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Ruggeri RM, Altieri B, Razzore P, Retta F, Sperti E, Scotto G, Brizzi MP, Zumstein L, Pia A, Lania A, Lavezzi E, Nappo G, Laffi A, Albertelli M, Boschetti M, Hasballa I, Veresani A, Prinzi N, Pusceddu S, Oldani S, Nichetti F, Modica R, Minotta R, Liccardi A, Cannavale G, Grossrubatscher EM, Tarsitano MG, Zamponi V, Zatelli MC, Zanata I, Mazzilli R, Appetecchia M, Davì MV, Guarnotta V, Giannetta E, La Salvia A, Fanciulli G, Malandrino P, Isidori AM, Colao A, Faggiano A. Gender-related differences in patients with carcinoid syndrome: new insights from an Italian multicenter cohort study. J Endocrinol Invest 2024; 47:959-971. [PMID: 37837555 DOI: 10.1007/s40618-023-02213-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The incidence of neuroendocrine neoplasm (NEN) and related carcinoid syndrome (CaS) has increased markedly in recent decades, and women appear to be more at risk than men. As per other tumors, gender may be relevant in influencing the clinical and prognostic characteristics of NEN-associated CS. However, specific data on carcinoid syndrome (CaS) are still lacking. PURPOSE To evaluate gender differences in clinical presentation and outcome of CaS. METHODS Retrospective analysis of 144 CaS patients from 20 Italian high-volume centers was conducted. Clinical presentation, tumor characteristics, therapies, and outcomes (progression-free survival, PFS, overall survival, OS) were correlated to gender. RESULTS Ninety (62.5%) CaS patients were male. There was no gender difference in the site of primary tumor, tumor grade and clinical stage, as well as in treatments. Men were more frequently smokers (37.2%) and alcohol drinkers (17.8%) than women (9.5%, p = 0.002, and 3.7%, p = 0.004, respectively). Concerning clinical presentation, women showed higher median number of symptoms (p = 0.0007), more frequent abdominal pain, tachycardia, and psychiatric disorders than men (53.3% vs 70.4%, p = 0.044; 6.7% vs 31.5%, p = 0.001; 50.9% vs. 26.7%, p = 0.003, respectively). Lymph node metastases at diagnosis were more frequent in men than in women (80% vs 64.8%; p = 0.04), but no differences in terms of PFS (p = 0.51) and OS (p = 0.64) were found between gender. CONCLUSIONS In this Italian cohort, CaS was slightly more frequent in males than females. Gender-related differences emerged in the clinical presentation of CaS, as well as gender-specific risk factors for CaS development. A gender-driven clinical management of these patients should be advisable.
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Affiliation(s)
- R M Ruggeri
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV, University of Messina, 98125, Messina, Italy
| | - B Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University of Würzburg, Würzburg, Germany
| | - P Razzore
- SC Endocrinologia, Diabetologia e Malattie del Metabolismo, AO Ordine Mauriziano di Torino, Largo Turati, 62 10128, Turin, Italy
| | - F Retta
- SC Endocrinologia, Diabetologia e Malattie del Metabolismo, AO Ordine Mauriziano di Torino, Largo Turati, 62 10128, Turin, Italy
| | - E Sperti
- SCDU Oncologia, AO Ordine Mauriziano di Torino, Largo Turati, 62 10128, Turin, Italy
| | - G Scotto
- Department of Oncology, University Hospital San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy
| | - M P Brizzi
- Department of Oncology, University Hospital San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy
| | - L Zumstein
- Department of Oncology, University Hospital San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy
| | - A Pia
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, Turin, Italy
| | - A Lania
- Department of Biomedical Sciences, Humanitas University, 20089, Pieve Emanuele, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - E Lavezzi
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - G Nappo
- Department of Biomedical Sciences, Humanitas University, 20089, Pieve Emanuele, Italy
- Pancreas Surgery Unit, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - A Laffi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M Albertelli
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, 16132, Genoa, Italy
- Endocrinology Unit, IRCCC Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - M Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, 16132, Genoa, Italy
- Endocrinology Unit, IRCCC Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - I Hasballa
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, 16132, Genoa, Italy
| | - A Veresani
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, 16132, Genoa, Italy
| | - N Prinzi
- Medical Oncology, Foundation IRCCS National Cancer Institute, Milan, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Padua, Italy
| | - S Pusceddu
- Medical Oncology, Foundation IRCCS National Cancer Institute, Milan, Italy
| | - S Oldani
- Medical Oncology, Foundation IRCCS National Cancer Institute, Milan, Italy
| | - F Nichetti
- Medical Oncology, Foundation IRCCS National Cancer Institute, Milan, Italy
| | - R Modica
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - R Minotta
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - A Liccardi
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - G Cannavale
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | | | - M G Tarsitano
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - V Zamponi
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy.
| | - M C Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - I Zanata
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - R Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy
| | - M Appetecchia
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M V Davì
- Department of Medicine, Section of Endocrinology, University and Hospital Trust of Verona, Verona, Italy
| | - V Guarnotta
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, 90127, Palermo, Italy
| | - E Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A La Salvia
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - G Fanciulli
- Neuroendocrine Tumour Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari-Endocrine Unit, AOU Sassari, Sassari, Italy
| | - P Malandrino
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania and Garibaldi, Nesima Medical Center, Catania, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Colao
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Federico II University, 80138, Naples, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy
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Croce L, Ruggeri RM, Cappelli C, Virili C, Coperchini F, Laganà M, Costa P, Dal Molin M, Chytiris S, Magri F, Chiovato L, Centanni M, Cannavò S, Rotondi M. Cardiovascular and metabolic comorbidities in patients with thyroid nodules: the impact of incidental diagnosis. J Endocrinol Invest 2024; 47:827-832. [PMID: 37702926 DOI: 10.1007/s40618-023-02191-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The prevalence of thyroid nodules (TN) in the general population has increased as screening procedures are implemented and an association with metabolic and cardiovascular disorders has been reported. The aim of this study was to investigate the reason leading to the diagnosis of TN and to compare the clinical characteristics of patients diagnosed incidentally with those of patients diagnosed for thyroid-related reasons. METHODS We designed a retrospective cross-sectional study including consecutive patients with TN from two high-volume hospital-based centers for thyroid diseases (Pavia and Messina) in Italy. Data regarding reason leading to TN diagnosis, age, sex, BMI, presence of cardio-metabolic comorbidities were collected. RESULTS Among the 623 enrolled subjects, the US diagnosis of TN was prompted by thyroid-related reasons in 421 (67.6%, TD group) and incidental in 202 (32.4%, ID group) with a similar distribution in the two centers (p = 0.960). The ID group patients were more frequently males (38.6% vs 22.1%, p < 0.001) and significantly older (58.9 ± 13.7 vs 50.6 ± 15.5 years, p < 0.001) than the TD group ones, and had a higher rate of cardiovascular comorbidities (73.8% vs 47.5%, p < 0.001), despite having a similar BMI (27.9 ± 5.2 vs 27.8 ± 13.5, p = 0.893). CONCLUSIONS Stratification of patients with TN according to the diagnostic procedure leading to diagnosis allows a better epidemiological characterization of this inhomogeneous and large population.
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Affiliation(s)
- L Croce
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia (PV), Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia (PV), Italy
| | - R M Ruggeri
- Department of Human Pathology and Childhood "G. Barresi" (DETEV), University of Messina, 98125, Messina (ME), Italy
| | - C Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia (BS), Italy
| | - C Virili
- Endocrinology Section, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, 04100, Latina (LT), Italy
| | - F Coperchini
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia (PV), Italy
| | - M Laganà
- Department of Human Pathology and Childhood "G. Barresi" (DETEV), University of Messina, 98125, Messina (ME), Italy
| | - P Costa
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia (PV), Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia (PV), Italy
| | - M Dal Molin
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia (PV), Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia (PV), Italy
| | - S Chytiris
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia (PV), Italy
| | - F Magri
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia (PV), Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia (PV), Italy
| | - L Chiovato
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia (PV), Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia (PV), Italy
| | - M Centanni
- Endocrinology Section, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, 04100, Latina (LT), Italy
| | - S Cannavò
- Department of Human Pathology and Childhood "G. Barresi" (DETEV), University of Messina, 98125, Messina (ME), Italy
| | - M Rotondi
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia (PV), Italy.
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia (PV), Italy.
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Spagnolo CC, Campo I, Campennì A, Cardile D, Cannavò S, Silvestris N, Santarpia M, Ruggeri RM. Challenges and pitfalls in the management of endocrine toxicities from immune checkpoint inhibitors: a case presentation of synchronous thyrotoxicosis and primary adrenal insufficiency in a melanoma patient. Hormones (Athens) 2024:10.1007/s42000-024-00535-0. [PMID: 38421588 DOI: 10.1007/s42000-024-00535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Immune checkpoint inhibitors have revolutionized the therapeutic approach to several solid tumors, becoming the standard of care for cancer treatment in different disease settings. Despite the fact that these agents are better tolerated than conventional chemotherapy, their use is associated with a specific toxicity profile, so-called immune-related adverse events (irAEs), that can involve several organs. Endocrine irAEs are among the most frequent toxicities (around 10 to 16%) and include hypophysitis, thyroid disorders, adrenalitis, and diabetes mellitus. Some of them may be life-threatening if not promptly recognized (such as diabetic ketoacidosis and acute adrenal crisis). CASE PRESENTATION A 55-year-old woman with a personal history of euthyroid Hashimoto's thyroiditis was diagnosed with a metastatic melanoma, BRAF wild type. Under treatment with anti-PD-1 pembrolizumab, she developed thyrotoxicosis followed by hypothyroidism due to destructive thyroiditis and concurrent primary adrenal insufficiency due to adrenalitis. CONCLUSIONS The simultaneous occurrence of adrenal and thyroid autoimmune diseases, resembling autoimmune polyendocrine syndrome type 2, may occur as a rare but serious side effect of ICI treatment. It often presents with abrupt onset and rapid evolution towards polyglandular insufficiency. Physicians should be aware of the potential association of two or more endocrine disorders and careful monitoring of endocrine function is needed during ICI therapy.
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Affiliation(s)
- Calogera Claudia Spagnolo
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, AOU G. Martino, V. Consolare Valeria 1, 98125, Messina, Italy
| | - Irene Campo
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, AOU G. Martino, V. Consolare Valeria 1, 98125, Messina, Italy
| | - Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125, Messina, Italy
| | - Davide Cardile
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125, Messina, Italy
| | - Salvatore Cannavò
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV, University of Messina, 98125, Messina, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, AOU G. Martino, V. Consolare Valeria 1, 98125, Messina, Italy
| | - Mariacarmela Santarpia
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, AOU G. Martino, V. Consolare Valeria 1, 98125, Messina, Italy.
| | - Rosaria Maddalena Ruggeri
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV, University of Messina, 98125, Messina, Italy
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Campennì A, Torregrossa L, Ruggeri RM, Ovčariček PP, Siracusa M, Giovanella L. Nodal metastasis in noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Endocrine 2024:10.1007/s12020-024-03719-1. [PMID: 38340243 DOI: 10.1007/s12020-024-03719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
The term noninvasive tumor with a follicular growth pattern and nuclear features of papillary thyroid cancer (NIFTP) is used to describe a tumor currently considered as a pre-malignant lesion for which a conservative therapeutic approach (i.e., lobectomy without radioiodine therapy) is strongly suggested. However, some patients with NIFTP and loco-regional or distant metastases have been already reported. We present an adult male patient with a final histological diagnosis of NIFTP and lymph node metastasis noted at post-therapy whole-body scintigraphy performed some days after radioiodine therapy.
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Affiliation(s)
- Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Clinical Area, University of Pisa, Pisa, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", Endocrinology Unit, University of Messina, 98125, Messina, Italy
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Massimiliano Siracusa
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Ruggeri RM, Spagnolo CC, Alibrandi A, Silvestris N, Cannavò S, Santarpia M. Predictors of thyroid adverse events during cancer immunotherapy: a real-life experience at a single center. J Endocrinol Invest 2023; 46:2399-2409. [PMID: 37076759 DOI: 10.1007/s40618-023-02096-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/07/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Thyroid dysfunction is among the most common immune-related adverse events (irAEs) of immune checkpoint inhibitors (ICIs) therapy. Data regarding potential predictors of the development of thyroid irAEs are still limited and sometimes conflicting. PATIENTS AND METHODS We assessed potential risk factors and clinical outcomes associated with the onset of thyroid irAEs in a cohort of patients with different types of cancer treated with ICIs at a single center. Clinical and biochemical data, including thyroid function tests and autoantibodies at baseline and during treatment, were collected, and the onset of thyroid irAEs was recorded. Patients with thyroid dysfunction and/or under levothyroxine therapy before starting ICI were excluded. RESULTS 110 patients (80 M, 30 F, aged 32-85 years; 56.4% non-small-cell lung cancer, 87% treated with anti-PD-1) with complete information were included in the study. Among them, 32 (29%) developed thyroid irAEs during ICIs therapy. Primary hypothyroidism was the most common irAEs, occurring in 31 patients (28.18% of the whole cohort), including 14 patients who experienced a transient thyrotoxicosis. About 60% of irAEs occurred within the first 8 weeks of therapy. At multivariate analysis, anti-thyroid autoantibodies positivity at baseline (OR 18.471, p = 0.022), a pre-existing (autoimmune and non-autoimmune) thyroid disorder (OR 16.307, p < 0.001), and a family history of thyroid diseases (OR = 9.287, p = 0.002) were independent predictors of the development of thyroid irAEs. CONCLUSION Our data confirm the high frequency of thyroid dysfunctions (mostly hypothyroidism) during ICIs, and provide data on valuable predictors of thyroid toxicities that may help clinicians in identifying patients at risk for developing irAEs.
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Affiliation(s)
- R M Ruggeri
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy.
- Medical Oncology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy.
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy.
