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Buijsse N, Jansen FE, Ockeloen CW, van Kempen MJA, Zeidler S, Willemsen MH, Scarano E, Monticone S, Zonneveld‐Huijssoon E, Low KJ, Bayat A, Sisodiya SM, Samanta D, Lesca G, de Jong D, Giltay JC, Verbeek NE, Kleefstra T, Brilstra EH, Vlaskamp DRM. Epilepsy is an important feature of KBG syndrome associated with poorer developmental outcome. Epilepsia Open 2023; 8:1300-1313. [PMID: 37501353 PMCID: PMC10690702 DOI: 10.1002/epi4.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe the epilepsy phenotype in a large international cohort of patients with KBG syndrome and to study a possible genotype-phenotype correlation. METHODS We collected data on patients with ANKRD11 variants by contacting University Medical Centers in the Netherlands, an international network of collaborating clinicians, and study groups who previously published about KBG syndrome. All patients with a likely pathogenic or pathogenic ANKRD11 variant were included in our patient cohort and categorized into an "epilepsy group" or "non-epilepsy group". Additionally, we included previously reported patients with (likely) pathogenic ANKRD11 variants and epilepsy from the literature. RESULTS We included 75 patients with KBG syndrome of whom 26 had epilepsy. Those with epilepsy more often had moderate to severe intellectual disability (42.3% vs 9.1%, RR 4.6 [95% CI 1.7-13.1]). Seizure onset in patients with KBG syndrome occurred at a median age of 4 years (range 12 months - 20 years), and the majority had generalized onset seizures (57.7%) with tonic-clonic seizures being most common (23.1%). The epilepsy type was mostly classified as generalized (42.9%) or combined generalized and focal (42.9%), not fulfilling the criteria of an electroclinical syndrome diagnosis. Half of the epilepsy patients (50.0%) were seizure free on anti-seizure medication (ASM) for at least 1 year at the time of last assessment, but 26.9% of patients had drug-resistant epilepsy (failure of ≥2 ASM). No genotype-phenotype correlation could be identified for the presence of epilepsy or epilepsy characteristics. SIGNIFICANCE Epilepsy in KBG syndrome most often presents as a generalized or combined focal and generalized type. No distinctive epilepsy syndrome could be identified. Patients with KBG syndrome and epilepsy had a significantly poorer neurodevelopmental outcome compared with those without epilepsy. Clinicians should consider KBG syndrome as a causal etiology of epilepsy and be aware of the poorer neurodevelopmental outcome in individuals with epilepsy.
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Affiliation(s)
- Nathan Buijsse
- Department of Medical GeneticsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Floor E. Jansen
- Department of Pediatric Neurology, Brain CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Charlotte W. Ockeloen
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Shimriet Zeidler
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | | | - Emanuela Scarano
- Department of PediatricsSt. Orsola‐Malpighi HospitalBolognaItaly
| | - Sonia Monticone
- Department of PediatricsAzienda Ospedaliero Universitaria Maggiore della CaritàNovaraItaly
| | | | - Karen J. Low
- Department of Clinical Genetics, University Hospitals Bristol and Weston NHS trustUniversity of BristolBristolUK
| | - Allan Bayat
- Department for Genetics and Personalized MedicineDanish Epilepsy CentreDianalundDenmark
- Institute for Regional Health ServicesUniversity of Southern DenmarkOdenseDenmark
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology and Chalfont Centre for EpilepsyChalfont St PeterUK
| | - Debopam Samanta
- Child Neurology Section, Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Gaetan Lesca
- Department of GeneticsUniversity Hospitals of LyonLyonFrance
| | - Danielle de Jong
- Department of NeurologyAcademic Center for Epileptology Kempenhaeghe/MUMC+HeezeThe Netherlands
| | - Jaqcues C. Giltay
- Department of Medical GeneticsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Nienke E. Verbeek
- Department of Medical GeneticsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Tjitske Kleefstra
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands
| | - Eva H. Brilstra
- Department of Medical GeneticsUniversity Medical Center UtrechtUtrechtThe Netherlands
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Raucci U, Parisi P, Ferro V, Margani E, Vanacore N, Raieli V, Bondone C, Calistri L, Suppiej A, Palmieri A, Cordelli DM, Savasta S, Papa A, Verrotti A, Orsini A, D'Alonzo R, Pavone P, Falsaperla R, Velardita M, Nacca R, Papetti L, Rossi R, Gioè D, Malaventura C, Drago F, Morreale C, Rossi L, Foiadelli T, Monticone S, Mazzocchetti C, Bonuccelli A, Greco F, Marino S, Monte G, Versace A, Masi S, Di Nardo G, Reale A, Villani A, Valeriani M. Children under 6 years with acute headache in Pediatric Emergency Departments. A 2-year retrospective exploratory multicenter Italian study. Cephalalgia 2023; 43:3331024231164361. [PMID: 37345616 DOI: 10.1177/03331024231164361] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Preschool age (i.e. children under six years of age) represents a red flag for requiring neuroimaging to exclude secondary potentially urgent intracranial conditions (PUIC) in patients with acute headache. We investigated the clinical characteristics of preschoolers with headache to