the diagnosis did not appear to portend a poor prognosis in the majority of affected patients.
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Affiliation(s)
- Nirupa Sachithanandan
- Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Liang YL, Teede H, Shiel LM, Thomas A, Craven R, Sachithanandan N, McNeil JJ, Cameron JD, Dart A, McGrath BP. Effects of oestrogen and progesterone on age-related changes in arteries of postmenopausal women. Clin Exp Pharmacol Physiol 1997; 24:457-9. [PMID: 9171959 DOI: 10.1111/j.1440-1681.1997.tb01225.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [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: 02/04/2023]
Abstract
1. Hormone replacement therapy (HRT) with oestrogen or oestrogen plus progestin may have different effects on arterial structure and function. To examine this question, carotid artery intima-medial thickness (IMT) and indices of systemic and carotid arterial compliance were measured in groups of older men, postmenopausal women not on HRT (non-HRT) and those women on long-term HRT with oestrogen alone (HRT-E) or oestrogen plus progestin (HRT-EP). 2. Sixty men, 90 postmenopausal women taking HRT and 91 not taking HRT participated in the study. The groups were similar for age, body mass index, numbers of smokers, physical activity, alcohol intake and blood pressure. 3. Plasma total cholesterol was reduced and high-density lipoprotein-cholesterol was increased in the HRT group compared with the non-HRT group; low-density lipoprotein-cholesterol, triglyceride and lipoprotein (a) values were similar in these two groups. Results for HRT-E and HRT-EP subgroups were similar. 4. Carotid IMT was significantly reduced in the HRT group compared with men and non-HRT groups. Results for HRT-E and HRT-EP subgroups were similar. 5. Mean systemic arterial compliance (SAC) was significantly greater in men than in women and was related to age; SAC was higher in both HRT-E and HRT-EP groups compared with the non-HRT group. Indices of carotid stiffness were similar in men and in non-HRT groups. The HRT-EP group showed increased carotid stiffness compared with the HRT-E group. 6. There is an apparent protective effect of long-term oestrogen therapy on carotid IMT and age-related changes in arterial stiffness. Progestin does not alter the IMT effects but may adversely influence arterial stiffness.
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Affiliation(s)
- Y L Liang
- Department of Medicine, Monash University, Clayton, Victoria, Australia
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