- Endocrine Unit, Department of Clinical and Experimental Medicine, "Gaetano Martino" University Hospital, 98125, Messina, Italy.
| | - C C Spagnolo
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Medical Oncology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | - A Alibrandi
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Medical Oncology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | - N Silvestris
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Medical Oncology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | - S Cannavò
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Medical Oncology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | - M Santarpia
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Medical Oncology Unit, Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", University of Messina, Messina, Italy
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
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Ruggeri RM, Barbalace MC, Croce L, Malaguti M, Campennì A, Rotondi M, Cannavò S, Hrelia S. Autoimmune Thyroid Disorders: The Mediterranean Diet as a Protective Choice. Nutrients 2023; 15:3953. [PMID: 37764737 PMCID: PMC10535745 DOI: 10.3390/nu15183953] [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: 08/14/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Autoimmune thyroid diseases are on the rise worldwide, and such a rapid increase is mainly driven by environmental factors related to changed lifestyles in "modern" societies. In this context, diet seems to play a crucial role. An unhealthy high-energy diet, rich in animal fat and proteins, salt and refined sugars (the so-called "Western diet") negatively influences the risk of autoimmunity by altering the immune balance and the gut microbiota composition, enhancing oxidative stress and promoting inflammation. In contrast, the Mediterranean diet represents a unique model of healthy eating, characterized by a high intake of food from vegetable sources, a low consumption of saturated fats in favor of unsaturated fats (mainly, olive oil), a moderate consumption of fish (typically, the small oily fishes) and dairy products, as well as a moderate consumption of wine at meals, and a low intake of meat. Thanks to its nutritional components, the Mediterranean Diet positively influences immune system function, gut microbiota composition, and redox homeostasis, exerting anti-oxidants, anti-inflammatory, and immunomodulatory effects. The present review was aimed at exploring the existing knowledge on the correlations between dietary habits and thyroid autoimmunity, to evaluate the role of the Mediterranean diet as a protective model.
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Affiliation(s)
- Rosaria Maddalena Ruggeri
- Department of Human Pathology of Adulthood and Childhood DETEV “G. Barresi”, Endocrinology Unit, University of Messina, 98125 Messina, Italy;
| | - Maria Cristina Barbalace
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (M.C.B.); (S.H.)
| | - Laura Croce
- Department of Internal Medicine and Therapeutics, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University of Pavia, 27100 Pavia, Italy; (L.C.); (M.R.)
| | - Marco Malaguti
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (M.C.B.); (S.H.)
| | - Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy;
| | - Mario Rotondi
- Department of Internal Medicine and Therapeutics, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University of Pavia, 27100 Pavia, Italy; (L.C.); (M.R.)
| | - Salvatore Cannavò
- Department of Human Pathology of Adulthood and Childhood DETEV “G. Barresi”, Endocrinology Unit, University of Messina, 98125 Messina, Italy;
| | - Silvana Hrelia
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (M.C.B.); (S.H.)
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Zirilli A, Ruggeri RM, Barbalace MC, Hrelia S, Giovanella L, Campennì A, Cannavò S, Alibrandi A. The Influence of Food Regimes on Oxidative Stress: A Permutation-Based Approach Using the NPC Test. Healthcare (Basel) 2023; 11:2263. [PMID: 37628461 PMCID: PMC10454221 DOI: 10.3390/healthcare11162263] [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: 06/28/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: This paper aims to assess the existence of significant differences between two dietary regimes (omnivorous vs. semi-vegetarian) with reference to some oxidative stress markers (SOD, GPx, TRxR, GR, AGEs, and AOPPs) using non-parametric combination methodology based on a permutation test. (2) Methods: At the endocrinology unit of Messina University Hospital, two hundred subjects were asked to fill out a questionnaire about their dietary habits. None were under any pharmacological treatment. Using the NPC test, all comparisons were performed stratifying patients according to gender, age (≤40 or >40 years), BMI (normal weight vs. overweight), physical activity (sedentary vs. active lifestyle), TSH, FT4 levels in quartiles, and diagnosis of Hashimoto's thyroiditis. We evaluated differences in oxidative stress parameters in relation to two examined dietary regimes (omnivorous vs. semi-vegetarian). (3) Results: The antioxidant parameters GPx and TRxR were significantly lower in subjects with an omnivorous diet than in semi-vegetarians, particularly in females, both age groups, subjects with normal weight, those not affected by Hashimoto's thyroiditis, and both the sedentary and active lifestyle groups. Finally, the AGE and AOPP markers were significantly lower in semi-vegetarians. (4) Conclusion: Thanks to the NPC methodology, we can state that dietary patterns exert a significant influence on some oxidative stress parameters.
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Affiliation(s)
- Agata Zirilli
- Department of Economics, University of Messina, 98122 Messina, Italy;
| | - Rosaria Maddalena Ruggeri
- Department of Human Pathology of Adults and Developmental Age “G. Barresi”, University of Messina, 98125 Messina, Italy; (R.M.R.); (S.C.)
| | - Maria Cristina Barbalace
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (M.C.B.); (S.H.)
| | - Silvana Hrelia
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (M.C.B.); (S.H.)
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Clinic for Nuclear Medicine, University Hospital of Zürich, 8091 Zürich, Switzerland
| | - Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy;
| | - Salvatore Cannavò
- Department of Human Pathology of Adults and Developmental Age “G. Barresi”, University of Messina, 98125 Messina, Italy; (R.M.R.); (S.C.)
| | - Angela Alibrandi
- Department of Economics, University of Messina, 98122 Messina, Italy;
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Cinque L, Pugliese F, Salcuni AS, Trombetta D, Battista C, Biagini T, Augello B, Nardella G, Conti F, Corbetta S, Fischetto R, Foiadelli T, Gaudio A, Giannini C, Grosso E, Guabello G, Massuras S, Palermo A, Politano L, Pigliaru F, Ruggeri RM, Scarano E, Vicchio P, Cannavò S, Celli M, Petrizzelli F, Mastroianno M, Castori M, Scillitani A, Guarnieri V. Clinical and molecular description of the first Italian cohort of 33 subjects with hypophosphatasia. Front Endocrinol (Lausanne) 2023; 14:1205977. [PMID: 37600704 PMCID: PMC10433156 DOI: 10.3389/fendo.2023.1205977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Hypophosphatasia (HPP) is a rare genetic disease caused by inactivating variants of the ALPL gene. Few data are available on the clinical presentation in Italy and/or on Italian HPP surveys. Methods There were 30 suspected HPP patients recruited from different Italian tertiary cares. Biological samples and related clinical, biochemical, and anamnestic data were collected and the ALPL gene sequenced. Search for large genomic deletions at the ALPL locus (1p36) was done. Phylogenetic conservation and modeling were applied to infer the effect of the variants on the protein structure. Results There were 21 ALPL variants and one large genomic deletion found in 20 out of 30 patients. Unexpectedly, NGS-driven differential diagnosis allowed uncovering three hidden additional HPP cases, for a total of 33 HPP subjects. Eight out of 24 coding variants were novel and classified as "pathogenic", "likely pathogenic", and "variants of uncertain significance". Bioinformatic analysis confirmed that all the variants strongly destabilize the homodimer structure. There were 10 cases with low ALP and high VitB6 that resulted negative to genetic testing, whereas two positive cases have an unexpected normal ALP value. No association was evident with other biochemical/clinical parameters. Discussion We present the survey of HPP Italian patients with the highest ALPL mutation rate so far reported and confirm the complexity of a prompt recognition of the syndrome, mostly for HPP in adults. Low ALP and high VitB6 values are mandatory for the genetic screening, this latter remaining the gold standard not only to confirm the clinical diagnosis but also to make differential diagnosis, to identify carriers, to avoid likely dangerous therapy in unrecognized cases.
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Affiliation(s)
- Luigia Cinque
- Department of Pediatrics, “G D’Annunzioof Pediatrics, ” University of Chieti-Pescara, Foggia, Italy
| | - Flavia Pugliese
- Unit of Endocrinology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, Foggia, Italy
| | - Antonio Stefano Salcuni
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia, Udine, Italy
| | - Domenico Trombetta
- Laboratory of Oncology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, Foggia, Italy
| | - Claudia Battista
- Unit of Endocrinology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, Foggia, Italy
| | - Tommaso Biagini
- Laboratory of Bioinformatics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Bartolomeo Augello
- Department of Pediatrics, “G D’Annunzioof Pediatrics, ” University of Chieti-Pescara, Foggia, Italy
| | - Grazia Nardella
- Department of Pediatrics, “G D’Annunzioof Pediatrics, ” University of Chieti-Pescara, Foggia, Italy
| | - Francesco Conti
- Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
| | - Sabrina Corbetta
- Endocrinology and Diabetology Service, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Rita Fischetto
- Clinical Genetics Unit, Department of Pediatric Medicine, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation-University of Pavia, Pavia, Italy
| | - Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Cosimo Giannini
- Department of Pediatrics, “G D’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Enrico Grosso
- Medical Genetics, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Gregorio Guabello
- Reumatology Unit, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, Italy
| | - Stefania Massuras
- Medical Genetics, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, University Hospital of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Pigliaru
- Endocrine Unit, Azienda Ospedaliera-Universitaria of Cagliari, Cagliari, Italy
| | - Rosaria Maddalena Ruggeri
- Unit of Endocrinology, Department of Human Pathology DETEV “G. Barresi”, University of Messina, Messina, Italy
| | - Emanuela Scarano
- Rare Diseases Unit, Department of Pediatrics, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Bologna, Italy
| | - Piera Vicchio
- Department of Pediatrics, Jazzolino Hospital, Vibo Valentia, Italy
| | - Salvatore Cannavò
- Unit of Endocrinology, Department of Human Pathology DETEV “G. Barresi”, University of Messina, Messina, Italy
| | - Mauro Celli
- Rare Bone Metabolism Center, Azienda Ospedaliera Universitaria (AOU) Policlinico Umberto I, Roma, Italy
| | - Francesco Petrizzelli
- Laboratory of Bioinformatics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Mario Mastroianno
- Scientific Direction, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, Foggia, Italy
| | - Marco Castori
- Department of Pediatrics, “G D’Annunzioof Pediatrics, ” University of Chieti-Pescara, Foggia, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, Foggia, Italy
| | - Vito Guarnieri
- Department of Pediatrics, “G D’Annunzioof Pediatrics, ” University of Chieti-Pescara, Foggia, Italy
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Campennì A, Ruggeri RM, Garo ML, Siracusa M, Restuccia G, Rappazzo A, Rosarno H, Nicocia A, Cardile D, Ovčariček PP, Baldari S, Giovanella L. Comparison of 1.1 GBq and 2.2 GBq Activities in Patients with Low-Risk Differentiated Thyroid Cancer Requiring Postoperative 131I Administration: A Real Life Study. Cancers (Basel) 2023; 15:cancers15092416. [PMID: 37173884 PMCID: PMC10177573 DOI: 10.3390/cancers15092416] [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: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES To compare the efficacy of low and moderate 131I activities in low-risk differentiated thyroid carcinoma (DTC) patients requiring postoperative thyroid remnant ablation in a real-world clinical setting. METHODS We retrospectively reviewed the records of 299 low-risk DTC patients (pT1-T2, Nx(0) Mx) who had undergone (near)-total thyroidectomy followed by 131I therapy, using either low (1.1 GBq) or moderate (2.2 GBq) radioiodine activities. The response to initial treatments was evaluated after 8-12 months, and patient responses were classified according to the 2015 American Thyroid Association guidelines. RESULTS An excellent response was observed in 274/299 (91.6%) patients, specifically, in 119/139 (85.6%) and 155/160 (96.9%) patients treated with low and moderate 131I activities, respectively (p = 0.029). A biochemically indeterminate or incomplete response was observed in seventeen (22.2%) patients treated with low 131I activities and three (1.8%) patients treated with moderate 131I activities (p = 0.001). Finally, five patients showed an incomplete structural response, among which three and two received low and moderate 131I activities, respectively (p = 0.654). CONCLUSIONS When 131I ablation is indicated, we encourage the use of moderate instead of low activities, in order to reach an excellent response in a significantly larger proportion of patients, including patients with the unexpected persistence of the disease.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Human Pathology DETEV, Unit of Endocrinology, University of Messina, 98122 Messina, Italy
| | - Maria Luisa Garo
- Department of Cardiovascular Research, University Campus Biomedico, 00128 Roma, Italy
| | - Massimiliano Siracusa
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Giovanna Restuccia
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Andrea Rappazzo
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Helena Rosarno
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Antonio Nicocia
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Davide Cardile
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, 8006 Zurich, Switzerland
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10
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Campennì A, Ruggeri RM, Siracusa M, Romano D, Giacoppo G, Crocè L, Rosarno H, Russo S, Cardile D, Capoccetti F, Alibrandi A, Baldari S, Giovanella L. Thyroglobulin Value Predict Iodine-123 Imaging Result in Differentiated Thyroid Cancer Patients. Cancers (Basel) 2023; 15:cancers15082242. [PMID: 37190170 DOI: 10.3390/cancers15082242] [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: 03/15/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
Background: In differentiated thyroid cancer (DTC) patients, the response to initial treatments is evaluated 6-12 months after radioiodine therapy (RIT) according to the 2015 American Thyroid Association (2015 ATA) criteria. In selected patients, diagnostic 131-radioiodine whole-body scintigraphy (Dx-WBS) is recommended. We evaluated the diagnostic performance of 123I-Dx-WBS-SPECT/CT imaging in detecting incomplete structural responses in the early follow-up of DTC patients and, additionally, derived optimized basal-Tg value as a yardstick for scintigraphic imaging. Methods: We reviewed the records of 124 low or intermediate-risk DTC patients with negative anti-thyroglobulin antibody. All patients had undergone (near)-total-thyroidectomy followed by RIT. The response to initial treatments was evaluated 6-12 months after RIT. Results: According to the 2015 ATA criteria, 87, 19 and 18 DTC patients were classified to have excellent response (ER), indeterminate/incomplete biochemical response (BIndR/BIR) or structural incomplete response (SIR), respectively. Among patients with less than ER, 18 had a positive 123I-Dx-WBS-SPECT/CT. Metastatic disease at 123I-Dx-WBS-SPECT/CT mainly involved lymph nodes within the central compartment, and corresponding neck ultrasound examinations were negative. The ROC curve analysis was performed to define the best basal-Tg cut-off (i.e., 0.39 ng/mL; AUC = 0.852) able to discriminate patients with and without positive 123I-Dx-WBS-SPECT/CT, respectively. The overall sensitivity, specificity, accuracy, PPV and NPV were 77.8%, 89.6%, 87.9%, 56.0% and 95.9%, respectively. Basal-Tg cut-off was an independent risk factor for having a positive 123I-Dx-WBS-SPECT/CT. Conclusion:123I-Dx-WBS-SPECT/CT identified lymph node metastases in 14/37 patients with less than ER and a negative neck ultrasound, thus modifying the management of such patients. The diagnostic performance of 123I-Dx-WBS-SPECT/CT significantly increased in patients with basal-Tg values ≥ 0.39 ng/mL.