identify the features associated with a greater risk of secondary "dangerous" headache. METHODS We performed a multicenter exploratory retrospective study in Italy from January 2017 to December 2018. Preschoolers with new-onset non-traumatic headache admitted to emergency department were included and were subsequently divided into two groups: hospitalized and discharged. Among hospitalized patients, we investigated the characteristics linked to potentially urgent intracranial conditions. RESULTS We included 1455 preschoolers with acute headache. Vomiting, ocular motility disorders, ataxia, presence of neurological symptoms and signs, torticollis and nocturnal awakening were significantly associated to hospitalization. Among the 95 hospitalized patients, 34 (2.3%) had potentially urgent intracranial conditions and more frequently they had neurological symptoms and signs, papilledema, ataxia, cranial nerves paralysis, nocturnal awakening and vomiting. Nevertheless, on multivariable logistic regression analysis, we found that only ataxia and vomiting were associated with potentially urgent intracranial conditions. CONCLUSION Our study identified clinical features that should be carefully evaluated in the emergency department in order to obtain a prompt diagnosis and treatment of potentially urgent intracranial conditions. The prevalence of potentially urgent intracranial conditions was low in the emergency department, which may suggest that age under six should not be considered an important risk factor for malignant causes as previously thought.
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Affiliation(s)
- Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Pediatrics, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Valentina Ferro
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Erika Margani
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Pediatrics, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Rome, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Unit, ISMEP- ARNAS CIVICO, Palermo, Italy
| | - Claudia Bondone
- AOU Città della Salute e della Scienza, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Italy
| | - Antonella Palmieri
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, IRCCS, Genova, Italy
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età Pediatrica, Bologna, Italy
| | - Salvatore Savasta
- Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amanda Papa
- S.C.D.O. Neuropsichiatria Infantile AOU Maggiore della Carità, Novara, Italy
| | | | - Alessandro Orsini
- Paediatric Neurology, Paediatric Department, Pisa University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Renato D'Alonzo
- Pediatric and Neonatological Unit, Maternal and Child Department, Nuovo Ospedale San Giovanni Battista, Foligno, Perugia, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, AOU Policlinico, PO San Marco, University of Catania, Italy
| | - Mario Velardita
- Department of Pediatrics, Gravina Hospital, Caltagirone, Catania, Italy
| | - Raffaella Nacca
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Papetti
- Pediatric Headache Center, Neuroscience Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Roberta Rossi
- AOU Città della Salute e della Scienza, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Daniela Gioè
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | | | - Flavia Drago
- Child Neuropsychiatry Unit, Department Pro.Mi.Se, G. D'Alessandro University of Palermo, Italy
| | - Cristina Morreale
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, IRCCS, Genova, Italy
| | - Lucia Rossi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età Pediatrica, Bologna, Italy
| | - Thomas Foiadelli
- Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Italy
| | - Sonia Monticone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Alice Bonuccelli
- Paediatric Neurology, Paediatric Department, Pisa University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Filippo Greco
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, AOU Policlinico, PO San Marco, University of Catania, Italy
| | - Gabriele Monte
- Pediatric Headache Center, Neuroscience Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonella Versace
- AOU Città della Salute e della Scienza, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Pediatrics, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Valeriani
- Pediatric Headache Center, Neuroscience Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Gallone G, Burrello J, Burrello A, Iannaccone M, De Luca L, Patti G, Cerrato E, Venuti G, De Filippo O, Mattesini A, Muscoli S, Trabattoni D, Giammaria M, Truffa A, Cortese B, Conrotto F, Mulatero P, Monticone S, Escaned J, Usmiani T, D‘ascenzo F, De Ferrari G, Breviario S. C25 PREDICTION OF ALL–CAUSE MORTALITY FOLLOWING PERCUTANEOUS CORONARY INTERVENTION IN BIFURCATION LESIONS USING MACHINE LEARNING ALGORITHMS – THE RAIN–ML PREDICTION MODEL. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Stratifying prognosis following coronary bifurcation percutaneous coronary intervention (PCI) is an unmet need. Machine learning (ML) may identify patterns from multidimensional, non–linear relationships to make outcome predictions. We sought to develop a ML–based risk stratification model built on clinical, anatomical and procedural features to predict all–cause mortality following contemporary bifurcation PCI.