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Affiliation(s)
- Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Massimiliano Siracusa
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Davide Romano
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Giulia Giacoppo
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Ludovica Crocè
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Helena Rosarno
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Simona Russo
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Davide Cardile
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Francesca Capoccetti
- Nuclear Medicine Unit, Service Department Macerata Hospital, ASUR Marche AV3, 62100 Macerata, Italy
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, 98125 Messina, Italy
| | - Sergio Baldari
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, 8006 Zurich, Switzerland
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11
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Ruggeri RM, Benevento E, De Cicco F, Fazzalari B, Guadagno E, Hasballa I, Tarsitano MG, Isidori AM, Colao A, Faggiano A. Neuroendocrine neoplasms in the context of inherited tumor syndromes: a reappraisal focused on targeted therapies. J Endocrinol Invest 2023; 46:213-234. [PMID: 36038743 DOI: 10.1007/s40618-022-01905-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 07/30/2022] [Accepted: 08/16/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Neuroendocrine neoplasms can occur as part of inherited disorders, usually in the form of well-differentiated, slow-growing tumors (NET). The main predisposing syndromes include: multiple endocrine neoplasias type 1 (MEN1), associated with a large spectrum of gastroenteropancreatic and thoracic NETs, and type 4 (MEN4), associated with a wide tumour spectrum similar to that of MEN1; von Hippel-Lindau syndrome (VHL), tuberous sclerosis (TSC), and neurofibromatosis 1 (NF-1), associated with pancreatic NETs. In the present review, we propose a reappraisal of the genetic basis and clinical features of gastroenteropancreatic and thoracic NETs in the setting of inherited syndromes with a special focus on molecularly targeted therapies for these lesions. METHODS Literature search was systematically performed through online databases, including MEDLINE (via PubMed), and Scopus using multiple keywords' combinations up to June 2022. RESULTS Somatostatin analogues (SSAs) remain the mainstay of systemic treatment for NETs, and radiolabelled SSAs can be used for peptide-receptor radionuclide therapy for somatostatin receptor (SSTR)-positive NETs. Apart of these SSTR-targeted therapies, other targeted agents have been approved for NETs: the mTOR inhibitor everolimus for lung, gastroenteropatic and unknown origin NET, and sunitinib, an antiangiogenic tyrosine kinase inhibitor, for pancreatic NET. Novel targeted therapies with other antiangiogenic agents and immunotherapies have been also under evaluation. CONCLUSIONS Major advances in the understanding of genetic and epigenetic mechanisms of NET development in the context of inherited endocrine disorders have led to the recognition of molecular targetable alterations, providing a rationale for the implementation of treatments and development of novel targeted therapies.
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Affiliation(s)
- R M Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "Gaetano Martino" University Hospital, 98125, Messina, Italy.
| | - E Benevento
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - F De Cicco
- SSD Endocrine Disease and Diabetology, ASL TO3, Pinerolo, TO, Italy
| | - B Fazzalari
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
| | - E Guadagno
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - I Hasballa
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M G Tarsitano
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - A M Isidori
- Gruppo NETTARE, Policlinico Umberto I, Università Sapienza, Rome, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
- UNESCO Chair "Education for Health and Sustainable Development", Federico II University, Naples, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
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Campennì A, Ruggeri RM. Early diagnosis of parathyroid carcinoma: A challenging for physicians. Clin Endocrinol (Oxf) 2023; 98:273-274. [PMID: 35918833 DOI: 10.1111/cen.14807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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13
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Ruggeri RM, Benevento E, De Cicco F, Fazzalari B, Guadagno E, Hasballa I, Tarsitano MG, Isidori AM, Colao A, Faggiano A. Correction to: Neuroendocrine neoplasms in the context of inherited tumor syndromes: a reappraisal focused on targeted therapies. J Endocrinol Invest 2023; 46:203. [PMID: 36205909 DOI: 10.1007/s40618-022-01924-1] [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: 01/11/2023]
Affiliation(s)
- R M Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "Gaetano Martino" University Hospital, 98125, Messina, Italy.
| | - E Benevento
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - F De Cicco
- SSD Endocrine Disease and Diabetology, ASL TO3, Pinerolo, TO, Italy
| | - B Fazzalari
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
| | - E Guadagno
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - I Hasballa
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M G Tarsitano
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - A M Isidori
- Gruppo NETTARE, Policlinico Umberto I, Università Sapienza, Rome, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
- UNESCO Chair "Education for Health and Sustainable Development", Federico II University, Naples, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
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14
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Hrelia S, Barbalace MC, Cannavò S, Ruggeri RM. Commentary: Fish and the thyroid: A Janus Bifrons relationship caused by pollutants and the omega-3 polyunsaturated fatty acids. Front Endocrinol (Lausanne) 2023; 14:1138245. [PMID: 37113488 PMCID: PMC10126423 DOI: 10.3389/fendo.2023.1138245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Silvana Hrelia
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Rimini, Italy
| | | | - Salvatore Cannavò
- Department of Human Pathology and Childhood “G. Barresi” (DETEV), University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Human Pathology and Childhood “G. Barresi” (DETEV), University of Messina, Messina, Italy
- *Correspondence: Rosaria Maddalena Ruggeri,
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Spagnolo CC, Giuffrida G, Cannavò S, Franchina T, Silvestris N, Ruggeri RM, Santarpia M. Management of Endocrine and Metabolic Toxicities of Immune-Checkpoint Inhibitors: From Clinical Studies to a Real-Life Scenario. Cancers (Basel) 2022; 15:cancers15010246. [PMID: 36612243 PMCID: PMC9818218 DOI: 10.3390/cancers15010246] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/03/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the therapeutic landscape of solid tumors. However, although ICIs are better tolerated than conventional chemotherapy, their use is associated with a peculiar toxicity profile, related to the enhancement of the immune response, affecting several organs. Among immune-related adverse events (irAEs), up to 10% involve the endocrine system. Most of them are represented by thyroid disorders (hypothyroidism and hyperthyroidism), mainly correlated to the use of anti-PD-1 and/or anti-PD-L1 agents. Less common endocrine irAEs include hypophysitis, adrenalitis, and metabolic irAEs. A deeper understanding of endocrine toxicities is a critical goal for both oncologists and endocrinologists. A strict collaboration between these specialists is mandatory for early recognition and proper treatment of these patients. In this review we will provide a comprehensive overview of endocrine and metabolic adverse events of ICIs, with particular interest in the pathogenesis, predisposing factors and clinical presentation of these irAEs, and their impact on clinical outcomes of patients. Furthermore, we will summarize the most recent studies and recommendations on the clinical approach to immune-related endocrinopathies with the purpose to optimize the diagnostic algorithm, and to help both oncologists and endocrinologists to improve the therapeutic management of these unique types of irAEs, in a real-life scenario.
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Affiliation(s)
- Calogera Claudia Spagnolo
- Medical Oncology Unit, Department of Human Pathology “G.Barresi”, University of Messina, 98125 Messina, Italy
| | - Giuseppe Giuffrida
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV, University of Messina, 98125 Messina, Italy
| | - Salvatore Cannavò
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV, University of Messina, 98125 Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit, Department of Human Pathology “G.Barresi”, University of Messina, 98125 Messina, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology “G.Barresi”, University of Messina, 98125 Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Endocrinology Unit, Department of Human Pathology of Adulthood and Childhood DETEV, University of Messina, 98125 Messina, Italy
| | - Mariacarmela Santarpia
- Medical Oncology Unit, Department of Human Pathology “G.Barresi”, University of Messina, 98125 Messina, Italy
- Correspondence:
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16
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Campennì A, Siracusa M, Ruggeri RM, Giovanella L, Baldari S. Malignant thyroid nodule topography as additional risk factor for lymph-node metastases in differentiated thyroid cancer patients. Eur Arch Otorhinolaryngol 2022; 279:5969-5970. [PMID: 35476131 DOI: 10.1007/s00405-022-07411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Via Consolare Valeria nr.1, 98125, Messina, Italy.
| | - Massimiliano Siracusa
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Via Consolare Valeria nr.1, 98125, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Via Consolare Valeria nr.1, 98125, Messina, Italy
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17
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Ruggeri RM, Giovanellla L, Campennì A. SARS-CoV-2 vaccine may trigger thyroid autoimmunity: real-life experience and review of the literature. J Endocrinol Invest 2022; 45:2283-2289. [PMID: 35829989 PMCID: PMC9277984 DOI: 10.1007/s40618-022-01863-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/03/2022] [Indexed: 10/27/2022]
Abstract
PURPOSE SARS-CoV-2 infection can be associated with destructive thyroiditis and triggers thyroid autoimmunity. More recent evidence suggests that SARS-CoV-2 vaccines may also be associated with permanent or transient thyroid dysfunction in susceptible individuals. METHODS We observed three patients who developed/exacerbated autoimmune thyroid diseases (AITDs) shortly after receiving mRNA-based vaccines against SARS-CoV2. Clinical histories are reported, and relevant literature in the field is summarized. RESULTS Our case series gives a description of the full spectrum of autoimmune disorders that may occur after SARS-CoV-2 vaccines administration, ranging from a case of new-onset Graves' disease to autoimmune hypothyroidism in two patients with pre-existing AITDs. Our three patients had a personal and/or family history of autoimmune disorders, suggesting that genetic predisposition is an important risk factor for the development of AITDs following vaccination. Moreover, our real-life experience demonstrates that persistent hypothyroidism may occur in the long run and should be overlooked; subjects with a previous AITDs are at risk of developing it. Reviewing the pertinent literature up to date Graves' disease is the most common vaccine-related AITDs with up to 51 cases reported in the literature, occurring mainly in female patients with no personal history of AIDTs, while only a case of autoimmune hypothyroidism has been reported so far. CONCLUSIONS SARS-CoV-2 vaccines can trigger autoimmune reactions and the present case series contributes to make clinicians aware of full spectrum of AITDs that may occur following vaccination. Thyroid function monitoring is recommended, mainly in subjects with a personal/family history of AITDs.
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Affiliation(s)
- R M Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - L Giovanellla
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - A Campennì
- Unit of Nuclear Medicine, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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18
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Campennì A, Aguennouz M, Siracusa M, Alibrandi A, Polito F, Oteri R, Baldari S, Ruggeri RM, Giovanella L. Thyroid Cancer Persistence in Patients with Unreliable Thyroglobulin Measurement: Circulating microRNA as Candidate Alternative Biomarkers. Cancers (Basel) 2022; 14:cancers14225620. [PMID: 36428713 PMCID: PMC9688692 DOI: 10.3390/cancers14225620] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We aimed to evaluate the role of circulating miRNAs as a biomarker of the persistence of papillary thyroid cancer (PTC) in patients with an "uninformative" thyroglobulin (Tg) measurement. METHODS We prospectively enrolled 49 consecutive PTC patients with Tg-positive antibodies (TgAb) who had undergone a (near)-total thyroidectomy and 131I therapy (RIT). The serum thyroid stimulating hormone (TSH), Tg, and TgAb levels were measured before and at 6 and 12 months after RIT, respectively. The serum miRNA (221, 222, 375, 155, and 146b) levels were measured simultaneously. RESULTS The response to the initial therapy was assessed according to the 2015 ATA criteria. A decrease in 50% or more of serum miRNA over time was observed in 41/49 PTC patients, who showed an excellent response (ER), but six and two patients were classified to have an indeterminate/incomplete biochemical or incomplete structural response to initial therapy. CONCLUSION Serum miRNA kinetics emerge as a promising biomarker for the early detection of a persistent disease in PTC patients with uninformative Tg results.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
- Correspondence: ; Tel.: +39-090-2217367; Fax: +39-090-2212842
| | - M’hammed Aguennouz
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, University of Messina, 98125 Messina, Italy
| | - Massimiliano Siracusa
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, 98125 Messina, Italy
| | - Francesca Polito
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, University of Messina, 98125 Messina, Italy
| | - Rosaria Oteri
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, University of Messina, 98125 Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Human Pathology DETEV, Unit of Endocrinology, University of Messina, 98125 Messina, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital, University of Zurich, 8091 Zurich, Switzerland
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Frasca F, Piticchio T, Le Moli R, Tumino D, Cannavò S, Ruggeri RM, Campennì A, Giovanella L. Early detection of suspicious lymph nodes in differentiated thyroid cancer. Expert Rev Endocrinol Metab 2022; 17:447-454. [PMID: 35993330 DOI: 10.1080/17446651.2022.2112176] [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: 03/03/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Early identification of cervical lymph node (LN) metastases cervical lymph node metastases (CLNM) is crucial in the management of differentiated thyroid cancer differentiated thyroid cancer (DTC) as it influences the indication and the extent of surgery with an impact on the recurrence risk and overall survival. The present review focused on novel sensitive and specific diagnostic techniques, by searching through online databases like MEDLINE and Scopus up to February 2022. AREAS COVERED The techniques identified included contrast-enhanced ultrasound (CEUS), dosage of fragment 21-1 of cytokeratin 19 (CYFRA 21-1) in lymph node fine needle aspiration washout, sentinel LN biopsy (SNB), and artificial intelligence (AI) - deep learning applied to ultrasonography and computed tomography. These methods displayed widely varying sensitivity and specificity results, ranging from approximately 60-100%. This variability is mainly due to the operator's experience because of the great complexity of execution of these new techniques, which require a long-learning curve. EXPERT OPINION Despite the appearance of many candidate methods to improve the detection of metastatic lymph nodes, none seem to be clearly superior to the tools currently used in clinical practice and FNA-Tg measurement remains the more accurate tool to detect neck recurrences and CLNM from DTC.
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Affiliation(s)
- Francesco Frasca
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Tommaso Piticchio
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Rosario Le Moli
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Dario Tumino
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Salvatore Cannavò
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy
- Department of Human Pathology DETEV, University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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20
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Aversa T, Ruggeri RM, Corica D, Cristani MT, Pepe G, Vicchio TM, Alibrandi A, Trimarchi F, Cannavò S, Pajno GB, Wasniewska MG. Serum Levels of Soluble Receptor for Advanced Glycation End Products Are Reduced in Euthyroid Children with Newly Diagnosed Hashimoto's Thyroiditis: A Pilot Study. Horm Res Paediatr 2022; 94:144-150. [PMID: 34237741 DOI: 10.1159/000517341] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE No data are available on advanced glycation end products (AGEs) and their soluble receptor (sRAGE) in pediatric patients with Hashimoto's thyroiditis (HT). The present study was aimed to simultaneously evaluate serum levels of sRAGE, AGEs, and advanced oxidation protein products (AOPPs) and investigate the relationships between these oxidative stress markers and clinical and biochemical parameters of thyroid function in euthyroid children with HT. DESIGN This is a case-control study carried out in a single university hospital center. METHODS We enrolled 19 newly diagnosed euthyroid HT pediatric patients (3 M, 16 F; median age 12.44 years, range 6.54-15.81 years) and 16 age-, sex-, and BMI-matched healthy controls (5 M, 11 F; median age 12.83 years, range 5.68-15.07 years). None was on levothyroxine treatment. The exclusion criteria were autoimmune, inflammatory, and infection comorbidities. Patients did not differ significantly from controls with regard to lipid or for anthropometric parameters. RESULTS sRAGE levels were significantly lower in HT patients (median 414.30 pg/mL, range 307.30-850.30 pg/mL) than in controls (561.30, 273.20-1121.60 pg/mL; p = 0.034). No differences emerged between patients and controls with regard to serum AGEs (124.25 AU/g prot, 71.98-186.72 vs. 133.90, 94.06-200.78 AU/g prot, p = 0.707) and AOPPs (1.13 nmol/mL, 0.62-1.83 vs. 1.17, 0.76-1.42 nmol/mL, p = 0.545). CONCLUSIONS sRAGE levels were decreased in euthyroid children/adolescents at the onset of HT, suggesting that autoimmunity per se seems to play an important role in such a reduction of sRAGE, irrespective of any functional alteration. Children and adolescents suffering from HT may exhibit increased susceptibility to oxidative damage, even when in euthyroid status.
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Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Endocrine Unit at University Hospital AOU Policlinico "G. Martino", Messina, Italy
| | - Domenico Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Maria Teresa Cristani
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | | | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | | | - Salvatore Cannavò
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy.,Endocrine Unit at University Hospital AOU Policlinico "G. Martino", Messina, Italy
| | - Giovanni Battista Pajno
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
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21
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Gallo M, Adinolfi V, Barucca V, Prinzi N, Renzelli V, Barrea L, Di Giacinto P, Ruggeri RM, Sesti F, Arvat E, Baldelli R, Arvat E, Colao A, Isidori A, Lenzi A, Baldell R, Albertelli M, Attala D, Bianchi A, Di Sarno A, Feola T, Mazziotti G, Nervo A, Pozza C, Puliani G, Razzore P, Ramponi S, Ricciardi S, Rizza L, Rota F, Sbardella E, Zatelli MC. Expected and paradoxical effects of obesity on cancer treatment response. Rev Endocr Metab Disord 2021; 22:681-702. [PMID: 33025385 DOI: 10.1007/s11154-020-09597-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
Obesity, whose prevalence is pandemic and continuing to increase, is a major preventable and modifiable risk factor for diabetes and cardiovascular diseases, as well as for cancer. Furthermore, epidemiological studies have shown that obesity is a negative independent prognostic factor for several oncological outcomes, including overall and cancer-specific survival, for several site-specific cancers as well as for all cancers combined. Yet, a recently growing body of evidence suggests that sometimes overweight and obesity may associate with better outcomes, and that immunotherapy may show improved response among obese patients compared with patients with a normal weight. The so-called 'obesity paradox' has been reported in several advanced cancer as well as in other diseases, albeit the mechanisms behind this unexpected relationship are still not clear. Aim of this review is to explore the expected as well as the paradoxical relationship between obesity and cancer prognosis, with a particular emphasis on the effects of cancer therapies in obese people.
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Affiliation(s)
- Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Via Genova, 3, 10126, Turin, Italy.
| | - Valerio Adinolfi
- Endocrinology and Diabetology Unit, ASL Verbano Cusio Ossola, Domodossola, Italy
| | - Viola Barucca
- Oncology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy
| | - Natalie Prinzi
- ENETS Center of Excellence, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori Milano, Milan, Italy
| | - Valerio Renzelli
- Department of Experimental Medicine, AO S. Andrea, Sapienza University of Rome, Rome, Italy
| | - Luigi Barrea
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, Naples, Italy
| | - Paola Di Giacinto
- Endocrinology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy
| | - Rosaria Maddalena Ruggeri
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico G. Martino, Messina, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Via Genova, 3, 10126, Turin, Italy
| | - Roberto Baldelli
- Endocrinology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy
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22
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Campennì A, Ruggeri RM, Giovanella L. Comment on: Report of One Case of Malignancy Among 17 Autonomous Thyroid Nodules in Children and Adolescents. J Paediatr Child Health 2021; 57:2039-2040. [PMID: 34523774 DOI: 10.1111/jpc.15743] [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] [Received: 08/31/2021] [Revised: 09/02/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.,Thyroid Committee, European Association of Nuclear Medicine, Vienna, Austria
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Endocrine Unit, "G. Martino" University Hospital, Messina, Italy
| | - Luca Giovanella
- Thyroid Committee, European Association of Nuclear Medicine, Vienna, Austria.,Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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23
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Marcucci G, Altieri P, Benvenga S, Bondanelli M, Camozzi V, Cetani F, Cianferotti L, Duradoni M, Fossi C, Degli Uberti E, Famà F, Mantovani G, Marcocci C, Masi L, Pagotto U, Palermo A, Parri S, Ruggeri RM, Zatelli MC, Brandi ML. Hypoparathyroidism and pseudohypoparathyroidism in pregnancy: an Italian retrospective observational study. Orphanet J Rare Dis 2021; 16:421. [PMID: 34627337 PMCID: PMC8501695 DOI: 10.1186/s13023-021-02053-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background Hypoparathyroidism (HypoPT) or pseudo-hypoparathyroidism (pseudo-HypoPT) during pregnancy may cause maternal and fetal/neonatal complications. In this regard, only a few case reports or case series of pregnant or lactating women have been published. The purpose of this study was to describe clinical and biochemical course, pharmacological management, and potential adverse events during pregnancy and post-partum in pregnant women with HypoPT or pseudo-HypoPT. This was a retrospective, observational, multicenter, study involving nine Italian referral centers for endocrine diseases affiliated with the Italian Society of Endocrinology and involved in “Hypoparathyroidism Working Group”. Results This study identified a cohort of 28 women (followed between 2005 and 2018) with HypoPT (n = 25, 84% postsurgical, 16% idiopathic/autoimmune) and pseudo-HypoPT (n = 3). In HypoPT women, the mean calcium carbonate dose tended to increase gradually from the first to third trimester (+ 12.6%) in pregnancy. This average increase in the third trimester was significantly greater compared to the pre-pregnancy period (p value = 0.03). However, analyzing the individual cases, in 44% the mean calcium dosage remained unchanged throughout gestation. Mean calcitriol doses tended to increase during pregnancy, with a statistically significant increase between the third trimester and the pre-pregnancy period (p value = 0.02). Nevertheless, analyzing the individual cases, in the third trimester most women with HypoPT (64%) maintained the same dosage of calcitriol compared to the first trimester. Both mean calcium carbonate and calcitriol doses tended to decrease from the third trimester to the post-partum six months. Most identified women (~ 70%) did not display maternal complications and (~ 90%) maintained mean serum albumin-corrected total calcium levels within the low-to-mid normal reference range (8.5 ± 0.8 mg/dl) during pregnancy. The main complications related to pregnancy period included: preterm birth (n = 3 HypoPT women), and history of miscarriages (n = 6 HypoPT women and n = 2 pseudo-HypoPT women). Conclusion This study shows that mean serum albumin-corrected total calcium levels were carefully monitored during pregnancy and post-pregnancy, with limited evaluation of other biochemical parameters, such as serum phosphate, 24 h urinary calcium, 25-OH vitamin D, and creatinine clearance. To avoid complications in mothers affected by (HypoPT) or (pseudo-HypoPT) and offspring, intense biochemical, clinical and pharmacological monitoring during pregnancy and breastfeeding is highly recommended.
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Affiliation(s)
- Gemma Marcucci
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Paola Altieri
- Endocrinology Unit and Prevention and Care of Diabetes, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marta Bondanelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Valentina Camozzi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luisella Cianferotti
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Mirko Duradoni
- Department of Information Engineering, University of Florence, Florence, Italy
| | - Caterina Fossi
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Ettore Degli Uberti
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Fausto Famà
- Division of Endocrine and Minimally Invasive Surgery Department of Human Pathology in Adulthood and Childhood "G. Barresi",, University Hospital "G. Martino" of Messina, Messina, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Masi
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Uberto Pagotto
- Endocrinology Unit and Prevention and Care of Diabetes, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Palermo
- Unit of Endocrinology, Campus Bio-Medico University, Rome, Italy
| | - Simone Parri
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Maria Luisa Brandi
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy.
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Muscogiuri G, Barrea L, Faggiano F, Maiorino MI, Parrillo M, Pugliese G, Ruggeri RM, Scarano E, Savastano S, Colao A. Obesity in Prader-Willi syndrome: physiopathological mechanisms, nutritional and pharmacological approaches. J Endocrinol Invest 2021; 44:2057-2070. [PMID: 33891302 PMCID: PMC8421305 DOI: 10.1007/s40618-021-01574-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 01/12/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
Prader-Willi syndrome (PWS) is a genetic disorder caused by the lack of expression of genes on the paternally inherited chromosome 15q11.2-q13 region. The three main genetic subtypes are represented by paternal 15q11-q13 deletion, maternal uniparental disomy 15, and imprinting defect. Clinical picture of PWS changes across life stages. The main clinical characteristics are represented by short stature, developmental delay, cognitive disability and behavioral diseases. Hypotonia and poor suck resulting in failure to thrive are typical of infancy. As the subjects with PWS age, clinical manifestations such as hyperphagia, temperature instability, high pain threshold, hypersomnia and multiple endocrine abnormalities including growth hormone and thyroid-stimulating hormone deficiencies, hypogonadism and central adrenal insufficiency due to hypothalamic dysfunction occur. Obesity and its complications are the most common causes of morbidity and mortality in PWS. Several mechanisms for the aetiology of obesity in PWS have been hypothesized, which include aberration in hypothalamic pathways of satiety control resulting in hyperphagia, disruption in hormones regulating appetite and satiety and reduced energy expenditure. However, despite the advancement in the research field of the genetic basis of obesity in PWS, there are contradictory data on the management. Although it is mandatory to adopt obesity strategy prevention from infancy, there is promising evidence regarding the management of obesity in adulthood with current obesity drugs along with lifestyle interventions, although the data are limited. Therefore, the current manuscript provides a review of the current evidence on obesity and PWS, covering physiopathological aspects, obesity-related complications and conservative management.
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Affiliation(s)
- G Muscogiuri
- Sezione di Endocrinologia, Unità di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via Sergio Pansini 5, 80131, Naples, Italy.
- Cattedra Unesco "Educazione alla Salute e allo Sviluppo Sostenibile", Università "Federico II" di Napoli, Naples, Italy.
| | - L Barrea
- Sezione di Endocrinologia, Unità di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Napoli, Italy
| | - F Faggiano
- Ambulatorio Diabetologia, Asp Cosenza, Cosenza, Italy
| | - M I Maiorino
- Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Parrillo
- Endocrinology and Metabolic Disease, AORN S. Anna S. Sebastiano Caserta, Caserta, Italy
| | - G Pugliese
- Sezione di Endocrinologia, Unità di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - R M Ruggeri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - E Scarano
- Sezione di Endocrinologia, Unità di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - S Savastano
- Sezione di Endocrinologia, Unità di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - A Colao
- Sezione di Endocrinologia, Unità di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione alla Salute e allo Sviluppo Sostenibile", Università "Federico II" di Napoli, Naples, Italy
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Frasca F, Piticchio T, Le Moli R, Malaguarnera R, Campennì A, Cannavò S, Ruggeri RM. Recent insights into the pathogenesis of autoimmune hypophysitis. Expert Rev Clin Immunol 2021; 17:1175-1185. [PMID: 34464545 DOI: 10.1080/1744666x.2021.1974297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Hypophysitis is an inflammation of the pituitary gland and a rare case of hypopituitarism. Despite the expanding spectrum of histological variants and causative agents, its pathogenesis is far to be fully understood. The present review is focused on recent evidence concerning the pathogenesis of autoimmune hypophysitis by searching through online databases like MEDLINE and Scopus up to May 2021. AREAS COVERED Hypophysitis frequently develops in the context of a strong autoimmune background, including a wide spectrum of subtypes ranging from the commonest form of lymphocytic hypophysitis to the newly described and less common IgG4-, anti-PIT-1, and ICI-induced forms. A peculiar combination of genetic predisposition, pituitary damage and immunological setting represents the pathogenetic basis of autoimmune hypophysitis, which is characterized by diffuse infiltration of the gland by lymphocytes and variable degrees of fibrosis followed by pituitary cell destruction. Anti-pituitary antibodies (APA) have been described in sera from patients suffering from autoimmune hypophysitis, though their pathophysiological significance remains largely unknown and their diagnostic value limited. EXPERT OPINION In recent years hypophysitis has gained interest due to the increased number of new diagnoses and the recognition of novel subtypes. Further studies could lead to improvements in biochemical/immunological diagnosis and targeted treatments.