Methods and Results
Multiple ML models to predict all–cause mortality were tested on a cohort of 2,393 patients (training, n = 1,795; internal validation, n = 598) undergoing bifurcation PCI with contemporary stents from the real–world RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry. Among 38 commonly available features, 25 (13 patient–related, 12 lesion–related) were selected to train ML models. The best performing model (the RAIN–ML prediction model) was validated in an external validation cohort of 1,701 patients undergoing bifurcation PCI from the DUTCH PEERS (DUrable polymer–based sTent CHallenge of Promus ElemEnt versus ReSolute integrity: TWENTE II) trial and the BIO–RESORT trial cohorts. The area under the receiver operating characteristic curves for the prediction of 2–year mortality was 0.786 (0.74–0.83) in the overall population, 0.736 (0.72–0.847) at internal validation and 0.706 (0.6919–0.794) at external validation. Performance at risk ranking analysis, k–center cross validation, and with continual learning confirmed the generalizability of the models, available also as an online interface.
Conclusions
The RAIN–ML prediction model represents the first tool combining clinical, anatomical and procedural features to predict all–cause mortality among patients undergoing contemporary bifurcation PCI with a good discriminative performance.
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Affiliation(s)
- G Gallone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - J Burrello
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Burrello
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - M Iannaccone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - L De Luca
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G Patti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - E Cerrato
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G Venuti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - O De Filippo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Mattesini
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Muscoli
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - D Trabattoni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - M Giammaria
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Truffa
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - B Cortese
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - F Conrotto
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - P Mulatero
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Monticone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - J Escaned
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - T Usmiani
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - F D‘ascenzo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G De Ferrari
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Breviario
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
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4
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Burrello J, Monticone S, Tetti M, Rossato D, Versace K, Castellano I, Williams TA, Veglio F, Mulatero P. Subtype Diagnosis of Primary Aldosteronism: Approach to Different Clinical Scenarios. Horm Metab Res 2015; 47:959-66. [PMID: 26575304 DOI: 10.1055/s-0035-1565089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/22/2022]
Abstract
Identification and management of patients with primary aldosteronism are of utmost importance because it is a frequent cause of endocrine hypertension, and affected patients display an increase of cardio- and cerebro-vascular events, compared to essential hypertensives. Distinction of primary aldosteronism subtypes is of particular relevance to allocate the patients to the appropriate treatment, represented by mineralocorticoid receptor antagonists for bilateral forms and unilateral adrenalectomy for patients with unilateral aldosterone secretion. Subtype differentiation of confirmed hyperaldosteronism comprises adrenal CT scanning and adrenal venous sampling. In this review, we will discuss different clinical scenarios where execution, interpretation of adrenal vein sampling and subsequent patient management might be challenging, providing the clinician with useful information to help the interpretation of controversial procedures.