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Affiliation(s)
- Francesco Frasca
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Tommaso Piticchio
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Rosario Le Moli
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | | | - Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Salvatore Cannavò
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy.,Department of Human Pathology DETEV, University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Abstract
Iodine deficiency is still the main cause of preventable thyroid disorders, worldwide. To optimize iodine intake, programs of voluntary or mandatory iodization of salt have been implemented in several iodine-deficient countries and iodine sufficiency has been achieved in many. Despite the clear beneficial effects on thyroid health, some concerns have been raised on the presumed detriment of iodine prophylaxis on thyroid autoimmunity. Very recent studies aimed at evaluating the long-term consequences of iodine supplementation on thyroid autoimmunity and related dysfunction, have clearly demonstrated that the early post-iodization increase in thyroid antibody positivity is largely transient and not clinically relevant, since the prevalence of overt thyroid dysfunction has remained reassuring low over two decades. The recommended iodine intake is therefore safe with regard to thyroid autoimmunity, the benefits largely outweighing the risks in a population with a stable median iodine concentration not exceeding 300 μg/L. Thus, a possible increase in thyroid autoimmunity should not represent a limitation to promoting iodine supplementation in the general population, also taking into account the steady rise in prevalence of autoimmune disorders which has occurred in the last few decades because of environmental factors other than iodine.
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Affiliation(s)
- R M Ruggeri
- Department of Clinical and Experimental Medicine, University of Messina, via Consolare Valeria, 1, 98125, Messina, Italy.
- Endocrine Unit At University Hospital "AOU Policlinico G.Martino", Messina, Italy.
| | - F Trimarchi
- Department of Clinical and Experimental Medicine, University of Messina, via Consolare Valeria, 1, 98125, Messina, Italy
- Accademia Peloritana Dei Pericolanti at the University of Messina, Messina, Italy
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Campennì A, Ruggeri RM, Siracusa M, Giacoppo G, La Torre F, Saccomanno A, Alibrandi A, Dionigi G, Tuccari G, Baldari S, Giovanella L. Isthmus topography is a risk factor for persistent disease in patients with differentiated thyroid cancer. Eur J Endocrinol 2021; 185:397-404. [PMID: 34232125 DOI: 10.1530/eje-21-0328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/06/2021] [Indexed: 11/08/2022]
Abstract
AIM The risk of differentiated thyroid cancer (DTC) recurrence is widely evaluated according to the 2015 ATA Risk Stratification System. Topography of malignant nodules has been previously reported as an additional risk factor but is not included in the ATA system. Thus, our study aimed to evaluate the relationship between DTC topography and response to initial therapy. PATIENTS AND METHODS We enrolled 401 low- to intermediate-risk patients with DTC who had undergone thyroidectomy and radioiodine therapy. DTC topography was recorded and compared with the response to therapy as assessed 12 months after the end of therapy. RESULTS Overall, 366/401 (91.3%) patients had an excellent response to initial therapy while 22/401 (5.5%) and 13/401 (3.2%) had incomplete biochemical or structural responses, respectively. Incomplete response occurred in 10/36 (27.8%), 5/125 (4.0%), and 4/111 (3.6%) patients whose unifocal malignant nodules were located in the isthmus, right lobe, or left lobe. Incomplete response was also observed in 4/54 (7.4%) and 12/75 (16%) patients carrying multifocal cancers in one or both lobes, respectively. Patients with isthmic cancer more frequently demonstrated incomplete response compared with those who had cancer in other locations (P = 0.00). No significant relationship was found with age, gender, maximum size of malignant nodule, Hashimoto's thyroiditis, vascular invasion, and extrathyroidal extension (P = 0.78, P = 0.77, P = 0.52, P = 0.19, P = 0.73, and P = 0.26, respectively). The risk of incomplete response was about 65% higher in patients with isthmic lesions compared with other patients (odds ratio = 6.725). A log-rank test demonstrated that disease-free survival (DFS) of patients with isthmic lesions was significantly shorter than that of other patients (P = 0.02). CONCLUSION Our data show that isthmus topography of malignant thyroid nodules is a risk factor for having both persistent disease 12 months after primary treatment and reduced DFS.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
- Thyroid Committee, European Association of Nuclear Medicine, Vienna, Austria
| | | | - Massimiliano Siracusa
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Giulia Giacoppo
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Flavia La Torre
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Angiola Saccomanno
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood 'G. Barresi'
| | - Giovanni Tuccari
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Unit of Pathological Anatomy, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Luca Giovanella
- Thyroid Committee, European Association of Nuclear Medicine, Vienna, Austria
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Ruggeri RM, Campennì A, Deandreis D, Siracusa M, Tozzoli R, Petranović Ovčariček P, Giovanella L. SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives. Expert Rev Clin Immunol 2021; 17:737-759. [PMID: 34015983 PMCID: PMC8182818 DOI: 10.1080/1744666x.2021.1932467] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Introduction: During the COVID-19 pandemic thyroid gland alteration/dysfunction has been emerged as a possible endocrine complication. The present review is focused on inflammatory and autoimmune thyroid complications triggered by SARS-CoV-2 infection by searching through databases like MEDLINE and Scopus up to April 2021.Areas covered: Beside the occurrence of 'non-thyroidal illness' in severe clinical conditions, alterations of thyroid function and structure may occur during COVID-19 as a consequence of either direct or indirect effects of SARS-CoV-2 infection on the gland. On the one hand, SARS-CoV-2 uses ACE2 as a receptor to infect the host cells and ACE2 is highly expressed by follicular thyroid cells. On the other hand, COVID-19 is associated with a systemic inflammatory and immune response, involving Th1/Th17/Th2 lymphocytes and proinflammatory cytokines, which resembles the immune activation that occurs in immune-mediated thyroid diseases. COVID-19-related thyroid disorders include destructive thyroiditis and onset or relapse of autoimmune thyroid disorders, leading to a broad spectrum of thyroid dysfunction ranging from thyrotoxicosis to hypothyroidism, that may worsen COVID-19 clinical course and affect prognosis.Expert opinion: Physicians should be aware of the possible occurrence of thyroid dysfunction during and after SARS-CoV-2 infection. Further longitudinal studies are warranted to evaluate potential long-term sequelae.
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Affiliation(s)
- Rosaria Maddalena Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Desiree Deandreis
- Department of Nuclear Medicine, Nuclear Medicine Division, AOU Città Della Salute E Della Scienza, University of Turin, Turin, Italy
| | - Massimiliano Siracusa
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Renato Tozzoli
- Endocrinology Unit, S. Giorgio Hospital, Pordenone, Italy
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Ruggeri RM, Campennì A, Siracusa M, Frazzetto G, Gullo D. Subacute thyroiditis in a patient infected with SARS-COV-2: an endocrine complication linked to the COVID-19 pandemic. Hormones (Athens) 2021; 20:219-221. [PMID: 32676935 PMCID: PMC7365600 DOI: 10.1007/s42000-020-00230-w] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/03/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Subacute thyroiditis (SAT) is an inflammatory thyroid disorder of viral origin, generally preceded by an upper respiratory tract infection. Since the disorder is self-limiting, it is frequently underdiagnosed. However, the disease should not be overlooked since the associated thyrotoxicosis may worsen the clinical course of concomitant disorders (e.g., respiratory distress) and long-term sequelae, such as autoimmune hypothyroidism, have been reported. METHODS Here we describe a woman who developed SAT with thyrotoxicosis after SARS-COV-2 infection. Coronavirus disease (COVID-19) symptoms were mild and the patient was managed with no specific treatment and recovered rapidly. RESULTS Six weeks after the onset of the upper respiratory tract infection, the patient developed pain and tenderness in the anterior cervical region, fatigue, tremors, and palpitations. Physical examination revealed mild tremors of the extremities, a diffuse and painful goiter, and enlarged and tender cervical and submandibular lymph nodes. At biochemical evaluation, TSH was suppressed, FT3 and FT4 were high, and serum thyroglobulin was markedly increased (188 pg/mL; n.v. 0-40). Thyroid scintigraphy showed markedly reduced 99mTc-perthecnetate uptake in the gland. All findings were consistent with SAT, and treatment with oral prednisone (25 mg/day as the starting dose, gradually tapered) was started. Under the corticosteroid therapy, there was progressive resolution of symptoms and signs, and, within 4 weeks, all thyroid functional tests and inflammatory indexes normalized. CONCLUSION Clinicians should be aware of thyroid manifestations potentially associated with COVID-19.
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Affiliation(s)
- Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, "Gaetano Martino" University Hospital, University of Messina, 98125, Messina, Italy.
| | - Alfredo Campennì
- Department of Biomedical Sciences and Morphological and Functional Images, Unit of Nuclear Medicine, University of Messina, Messina, Italy
| | - Massimiliano Siracusa
- Department of Biomedical Sciences and Morphological and Functional Images, Unit of Nuclear Medicine, University of Messina, Messina, Italy
| | - Giuseppe Frazzetto
- Endocrine Unit, Department of Clinical and Molecular Biomedicine, Garibaldi-Nesima Hospital, University of Catania Medical School, Catania, Italy
| | - Damiano Gullo
- Endocrine Unit, Department of Clinical and Molecular Biomedicine, Garibaldi-Nesima Hospital, University of Catania Medical School, Catania, Italy
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Gallo M, Campione S, Di Vito V, Fortunati N, Lo Calzo F, Messina E, Ruggeri RM, Faggiano A, Colao AAL. Primary Neuroendocrine Neoplasms of the Breast: Still Open Issues. Front Endocrinol (Lausanne) 2021; 11:610230. [PMID: 33584543 PMCID: PMC7874233 DOI: 10.3389/fendo.2020.610230] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
Neuroendocrine breast tumors represent a rare subtype of breast cancer, accounting for less than 1% of all neuroendocrine neoplasms. Starting from their pathology definition, and going through their prevalence, prognosis and treatment, our knowledge is still really uncertain. In the present short review of the medical literature on this topic, we have evaluated in details their epidemiology, risk factors, pathogenesis, pathology, clinical presentation, radiographic aspects, prognosis, and therapy. We have thus been able to identify a number of open issues regarding primary neuroendocrine neoplasms of the breast that need to be clarified. Our ultimate aim was actually to try to understand whether neuroendocrine neoplasms of the breast can be considered a definite clinical entity and if neuroendocrine differentiation of breast tumors has a really clinical relevance.
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Affiliation(s)
- Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
- Endocrinology and Metabolic Diseases Unit, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Valentina Di Vito
- Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Nicoletta Fortunati
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Fabio Lo Calzo
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University “Federico II”, Naples, Italy
| | - Erika Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Antongiulio Faggiano
- Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
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Ruggeri RM, Giovinazzo S, Barbalace MC, Cristani M, Alibrandi A, Vicchio TM, Giuffrida G, Aguennouz MH, Malaguti M, Angeloni C, Trimarchi F, Hrelia S, Campennì A, Cannavò S. Influence of Dietary Habits on Oxidative Stress Markers in Hashimoto's Thyroiditis. Thyroid 2021; 31:96-105. [PMID: 32729374 DOI: 10.1089/thy.2020.0299] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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] [Indexed: 02/06/2023]
Abstract
Background: There is a growing awareness that nutritional habits may influence risk of several inflammatory and immune-mediated disorders, including autoimmune diseases, through various mechanisms. The aim of the present study was to investigate dietary habits and their relationship with redox homeostasis in the setting of thyroid autoimmunity. Materials and Methods: Two hundred subjects (173 females and 27 males; median age, 37 years) were enrolled. None were under any pharmacological treatment. Exclusion criteria were any infectious/inflammatory/autoimmune comorbidity, kidney failure, diabetes, and cancer. In each subject, serum thyrotropin (TSH), free thyroxine, antithyroid antibodies, and circulating oxidative stress markers were measured. A questionnaire on dietary habits, evaluating the intake frequencies of food groups and adherence to the Mediterranean diet, was submitted to each participant. Results: Among the 200 recruited subjects, 81 (71 females and 10 males) were diagnosed with euthyroid Hashimoto's thyroiditis (HT); the remaining 119 (102 females and 17 males) served as controls. In questionnaires, HT subjects reported higher intake frequencies of animal foods (meat, p = 0.0001; fish, p = 0.0001; dairy products, p = 0.004) compared with controls, who reported higher intake frequencies of plant foods (legumes, p = 0.001; fruits and vegetables, p = 0.030; nuts, p = 0.0005). The number of subjects who preferentially consumed poultry instead of red/processed meat was lower in HT subjects than in controls (p = 0.0141). In logistic regression analysis, meat consumption was associated with increased odds ratio of developing thyroid autoimmunity, while the Mediterranean diet traits were protective. In HT subjects, serum advanced glycation end products (markers of oxidative stress) were significantly higher (p = 0.0001) than in controls, while the activity of glutathione peroxidase and thioredoxin reductase, as well as total plasma antioxidant activity, were lower (p = 0.020, p = 0.023, and p = 0.002, respectively), indicating a condition of oxidative stress. Stepwise regression models demonstrated a significant dependence of oxidative stress parameters on consumption of animal foods, mainly meat. Conclusions: The present study suggests a protective effect of low intake of animal foods toward thyroid autoimmunity and a positive influence of such nutritional patterns on redox balance and potentially on oxidative stress-related disorders.
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Affiliation(s)
- Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy
| | | | - Maria Cristina Barbalace
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mariateresa Cristani
- Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | - Teresa M Vicchio
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy
| | - Giuseppe Giuffrida
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy
| | - Mohamed H Aguennouz
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Malaguti
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | | | - Silvana Hrelia
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alfredo Campennì
- Department of Biomedical Sciences and Morphological and Functional Images, Unit of Nuclear Medicine, University of Messina, Messina, Italy
| | - Salvatore Cannavò
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy
- Department of Human Pathology DETEV, University of Messina, Messina, Italy
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D'Ascola A, Scuruchi M, Ruggeri RM, Avenoso A, Mandraffino G, Vicchio TM, Campo S, Campo GM. Hyaluronan oligosaccharides modulate inflammatory response, NIS and thyreoglobulin expression in human thyrocytes. Arch Biochem Biophys 2020; 694:108598. [PMID: 32976824 DOI: 10.1016/j.abb.2020.108598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/28/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 02/07/2023]
Abstract
Autoimmune thyroid diseases, such as Hashimoto's thyroiditis, are characterized by lymphocytic infiltration and altered function of the thyroid. During inflammation, it has been reported a decreased expression in Tg and NIS, accompanied by an increase in HA production that accumulates in the gland. HA fragments produced in different pathological states can modulate gene expression in a variety of cell types and may prime inflammatory response by interacting with the TLR-2, TLR-4 and CD44 that, in turn, induce NF-kB activation finally responsible of inflammatory mediator transcription, such as IL-1β, TNF-α and IL-6. The aim of this study was to investigate the potential inflammatory effect and the biochemical pathways activated by 6-mer HA oligosaccharides in cultured human thyrocytes. 6-mer HA treatment induced up-regulation of TLR-2, TLR-4, CD44 mRNA and related protein levels, increased HA production and NF-kB activation, that in turn increased IL-1β and IL-6 concentrations. Instead, we found evidence of an opposite effect on thyroid specific-gene Tg and NIS, that were decreased after 6-mer HA addition. Thyrocytes exposition to specific blocking antibodies for TLR-2, TLR-4 and CD44 abolished up-regulation of NF-κB activation and the consequent pro-inflammatory cytokine production, while restored Tg and NIS levels. A further goal of this study was demonstrate that also other LMW HA have pro inflammatory proprieties. These data suggest that HA fragments, through the involvement of TLR-2, TLR-4 and CD44 signaling cascade, contribute to prime the inflammatory response in thyrocytes and, by reducing the expression of thyroid-specific genes, could promote the loss of function of gland such as in Hashimoto's thyroiditis.
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Affiliation(s)
- Angela D'Ascola
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital, via C. Valeria 1, 98125, Messina, Italy.
| | - Michele Scuruchi
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital, via C. Valeria 1, 98125, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital, via C. Valeria 1, 98125, Messina, Italy
| | - Angela Avenoso
- Department of Biomedical and Dental Sciences, and Morphofunctional Images, University of Messina, University Hospital, via C. Valeria 1, 98125 Messina, Italy University of Messina, via C. Valeria 1, 98125, Messina, Italy
| | - Giuseppe Mandraffino
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital, via C. Valeria 1, 98125, Messina, Italy
| | - Teresa Manuela Vicchio
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital, via C. Valeria 1, 98125, Messina, Italy
| | - Salvatore Campo
- Department of Biomedical and Dental Sciences, and Morphofunctional Images, University of Messina, University Hospital, via C. Valeria 1, 98125 Messina, Italy University of Messina, via C. Valeria 1, 98125, Messina, Italy
| | - Giuseppe Maurizio Campo
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital, via C. Valeria 1, 98125, Messina, Italy
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Ruggeri RM, Barbalace MC, Cristani MT, Alibrandi A, Giovinazzo S, Giuffrida G, Trimarchi F, Cannavò S, Campennì A. Serum levels of advanced glycation end products (AGEs) are increased and their soluble receptor (sRAGE) reduced in Hashimoto's thyroiditis. J Endocrinol Invest 2020; 43:1337-1342. [PMID: 32232775 DOI: 10.1007/s40618-020-01231-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/08/2020] [Accepted: 03/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Advanced glycation end products (AGEs) are increased in conditions of oxidative stress and promote inflammation by interacting with their receptor RAGE on cell membrane. By contrast, the soluble receptor sRAGE exerts protective effects by competing with RAGE for ligand binding. AGEs/sRAGEs interaction is involved in the pathogenesis of several diseases related to oxidative stress. In the present study, we evaluated the AGEs/sRAGEs oxidative balance in Hashimoto' thyroiditis (HT). METHODS We measured the levels of sRAGE, by ELISA, and AGEs, by spectrophotometric method, in the serum of 50 HT patients (5 M, 45 F; mean age 38.5 ± 12 years) and 50 age-, sex- and BMI-matched healthy controls. All subjects were euthyroid at recruitment and none was on LT-4 therapy. RESULTS Serum sRAGEs were significantly lower (median 424 vs 738 pg/ml; p = 0.001) and AGEs higher (205 vs 114 AU/g prot; p = 0.001) in HT patients compared to controls, and the two parameters were inversely correlated (p = 0.016). Accordingly, the AGEs/sRAGEs ratio was threefold higher in HT patients than controls (0.48 vs 0.15; p = 0.0001). In regression analysis models, serum TPO-Ab were the main predictors for AGEs and sRAGEs levels and AGEs/sRAGEs ratio (p < 0.0001), irrespective of TSH and/or FT4 values. CONCLUSION sRAGEs were decreased and AGEs increased, suggesting a dysregulation of AGE/sRAGEs-related oxidative homeostasis in HT patients, even when in euthyroid status. Autoimmunity per se seems to play an important role in AGEs/sRAGE imbalance, irrespective of thyroid function alterations.
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Affiliation(s)
- R M Ruggeri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
- Endocrine Unit, University Hospital AOU Policlinico G. Martino, 98125, Messina, Italy.
| | - M C Barbalace
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M T Cristani
- Department of Pharmaceutical Sciences and Health Products, University of Messina, Messina, Italy
| | - A Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | - S Giovinazzo
- Endocrine Unit, University Hospital AOU Policlinico G. Martino, 98125, Messina, Italy
| | - G Giuffrida
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Endocrine Unit, University Hospital AOU Policlinico G. Martino, 98125, Messina, Italy
| | - F Trimarchi
- Accademia Peloritana dei Pericolanti, University of Messina, Messina, Italy
| | - S Cannavò
- Endocrine Unit, University Hospital AOU Policlinico G. Martino, 98125, Messina, Italy
- Department of Human Pathology DETEV, University of Messina, Messina, Italy
| | - A Campennì
- Unit of Nuclear Medicine, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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Muscogiuri G, Altieri B, Albertelli M, Dotto A, Modica R, Barrea L, Fanciulli G, Feola T, Baldelli R, Ruggeri RM, Gallo M, Guarnotta V, Malandrino P, Messina E, Venneri MA, Giannetta E, Ferone D, Colao A, Faggiano A. Epidemiology of pancreatic neuroendocrine neoplasms: a gender perspective. Endocrine 2020; 69:441-450. [PMID: 32468269 DOI: 10.1007/s12020-020-02331-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 02/03/2020] [Accepted: 04/25/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Pancreatic neuroendocrine neoplasms (PNENs) are a group of clinically rare and heterogeneous tumors of the pancreas. Currently there are no studies investigating the gender difference in PNEN susceptibility. Thus, the purpose of this study was aimed at examining how gender shapes risk factors, clinicopathological features, and comorbidities in PNENs. METHODS The study design consisted of an Italian multicenter, retrospective study. The study included all consecutive patients with PNENs followed at the participating centers. Two hundred and twenty-nine patients (105 males,124 females, age 54 ± 0.98 years) with PNENs were enrolled at the participating centers. The clinicopathological features (age, gender, BMI, histology, tumor size, tumor grade, distant metastasis, hormonal function, and diagnostic circumstances), comorbidities (cardiovascular diseases (CVD), pancreatitis, type 2 diabetes (T2DM), and potential risk factors (smoking and drinking) were included in the analysis. RESULTS Females were slightly prevalent (54.15%). PNENs were diagnosed at younger age in females compared to males (p = 0.04). The prevalence of CVD was significantly higher in males than in females (p = 0.006). In the female group, the presence of T2DM was significantly associated with higher tumor grade (p = 0.04) and metastatic disease (p = 0.02). The proportion of smokers and alcohol drinkers was significantly higher in the male group (p < 0.001). No significant gender differences were detected regarding the other parameters included in the analysis. CONCLUSIONS This study has identified gender differences of PNENs in terms of age at diagnosis, associated comorbidities, and potential risk factors. A gender-tailored approach could become a potential strategy to better understand the natural history of PNENs and improve the effectiveness of PNENs clinical management.
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Affiliation(s)
- Giovanna Muscogiuri
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy.
| | - Barbara Altieri
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Manuela Albertelli
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialities (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Andrea Dotto
- Endocrinology Unit, Department of Internal Medicine and Medical Specialities (DIMI), University of Genoa, Genoa, Italy
| | - Roberta Modica
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Luigi Barrea
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Giuseppe Fanciulli
- Department of Surgical, Medical and Experimental Sciences, University of Sassari-Endocrine Unit, AOU Sassari, Sassari, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Baldelli
- Endocrinological Oncology, Service of Endocrinology, A.O. San Camillo-Forlanini, Rome, Italy
| | | | - Marco Gallo
- Department of Medical Sciences, Oncological Endocrinology Unit, University of Turin, Turin, Italy
| | - Valentina Guarnotta
- Section of Endocrine-Metabolic Diseases, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Pasqualino Malandrino
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Erika Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mary Anna Venneri
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Diego Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialities (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
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Vicchio TM, Aliquò F, Ruggeri RM, Ragonese M, Giuffrida G, Cotta OR, Spagnolo F, Torre ML, Alibrandi A, Asmundo A, Angileri FF, Esposito F, Polito F, Oteri R, Aguennouz MH, Cannavò S, Ferraù F. MicroRNAs expression in pituitary tumors: differences related to functional status, pathological features, and clinical behavior. J Endocrinol Invest 2020; 43:947-958. [PMID: 31939196 DOI: 10.1007/s40618-019-01178-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 07/03/2019] [Accepted: 12/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND MicroRNAs (miRNAs) are small non-coding RNA molecules that regulate gene expression at post-transcriptional level, having a role in many biological processes, such as control of cell proliferation, cell cycle, and cell death. Altered miRNA expression has been reported in many neoplasms, including pituitary adenomas (PAs). PURPOSE In this study, we aimed to evaluate the expression of 20 miRNAs involved in pathways relevant to pituitary pathophysiology, in PAs and normal pituitary tissue and to correlate their expression profile with clinical and pathological features. METHODS Pituitary tumor samples were obtained during transphenoidal surgery from patients with non-functioning (NFPA, n = 12) and functioning (n = 11, 5 GH-, 3 ACTH-, 3 PRL-omas) PAs. The expression of selected miRNAs in PAs and in normal pituitary was analyzed by RT-qPCR. miRNAs expression was correlated with demographic, clinical, and neuroradiological data and with histopathological features including pituitary hormones immunostaining, Ki-67 proliferation index, and p53 immunohistochemistry evaluation. RESULTS All evaluated miRNAs except miR-711 were expressed in both normal and tumor pituitary tissue. Seventeen miRNAs were significantly down-regulated in pituitary tumors compared to normal pituitary. miRNAs were differentially expressed in functioning PAs or in NFPAs, as in the latter group miR-149-3p (p = 0.036), miR-130a-3p (p = 0.014), and miR-370-3p (p = 0.026) were significantly under expressed as compared to functioning tumors. Point-biserial correlation analysis demonstrated a negative correlation between miR-26b-5p and Ki-67 (p = 0.031) and between miR-30a-5p and 'atypical' morphological features (p = 0.038) or cavernous sinus invasion (p = 0.049), while 508-5p was inversely correlated with clinical aggressiveness (p = 0.043). CONCLUSIONS In this study, we found a significant down-regulation of 17 miRNAs in PAs vs normal pituitary, with differential expression profile related to functional status and tumor aggressiveness.
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Affiliation(s)
- T M Vicchio
- Unit of Endocrinology, University Hospital 'G. Martino', Messina, Italy
| | - F Aliquò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - R M Ruggeri
- Unit of Endocrinology, University Hospital 'G. Martino', Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M Ragonese
- Unit of Endocrinology, University Hospital 'G. Martino', Messina, Italy
| | - G Giuffrida
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - O R Cotta
- Unit of Endocrinology, University Hospital 'G. Martino', Messina, Italy
| | - F Spagnolo
- Unit of Endocrinology, University Hospital 'G. Martino', Messina, Italy
| | - M L Torre
- Unit of Endocrinology, University Hospital 'G. Martino', Messina, Italy
| | - A Alibrandi
- Department of Economics, University of Messina, Messina, Italy
| | - A Asmundo
- Department of Biomedical Sciences, Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - F F Angileri
- Department of Biomedical Sciences, Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - F Esposito
- Department of Biomedical Sciences, Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - F Polito
- Department of Human Pathology of Adulthood and Childhood 'G. Barresi', University of Messina, UOC di Endocrinologia, Pad. H, 4° Piano, AOU Policlinico Gaetano Martino, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - R Oteri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M H Aguennouz
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - S Cannavò
- Unit of Endocrinology, University Hospital 'G. Martino', Messina, Italy
- Department of Human Pathology of Adulthood and Childhood 'G. Barresi', University of Messina, UOC di Endocrinologia, Pad. H, 4° Piano, AOU Policlinico Gaetano Martino, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - F Ferraù
- Department of Human Pathology of Adulthood and Childhood 'G. Barresi', University of Messina, UOC di Endocrinologia, Pad. H, 4° Piano, AOU Policlinico Gaetano Martino, Via Consolare Valeria, 1, 98125, Messina, Italy.
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Giuffrida G, Campennì A, Trimarchi F, Ruggeri RM. Comment on “Prevalence of undifferentiated inflammatory arthropathy in patients with Hashimoto's thyroiditis in an endocrinology clinic” by Luis M. Valderrama‐Hinds and co‐workers.