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Affiliation(s)
- J Burrello
- Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
| | - S Monticone
- Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
| | - M Tetti
- Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
| | - D Rossato
- Division of Radiology, University of Torino, Torino, Italy
| | - K Versace
- Division of Radiology, University of Torino, Torino, Italy
| | - I Castellano
- Division of Pathology, Department of Medical Sciences, University of Torino, Torino, Italy
| | - T A Williams
- Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
| | - F Veglio
- Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
| | - P Mulatero
- Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
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5
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Mulatero P, Schiavi F, Williams TA, Monticone S, Barbon G, Opocher G, Fallo F. ARMC5 mutation analysis in patients with primary aldosteronism and bilateral adrenal lesions. J Hum Hypertens 2015; 30:374-8. [PMID: 26446392 DOI: 10.1038/jhh.2015.98] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/11/2015] [Accepted: 08/17/2015] [Indexed: 11/09/2022]
Abstract
Idiopathic hyperaldosteronism (IHA) due to bilateral adrenal hyperplasia is the most common subtype of primary aldosteronism (PA). The pathogenesis of IHA is still unknown, but the bilateral disease suggests a potential predisposing genetic alteration. Heterozygous germline mutations of armadillo repeat containing 5 (ARMC5) have been shown to be associated with hypercortisolism due to sporadic primary bilateral macronodular adrenal hyperplasia and are also observed in African-American PA patients. We investigated the presence of germline ARMC5 mutations in a group of PA patients who had bilateral computed tomography-detectable adrenal alterations. We sequenced the entire coding region of ARMC5 and all intron/exon boundaries in 39 patients (37 Caucasians and 2 black Africans) with confirmed PA (8 unilateral, 27 bilateral and 4 undetermined subtype) and bilateral adrenal lesions. We identified 11 common variants, 5 rare variants with a minor allele frequency <1% and 2 new variants not previously reported in public databases. We did not detect by in silico analysis any ARMC5 sequence variations that were predicted to alter protein function. In conclusion, ARMC5 mutations are not present in a fairly large series of Caucasian patients with PA associated to bilateral adrenal disease. Further studies are required to definitively clarify the role of ARMC5 in the pathogenesis of adrenal nodules and aldosterone excess in patients with PA.
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Affiliation(s)
- P Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences-DSM, University of Torino, Torino Italy
| | - F Schiavi
- Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IRCCS, University of Padova, Padova, Italy
| | - T A Williams
- Division of Internal Medicine and Hypertension, Department of Medical Sciences-DSM, University of Torino, Torino Italy
| | - S Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences-DSM, University of Torino, Torino Italy
| | - G Barbon
- Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IRCCS, University of Padova, Padova, Italy
| | - G Opocher
- Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IRCCS, University of Padova, Padova, Italy
| | - F Fallo
- Department of Medicine-DIMED, Clinica Medica 3, University of Padova, Padova, Italy
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6
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Viola A, Monticone S, Burrello J, Buffolo F, Lucchiari M, Rabbia F, Williams TA, Veglio F, Mengozzi G, Mulatero P. Renin and aldosterone measurements in the management of arterial hypertension. Horm Metab Res 2015; 47:418-26. [PMID: 25993253 DOI: 10.1055/s-0035-1548868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Indexed: 10/23/2022]
Abstract
Renin-angiotensin-aldosterone system (RAAS) is recognized as the main regulatory system of hemodynamics in man, and its derangements have a key role in the development and maintenance of arterial hypertension. Classification of the hypertensive states according to different patterns of renin and aldosterone levels ("RAAS profiling") allows the diagnosis of specific forms of secondary hypertension and may identify distinct hemodynamic subsets in essential hypertension. In this review, we summarize the application of RAAS profiling for the diagnostic assessment of hypertensive patients and discuss how the pathophysiological framework provided by RAAS profiling may guide therapeutic decision-making, especially in the context of uncontrolled hypertension not responding to multi-therapy.