Int J Rheum Dis
2019; 22: 1985‐1989. Int J Rheum Dis 2020; 23:597-598. [DOI: 10.1111/1756-185x.13820] [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: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Giuseppe Giuffrida
- Department of Clinical and Experimental Medicine University of Messina Messina Italy
- Endocrine Unit at University Hospital of Messina Messina Italy
| | - Alfredo Campennì
- Unit of Nuclear Medicine Department of Biomedical and Dental Sciences and Morpho‐functional Imaging University of Messina Messina Italy
| | - Francesco Trimarchi
- Accademia Peloritana dei Pericolanti at the University of Messina Messina Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine University of Messina Messina Italy
- Endocrine Unit at University Hospital of Messina Messina Italy
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Scappaticcio L, Castellana M, Virili C, Bellastella G, Centanni M, Cannavò S, Campennì A, Ruggeri RM, Giovanella L, Trimboli P. Alemtuzumab-induced thyroid events in multiple sclerosis: a systematic review and meta-analysis. J Endocrinol Invest 2020; 43:219-229. [PMID: 31452116 DOI: 10.1007/s40618-019-01105-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 07/24/2019] [Accepted: 08/21/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE Autoimmune thyroid events (ATEs) are common side effects after alemtuzumab (ALZ) therapy in patients with multiple sclerosis (MS). Our purpose was to reach more robust evidence on prevalence and outcome of the spectrum of alemtuzumab-induced autoimmune thyroid events in patients with multiple sclerosis. METHODS PubMed and Scopus were systematically searched through July 2019. Studies dealing with patients without personal history of thyroid dysfunctions and affected by MS treated with ALZ and reporting ATEs were selected. Data on prevalence and outcome of ATEs were extracted. A proportion of meta-analysis with random-effects model was performed. RESULTS Considering the overall pooled number of 1362 MS patients treated with ALZ (seven included studies), a 33% prevalence of newly diagnosed ATEs was recorded. Among all ATEs, Graves' disease (GD) was the most represented [63% of cases, 95% confidence interval (CI) 52-74%], followed by Hashimoto thyroiditis (15%, 95% CI 10-22%). Interestingly, GD showed a fluctuating course in 15% of cases (95% CI 8-25%). Of all GD, 12% (95% CI 2-42%) likely had spontaneous remission, 56% (95% CI 34-76%) required only antithyroid drugs, 22% (95% CI 13-32%) needed additional RAI, and 11% (95% CI 0.9-29%) underwent definitive surgery. CONCLUSION Among different categories of ATEs, Graves' hyperthyroidism was the most common thyroid dysfunction, occurring in more than half of cases. Antithyroid drugs should represent the first-line treatment for ALZ-induced GD patients. However, alemtuzumab-induced GD could not be considered as having a more favourable outcome than conventional GD, given the substantial chance to encounter a fluctuating and unpredictable course.
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Affiliation(s)
- L Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, University of Campania "L.Vanvitelli", 80138, Naples, Italy.
| | - M Castellana
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - C Virili
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - G Bellastella
- Unit of Endocrinology and Metabolic Diseases, University of Campania "L.Vanvitelli", 80138, Naples, Italy
| | - M Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - S Cannavò
- Department of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
- Unit of Endocrinology, "G. Martino" University Hospital, University of Messina, Messina, Italy
| | - A Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - R M Ruggeri
- Unit of Endocrinology, "G. Martino" University Hospital, University of Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - P Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Barrea L, Gallo M, Ruggeri RM, Giacinto PD, Sesti F, Prinzi N, Adinolfi V, Barucca V, Renzelli V, Muscogiuri G, Colao A, Baldelli R. Nutritional status and follicular-derived thyroid cancer: An update. Crit Rev Food Sci Nutr 2020; 61:25-59. [PMID: 31997660 DOI: 10.1080/10408398.2020.1714542] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The incidence of differentiated thyroid cancer has been increasing in the last decades all over the world. Such a steady growth cannot be entirely attributable to more intensive thyroid nodule screening and more sensitive diagnostic procedures. Several environmental factors have changed with sufficient rapidity in the same time frame and may represent credible candidates for this increase. They include modified iodine intake, lifestyle-associated risk factors, exposure to various toxic compounds, pollutants and xenobiotics, nutritional deficiencies, eating habits and comorbidities. Foremost, nutritional patterns have gained high interest as possible promoters and modifiable risk factors for thyroid cancer in recent years. The aim of this narrative review is to focus on the relationship between thyroid cancer and nutritional factors, dietary habits and obesity. Low iodine intake has been associated to increased risk of thyroid cancer, favoring the development of more aggressive histotypes. Moreover, correction of iodine deficiency can shift thyroid cancer subtypes toward less aggressive forms, without affecting the overall risk for cancer. Actually, evidence regarding the association between selenium and vitamin D deficiency and thyroid cancer is very limited, despite their well-known anti-cancer potentials, and the clinical usefulness of their supplementation is still uncertain in this setting. Albeit the relationship between single foods and thyroid cancer is difficult to examine, fish and iodine-rich foods, vegetables, and fruits might exert protective effects on thyroid cancer risk. Conversely, no clear association has been found for other foods to date. Lastly, a clear association between obesity and the risk of thyroid cancer, with more aggressive behavior, seems to emerge from most studies, likely involving variations in thyroid function and chronic inflammation mediated by cytokines, insulin, leptin and adiponectins. Although no definite association between dietary factors and thyroid cancer has been firmly established so far, some nutritional patterns, together with excessive weight, seem to play a relevant role in thyroid cancer carcinogenesis as well as in its severity and aggressiveness. These effects may play an additive role to the well-established one exerted by environmental carcinogens, such as pollutants and radiation exposure.
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Affiliation(s)
- Luigi Barrea
- Unit of Endocrinology, Dipartimento di Medicina Clinica e Chirurgia, Federico II University Medical School of Naples, Naples, Italy
| | - Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Rosaria Maddalena Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paola Di Giacinto
- Endocrinology Unit, Department of Oncology and Medical Specialities, A.O. San Camillo-Forlanini, Rome, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Natalie Prinzi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Milan, Italy
| | - Valerio Adinolfi
- Endocrinology and Diabetology Unit, ASL Verbano Cusio Ossola, Domodossola, Italy
| | - Viola Barucca
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Valerio Renzelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanna Muscogiuri
- Unit of Endocrinology, Dipartimento di Medicina Clinica e Chirurgia, Federico II University Medical School of Naples, Naples, Italy
| | - Annamaria Colao
- Unit of Endocrinology, Dipartimento di Medicina Clinica e Chirurgia, Federico II University Medical School of Naples, Naples, Italy
| | - Roberto Baldelli
- Endocrinology Unit, Department of Oncology and Medical Specialities, A.O. San Camillo-Forlanini, Rome, Italy
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Giuffrida G, Bagnato G, Campennì A, Giovinazzo S, Keller KP, Alibrandi A, Roberts WN, Trimarchi F, Ruggeri RM. Non-specific rheumatic manifestations in patients with Hashimoto's thyroiditis: a pilot cross-sectional study. J Endocrinol Invest 2020; 43:87-94. [PMID: 31301020 DOI: 10.1007/s40618-019-01083-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/22/2019] [Accepted: 07/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Hashimoto's thyroiditis (HT) is often associated with rheumatic disorders (arthritis, etc.), but many HT patients report non-specific rheumatic signs and symptoms in the absence of clinically evident rheumatic diseases. Aim of this study was to evaluate the prevalence of non-specific rheumatic manifestations (RMs) in HT subjects without classified autoimmune comorbidities. METHODS 500 HT patients (467 F, 33 M; median age 41 years, range 14-69) and 310 age- and sex-matched controls, consecutively referred to the Endocrine Unit of Messina University Hospital, were evaluated for non-specific RMs. None took L-thyroxine. EXCLUSION CRITERIA autoimmune comorbidities, infectious, and/or inflammatory diseases, history of neoplasia, BMI > 30 kg/m2. RESULTS In our HT cohort, 100 patients (20%) complained of one or more RMs, vs 21 controls (6.8%; P < 0.001). There were minimal differences between the manifestations recorded in the two groups, the most common being polyarthralgias and myalgias/fibromyalgia, but non-specific RMs occurred threefold more in HT patients. Comparing HT patients with RMs (96 F and 4 M) with those affected by HT alone, female sex was prevalent (F:M ratio 24:1 vs 5:1) with higher age at diagnosis (median 43 vs 37 years; P < 0.001). HT patients with RMs (62%) were mostly euthyroid (median TSH 2.0 µIU/L) and only 7% overtly hypothyroid, discouraging a possible causal relationship between thyroid dysfunction per se and RMs. CONCLUSIONS A significant percentage of HT patients complains of non-specific rheumatic signs and symptoms, in the absence of other diagnosed systemic comorbidities and regardless of thyroid functional status, deserving careful evaluation and prolonged follow-up.
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Affiliation(s)
- G Giuffrida
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Gaetano Martino University Hospital, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
- Endocrine Unit at University Hospital of Messina, Messina, Italy.
| | - G Bagnato
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - A Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - S Giovinazzo
- Endocrine Unit at University Hospital of Messina, Messina, Italy
| | - K P Keller
- Unit of Rheumatology, Division of Medicine, University of Kentucky, Lexington, KY, USA
| | - A Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - W N Roberts
- Unit of Rheumatology, Division of Medicine, University of Kentucky, Lexington, KY, USA
| | - F Trimarchi
- Accademia Peloritana dei Pericolanti at the University of Messina, Messina, Italy
| | - R M Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Gaetano Martino University Hospital, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
- Endocrine Unit at University Hospital of Messina, Messina, Italy
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Trimboli P, Palermo A, Deandrea M, Piccardo A, Campennì A, Valabrega S, Grani G, Santolamazza G, Bottoni G, Barnabei A, Ramundo V, Lauretta R, Monte L, Ferrarazzo G, Paone G, Crosetto C, Ruggeri RM, Baldari S, Chiefari A, Vottari S, Giarnieri E, Perrella E, Limone P, Durante C, Giovanella L, Appetecchia M, Crescenzi A. Prognosis of patients with differentiated thyroid carcinomas having a preoperative cytological report of indeterminate at low or high risk. A multicenter study. Endocrine 2019; 66:557-562. [PMID: 31313225 DOI: 10.1007/s12020-019-02013-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Italian cytology system for thyroid fine-needle aspiration (FNA) includes indeterminate lesions at low- (Tir 3A) and high-risk (Tir 3B). The present retrospective multicenter study was undertaken to compare the histological type of cancers and disease-free survival in these two groups. METHODS Eight institutions participated. Thyroid cancer patients diagnosed and followed-up after Tir 3A or Tir 3B were reviewed. Histological diagnosis was adopted as the gold standard. Patients were defined with cancer recurrence or no evidence of disease. Disease-free survival (DFS) was calculated. A non-parametric statistical analysis was used. DFS was estimated by Kaplan-Meier method and Hazard Ratio (HR) defined the slope of curves. RESULTS Two hundred and nine patients (median DFS 24 months) were enrolled and a 6.3% of these recurred. Tir 3B group had higher age (p = 0.014), larger cancer size (p = 0.0002), shorter DFS (p = 0.003), higher number of aggressive cancers (p = 0.006), and relapse frequency double than Tir 3A. At survival curves analysis, Tir 3B group had HR of 2.37 with respect to Tir 3A. At Cox's proportional hazard regression analysis histology was the only significant predictor of relapse. CONCLUSIONS While patients with thyroid FNA of Tir 3B should be addressed to surgery due to high likelihood of more aggressive cancer, a diagnostic surgery could be avoided in patients with Tir 3A if concurrent unsuspicious clinical features are found.
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Affiliation(s)
- Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
| | - Andrea Palermo
- Units of Endocrinology and Diabetes, Department of Medicine, University Hospital Campus Bio Medico, Rome, Italy
| | - Maurilio Deandrea
- Endocrinology, Diabetes, and Metabolism Unit, A.O. Ordine Mauriziano di Torino, "Umberto I" Hospital, Turin, Italy
| | | | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Stefano Valabrega
- Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy
| | - Giorgio Grani
- Department of Traslational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giuliano Santolamazza
- Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy
| | | | - Agnese Barnabei
- Oncological Endocrinology Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria Ramundo
- Department of Traslational and Precision Medicine, Sapienza University, Rome, Italy
| | - Rosa Lauretta
- Oncological Endocrinology Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Lavinia Monte
- Endocrinology, Diabetes, and Metabolism Unit, A.O. Ordine Mauriziano di Torino, "Umberto I" Hospital, Turin, Italy
| | | | - Gaetano Paone
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Cecilia Crosetto
- Endocrinology, Diabetes, and Metabolism Unit, A.O. Ordine Mauriziano di Torino, "Umberto I" Hospital, Turin, Italy
| | - Rosaria Maddalena Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, "G. Martino" University Hospital, University of Messina, Messina, Italy
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Alfonsina Chiefari
- Oncological Endocrinology Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Sebastiano Vottari
- Oncological Endocrinology Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Giarnieri
- Departments of Clinical and Molecular Medicine, Sapienza University, St. Andrea Hospital, Rome, Italy
| | - Eleonora Perrella
- Section of Pathology, University Hospital Campus Bio Medico, Rome, Italy
| | - Paolo Limone
- Endocrinology, Diabetes, and Metabolism Unit, A.O. Ordine Mauriziano di Torino, "Umberto I" Hospital, Turin, Italy
| | - Cosimo Durante
- Department of Traslational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Crescenzi
- Section of Pathology, University Hospital Campus Bio Medico, Rome, Italy
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Campennì A, Amato E, Laudicella R, Alibrandi A, Cardile D, Pignata SA, Trimarchi F, Ruggeri RM, Auditore L, Baldari S. Recombinant human thyrotropin (rhTSH) versus Levo-thyroxine withdrawal in radioiodine therapy of differentiated thyroid cancer patients: differences in abdominal absorbed dose. Endocrine 2019; 65:132-137. [PMID: 30875058 DOI: 10.1007/s12020-019-01897-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/10/2019] [Accepted: 03/07/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE In DTC patients, 131-radioiodine therapy has routinely been used for many years for thyroid remnant ablation after thyroid surgery. To date, two different strategies can be used to achieve sufficient TSH stimulation on thyroid remnant: (I) Levo-thyroxine withdrawal or (II) rhTSH stimulation. The aim of our study was to compare the abdominal absorbed dose ratio between differentiated thyroid cancer patients who underwent thyroid remnant ablation after either L-T4 withdrawal or rhTSH stimulation. METHODS We reviewed the records of 63 patients affected by differentiated thyroid cancer. All patients underwent thyroid remnant ablation after either L-T4 withdrawal or rhTSH stimulation. A post-therapy whole-body scan was obtained 5 days after 131-radioiodine therapy. Qualitative and quantitative image analysis was performed. Quantitative analysis was performed by drawing seven regions of interest on the abdomen (anterior and posterior views) to estimate both the activity ratio (AR) and absorbed dose ratio (DR) obtained in patients treated in hypothyroidism or after rhTSH stimulation. RESULTS The values of the activity and absorbed dose ratios obtained on each abdomen region (liver, stomach, ascending colon, transverse colon, descending colon, rectum, and small intestine) were always higher in patients treated after L-T4 withdrawal than after rhTSH stimulation with p-values of 0.000, 0.000, 0.001, 0.000, 0.022, 0.007, and 0.002, respectively. CONCLUSIONS DTC patients treated with 131-radioiodine after rhTSH stimulation have lower abdominal radioiodine activity than hypothyroid patients. Our data could be of practical relevance in terms of patient management. The potential impact on rare radioiodine-related gastrointestinal side effects is to be established in specifically designed prospective studies.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.