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Affiliation(s)
- A Viola
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - S Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - J Burrello
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - F Buffolo
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - M Lucchiari
- Clinical Chemistry Laboratory, University of Torino, Torino, Italy
| | - F Rabbia
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - T A Williams
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - F Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - G Mengozzi
- Clinical Chemistry Laboratory, University of Torino, Torino, Italy
| | - P Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
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Abstract
Primary aldosteronism (PA) has a prevalence in the general hypertensive population from 5 to 10%, and is widely recognized as the most frequent form of secondary hypertension. The 2 main PA subtypes are aldosterone producing adenoma (APA) and bilateral adrenal hyperplasia (BAH) that account for 95% of all PA cases. The diagnosis of PA is a 3-step process that comprises screening, confirmatory testing, and subtype differentiation. The different categories of patients at an increased risk of PA who should thus undergo a screening test were described in the first Endocrine Society (ES) Practice Guidelines for diagnosis and treatment of PA published in 2008. These categories include patients with Joint National Committee Stage 2, Stage 3, or drug-resistant hypertension; hypertension, and spontaneous or diuretic-induced hypokalemia; hypertension with adrenal incidentaloma; hypertension and a family history of early-onset hypertension or cerebrovascular accident at a young age and all hypertensive first degree relatives of patients with PA. Recently, a growing number of studies have linked PA with the metabolic syndrome, diabetes, and obstructive sleep apnea that may be partly responsible for the higher rate of cardio and cerobrovascular accidents in PA patients. The aim of this review is to discuss, which patients should be screened for PA, focusing not only on the well-established categories of the ES Guidelines, but also on additional other group of patients with a potentially high prevalence of PA that has emerged from recent research.
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Affiliation(s)
- S Monticone
- Department of Medicine and Experimental Oncology, D ivision of Internal Medicine and Hypertension, University of Torino, Torino, Italy
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8
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Verhovez A, Williams TA, Morello F, Monticone S, Brizzi MF, Dentelli P, Fallo F, Fabris B, Amenta F, Gomez-Sanchez C, Veglio F, Mulatero P. Aldosterone does not modify gene expression in human endothelial cells. Horm Metab Res 2012; 44:234-8. [PMID: 22068811 DOI: 10.1055/s-0031-1291272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 10/15/2022]
Abstract
The toxic effects of aldosterone on the vasculature, and in particular on the endothelial layer, have been proposed as having an important role in the cardiovascular pathology observed in mineralocorticoid-excess states. In order to characterize the genomic molecular mechanisms driving the aldosterone-induced endothelial dysfunction, we performed an expression microarray on transcripts obtained from both human umbilical vein endothelial cells and human coronary artery endothelial cells stimulated with 10 - 7 M aldosterone for 18 h. The results were then subjected to qRT-PCR confirmation, also including a group of genes known to be involved in the control of the endothelial function or previously described as regulated by aldosterone. The state of activation of the mineralocorticoid receptor was investigated by means of a luciferase-reporter assay using a plasmid encoding a mineralocorticoid and glucocorticoid-sensitive promoter. Aldosterone did not determine any significant change in gene expression in either cell type both in the microarray and in the qRT-PCR analysis. The luciferase-reporter assay showed no activation of the mineralocorticoid receptor following aldosterone stimulation. The status of nonfunctionality of the mineralocorticoid receptor expressed in cultured human umbilical and coronary artery endothelial cells does not allow aldosterone to modify gene expression and provides evidence against either a beneficial or harmful genomic effect of aldosterone on healthy endothelial cells.
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Affiliation(s)
- A Verhovez
- Department of Internal Medicine, University of Torino, Torino, Italy.
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10
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Abstract
Primary aldosteronism is the most common form of secondary hypertension and patients with hyperaldosteronism are more prone to premature cardiovascular complications compared to essential hypertensives. The diagnostic flow-chart for the diagnosis of PA is performed in three steps: a) screening; b) confirmation; and c) subtype differentiation. Instead of proceeding directly to subtype classification, the recently published Endocrine Society Guidelines recommend that patients with a positive ARR should undergo a confirmatory test, in order to definitively confirm or exclude the diagnosis of PA. The Guidelines recognize four testing procedures: oral sodium loading, saline infusion, fludrocortisone suppression, and captopril challenge. Herein we discuss the diagnostic protocols for these confirmatory tests and highlight both the advantages and contraindications and we discuss studies in which these confirmatory tests have been compared.
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Affiliation(s)
- P Mulatero
- Division of Internal Medicine, Department of Medicine and Experimental Oncology, University of Torino, Torino, Italy.
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Mulatero P, Leotta G, Terzolo M, Maffei P, Monticone S, Saglio E, Viola A, Tosello F, Degli Uberti EC, Angeli A, Veglio F. Relationship Between CYP11B2 -344T/C Gene Polymorphism and Blood Pressure Values in Acromegalic Patients. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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12
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Milan A, Movio L, Tosello F, De Andres MI, Monticone S, Saglio E, Viola A, Rabbia F, Papotti G, Mulatero P, Veglio F. ‘Framingham Score’ and ‘Progetto Cuore’: Comparison Between Cardiovascular Risk Score. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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13
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Leotta G, Rabbia F, Modica C, Testa E, Monticone S, Saglio E, Magnino C, Viola A, Tosello F, Papotti G, Paglieri C, Veglio F. Role of Trained Nurses in the Blood Pressure Control of Treated Essential Hypertensive Patients. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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14
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Morella F, Saglio E, Schiavone D, Williams TA, Verhovez A, Monticone S, Veglio F, Mulatero P. Liver X Receptor Agonists Induce Endothelial Dysfunction. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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15
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Maule S, Mulatero P, Monticone S, Saglio E, Testa E, Puglisi E, Magnino C, Veglio F. QT Interval in Patients with Primary Aldosteronism and Low-Renin Essential Hypertension. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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16
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Caserta MA, Milan A, Del Colle S, Dematteis A, Naso D, Magnino C, Puglisi E, Pertusio A, Tosello F, Saglio E, Monticone S, De Andres MI, Veglio F. Baroreflex Sensitivity Correlates with Left Ventricular Systolic Function in Hypertensive Patients. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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17
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Paglieri C, Bisbocci D, Cerrato P, Rabbia F, Perozzo P, Genesia M, Viola A, Tosello F, Monticone S, Magnino C, Saglio E, Veglio F. 24 Hours Blood Pressure Pattern and Cerebrovascular Damage in Essential Hypertension. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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18
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Milan A, Caserta MA, Del Colle S, Dematteis A, Naso D, Magnino C, Puglisi E, Tosello F, Monticone S, Saglio E, De Andres MI, Mulatero P, Pandian NG, Veglio F. Diastolic Dysfunction is Associated with a Reduced Baroreflex Sensitivity. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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19
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Del Colle S, Milan A, Caserta C, Naso D, Magnino C, Puglisi E, Tosello F, Monticone S, Veglio F, De Castro S. Left Ventricular Remodelling Conditions Left Atrial Volume and Function In Hypertensive Patients? Evaluation in RT3D Echocardiography. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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20
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Mulatero P, Bertello C, Verhovez A, Testa E, Puglisi E, Morello F, Monticone S, Fallo F, Veglio F. [Role of aldosterone in the metabolic syndrome]. G Ital Nefrol 2006; 23:406-14. [PMID: 17063441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The purpose of this review is to summarize the current knowledge regarding metabolic syndrome prevalence and features in primary aldosteronism. We will also discuss the link between aldosterone and the different metabolic changes typical of the metabolic syndrome. Hypertensive patients have a high prevalence of obesity, dyslipidemia and hyperglycaemia. These are risk factors for the metabolic syndrome, and are associated with an increased cardiovascular risk profile. In particular, insulin resistance seems to be the major alteration in patients affected by primary aldosteronism. We will then describe the experimental and clinical evidences of the role of aldosterone in the pathogenesis of insulin resistance. Higher rates of cardiovascular events have been recently reported in primary aldosteronism: they could be partly due to the increased prevalence of the metabolic syndrome in this disorder.
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Affiliation(s)
- P Mulatero
- Divisione di Medicina Interna e Ipertensione, Università di Torino, Torino.
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Kanaev AV, Museur L, Laarmann T, Monticone S, Castex MC, von Haeften K, Möller T. Dissociation and suppressed ionization of H[sub 2]O molecules embedded in He clusters: The role of the cluster as a cage. J Chem Phys 2001. [DOI: 10.1063/1.1415434] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Monticone S, Tufeu R, Kanaev AV. Complex Nature of the UV and Visible Fluorescence of Colloidal ZnO Nanoparticles. J Phys Chem B 1998; 102:2854-2862. [DOI: 10.1021/jp973425p] [Citation(s) in RCA: 477] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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