| | - Ernesto Amato
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Riccardo Laudicella
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
| | - Davide Cardile
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Salvatore Antonio Pignata
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Francesco Trimarchi
- Accademia Peloritana dei Pericolanti at the University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - Lucrezia Auditore
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
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Ruggeri RM, Campennì A, Giuffrida G, Trimboli P, Giovanella L, Trimarchi F, Cannavò S. Endocrine and metabolic adverse effects of immune checkpoint inhibitors: an overview (what endocrinologists should know). J Endocrinol Invest 2019; 42:745-756. [PMID: 30471004 DOI: 10.1007/s40618-018-0984-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/15/2018] [Indexed: 12/26/2022]
Abstract
Immune checkpoint inhibitors (ICIs) are novel anticancer agents, recently introduced with the aim of boosting the immune response against tumors. ICIs are monoclonal autoantibodies that specifically target inhibitory receptors on T cells: cytotoxic T lymphocyte antigen 4 (CTLA4), programmed death 1 (PD-1) and its ligand (PD-1L). ICIs also generate peculiar dysimmune toxicities, called immune-related adverse events (irAEs), that can potentially affect any tissue, and some may be life-threatening if not promptly recognized. The endocrine and metabolic side effects of ICIs are reviewed here, with a particular focus on their clinical presentation and management. They are among the most frequent toxicities (around 10%) and include hypophysitis, thyroid disorders, adrenalitis, and diabetes mellitus. Treatment is based on the replacement of specific hormone deficits, accompanied by immunosuppression (with corticosteroids or other drugs), depending on irAEs grade, often without the need of ICI withdrawal, except in more severe forms. Prompt recognition of endocrine and metabolic irAEs and adequate treatment allow the patients to continue a therapy they are benefiting from. Endocrinologists, as an integral part of the multidisciplinary oncologic team, need to be familiar with the unique toxicity profile of these anticancer agents. Practical recommendations for their management are proposed.
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Affiliation(s)
- R M Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Building H, Floor 4, "G. Martino" University Hospital, University of Messina, 98125, Messina, Italy
| | - A Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - G Giuffrida
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Building H, Floor 4, "G. Martino" University Hospital, University of Messina, 98125, Messina, Italy.
| | - P Trimboli
- Nuclear Medicine, PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Giovanella
- Nuclear Medicine, PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - F Trimarchi
- Accademia Peloritana dei Pericolanti at the University of Messina, Messina, Italy
| | - S Cannavò
- Department of Human Pathology of Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
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Abstract
Prader-Willi syndrome (PWS) is a genetic disorder characterized by short stature, low lean body mass, muscular hypotonia, mental retardation, behavioral abnormalities, dysmorphic features, and excessive appetite with progressive obesity. It is caused by lack of expression of genes on the paternally inherited chromosome 15q11.2-q13. This genetic disorder has an estimated prevalence that ranges between 1/10,000-1/30,000. Hypothalamic dysfunction is a common finding in PWS and it has been implicated in several manifestations of this syndrome such as hyperphagia, temperature instability, high pain threshold, sleep disordered breathing, and multiple endocrine abnormalities. These include growth hormone deficiency, central adrenal insufficiency, hypogonadism, hypothyroidism, and obesity often complicated by type 2 diabetes. The aim of this manuscript is to overview the current literature on metabolic and endocrine complications of PWS, focusing on human studies and providing insights on the physio pathological mechanisms. A careful management of metabolic and endocrine complications can contribute to improve quality of life, prevent complications, and prolong life expectancy of PW patients.
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Affiliation(s)
- Giovanna Muscogiuri
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pasini 5, 80121, Naples, Italy.
| | - Gloria Formoso
- Department of Medicine and Aging Sciences; Aging and Translational Medicine Research Center (CeSI-Met), G. d'Annunzio University, Chieti, Italy
| | - Gabriella Pugliese
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pasini 5, 80121, Naples, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - Elisabetta Scarano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pasini 5, 80121, Naples, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pasini 5, 80121, Naples, Italy
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Ruggeri RM, Cristani M, Vicchio TM, Alibrandi A, Giovinazzo S, Saija A, Campennì A, Trimarchi F, Gangemi S. Increased serum interleukin-37 (IL-37) levels correlate with oxidative stress parameters in Hashimoto's thyroiditis. J Endocrinol Invest 2019; 42:199-205. [PMID: 29796799 DOI: 10.1007/s40618-018-0903-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 04/27/2018] [Accepted: 05/14/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Interleukin-37 (IL-37), member of the IL-1 family, is a natural suppressor of immune and inflammatory responses. Increased serum IL-37 levels were observed in several autoimmune diseases, including Graves' disease. To our knowledge, no data on Hashimoto's thyroiditis (HT) are available in the literature. METHODS Aim of our study was to measure serum IL-37 levels and evaluate their relationship, if any, with oxidative stress markers in HT patients. We enrolled 45 euthyroid HT patients (5 M e 40 F, median age 40 years) and 50 age- and sex-matched healthy controls. None was under L-thyroxine therapy. Serum IL-37 levels were measured by ELISA. Specific serum tests, such as derived reactive oxygen metabolites (d-ROMs), and biological anti-oxidant potential (BAP) test were performed in all subjects to investigate the changes in oxidative balance, and advanced glycation end products (AGEs) were determined as a specific marker of oxidative stress. RESULTS IL-37 levels were significantly higher in HT than in controls (median 475 vs. 268 pg/ml, P = 0.018). In the same patients, serum oxidants (d-ROMs) were increased and anti-oxidants (BAP) decreased compared with controls (P = 0.011 and < 0.0001, respectively), clearly indicating an enhanced oxidative stress. In addition, AGEs levels were higher in HT patients than in controls (210 vs. 140 AU/g prot, P < 0.0001) and directly correlated with IL-37 levels (P = 0.048). At multivariate analysis, the main independent predictors that influenced IL-37 levels were both anti-thyroid antibodies (P = 0.026) and AGEs levels (P = 0.001). CONCLUSIONS IL-37 is up-regulated in HT and may exert a protective role by counteracting oxidative stress and inflammation.
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Affiliation(s)
- R M Ruggeri
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
- UOC di Endocrinologia, Dipartimento di Medicina Clinica e Sperimentale, Padiglione H, 4 piano - Policlinico Universitario "G. Martino", 98125, Messina, Italy.
| | - M Cristani
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - T M Vicchio
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | - S Giovinazzo
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Saija
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - A Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences, and Morpho-Functional Images, University of Messina, Messina, Italy
| | - F Trimarchi
- Accademia Peloritana dei Pericolanti, University of Messina, Messina, Italy
| | - S Gangemi
- Department of Clinical and Experimental Medicine, Postgraduate School and Division of Allergy and Clinical Immunology, University of Messina, Messina, Italy
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Corica D, Aversa T, Ruggeri RM, Cristani M, Alibrandi A, Pepe G, De Luca F, Wasniewska M. Could AGE/RAGE-Related Oxidative Homeostasis Dysregulation Enhance Susceptibility to Pathogenesis of Cardio-Metabolic Complications in Childhood Obesity? Front Endocrinol (Lausanne) 2019; 10:426. [PMID: 31316471 PMCID: PMC6611173 DOI: 10.3389/fendo.2019.00426] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/14/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Advanced glycation end-products (AGEs) and their cell receptor (RAGE) are involved in the pathophysiology of cardio-metabolic diseases. Interaction of AGEs with RAGE results in increased generation of oxygen radicals and pro-inflammatory cytokines. Circulating soluble RAGE (sRAGE) interacts with AGEs in order to counterbalance the negative effects of AGEs-RAGE interaction. Objectives: To define factors influencing AGEs, sRAGE, AGEs/sRAGE-ratio, and advanced oxidation-protein products (AOPPs) levels and to investigate changes in oxidative balance among overweight/obese children. Materials and methods: Cross-sectional, one Center, case-control study included 41 overweight and obese children aged between 5 and 16 years and 36 lean matched controls. Inclusion criteria were: BMI ≥ 1 SD; term birth; no genetic or endocrine causes of obesity; no associated chronic diseases neither chronic therapies. All patients underwent clinical and biochemical investigations (lipid and glucose profiles, liver, renal and thyroid function tests, uric acid, C-reactive protein (CRP), AGEs, sRAGE, and AOPPs serum concentrations). Significance was established at 0.050. Results: AOPPs, AGEs/sRAGE-ratio, HOMA-IR, triglycerides, triglycerides/HDL-ratio, total cholesterol (TC)/HDL-ratio, atherogenic-index of plasma (AIP), uric acid, CRP were significantly higher, whereas sRAGE and HDL were significantly lower in overweight/obese children than controls. sRAGE was significantly negatively correlated with BMI SD, TC/HDL-ratio, CRP, AOPPs, and positively with HDL. AGE/sRAGE-ratio and AOPPs were significantly positively correlated with BMI SD, TC/HDL-ratio, AIP, CRP, and negatively with HDL. BMI SD was independently associated with AGEs/sRAGE-ratio (B = 0.06; p = 0.008), AOPPs (B = 0.13; p = 0.02), and sRAGE (B = -73.18; p = 0.000). Conclusions: We demonstrated, for the first time in a pediatric cohort, a significant higher value of AGEs/sRAGE-ratio among overweight/obese children, expression of a relative shift to oxidant from anti-oxidant factors, suggesting an AGE/RAGE-related oxidative homeostasis dysregulation that could enhance susceptibility to oxidative/inflammatory tissues damage. Severity of overweight, influencing the increase of oxidative stress in human organism and even in children, may contribute to the pathogenesis of long-term cardiovascular and metabolic alterations.
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Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
- *Correspondence: Domenico Corica
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - Mariateresa Cristani
- Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences, University of Messina, Messina, Italy
| | | | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
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Campennì A, Ruggeri RM, Siracusa M, Pignata SA, Di Mauro F, Vento A, Trimarchi F, Baldari S. Combined BRAF V600E analysis and 99mTc-MIBI scintigraphy can be a useful diagnostic tool in differentiated thyroid cancer patients with incomplete bio-chemical response to first radioiodine therapy (RAIT): a pilot investigation. J Endocrinol Invest 2018; 41:1283-1288. [PMID: 29549631 DOI: 10.1007/s40618-018-0864-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/07/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of the present study was to evaluate the possible diagnostic role of the combined performance of BRAF mutation analysis and MIBI scintigraphy in papillary thyroid cancer (PTC) patients with incomplete bio-chemical response to first radioiodine therapy (RAIT) performed for thyroid remnant ablation. METHODS The records of 15 PTC patients with bio-chemical incomplete response to first RAIT were retrospectively analyzed. BRAFV600E analysis on primary tumor samples was obtained in all cases along with neck ultrasonography and 99mTc-MIBI scintigraphy of the neck-thorax regions at first follow-up. All patients then underwent RAIT with high radioiodine activities. A post-therapy whole-body scan (pT-WBS) was acquired 5-7 days after RAIT. RESULTS Abnormal radioiodine uptake was found in 10 out of the 15 patients (67%, 131I+ve), while in the remaining 33%, no abnormal radioiodine uptake was detected (5/15, 131I-ve). Abnormal tracer uptake was found in 6 out of 10 131I+ve patients at 99mTc-MIBI scintigraphy (MIBI+ve). BRAFV600E mutation was not found in the majority of 131I+ve patients (9 out of 10 BRAFV600E-ve). On the contrary, in the 5 131I-ve patients, 99mTc-MIBI scintigraphy did not show any abnormal tracer uptake (MIBI-ve), while BRAFV600E mutation was present (BRAFV600E+ve). Thus, in our series, the association between MIBI-ve scintigraphy and BRAF+ve mutation was a useful diagnostic tool in predicting negative pT-WBS outcome. CONCLUSION Albeit obtained in a small retrospective series, our results suggest that the combination of BRAFV600E+ve mutation and MIBI-ve scintigraphy may be considered a negative prognostic clue, which predicts the absence of radioiodine uptake at pT-WBS in DTC patients with incomplete bio-chemical response to first RAIT.
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Affiliation(s)
- A Campennì
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.
| | - R M Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - M Siracusa
- Dipartimento Servizi Diagnostici, UOC di Medicina Nucleare-ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - S A Pignata
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - F Di Mauro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - A Vento
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - F Trimarchi
- Accademia Peloritana dei Pericolanti at the University of Messina, Messina, Italy
| | - S Baldari
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
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Trovato MC, Andronico D, Sciacchitano S, Ruggeri RM, Picerno I, Di Pietro A, Visalli G. Nanostructures: between natural environment and medical practice. Rev Environ Health 2018; 33:295-307. [PMID: 30205650 DOI: 10.1515/reveh-2017-0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
Abstract
Nanoparticles (NPs) are small structures under 100 nm in dimension. Interrelationships among the morphological parameters and toxicity of NPs have been the focus of several investigations that assessed potential health risk in environmentally-exposed subjects and the realistic uses of NPs in medical practice. In the current review, we provide a summary of the cellular mechanisms of membrane-mediated transport, including old and novel molecules that transport nanostructures across cellular membranes. The effects of geochemical exposure to natural NPs are evaluated through epidemiological data and cancerous pathways activated by Fe2+ NPs. Specifically, we discuss screening for papillary thyroid carcinomas in the inhabitants of the Sicilian volcanic area surrounding Mount Etna to compare the incidence of thyroid carcinoma in this population. Lastly, considering the increased production of carbon nanotubes (CNTs), we examine the toxicity and potential use of these engineered NPs in drug delivery of an extensive amount of therapeutic and imaging molecules (theranosis) that can be conjugated to CNTs.
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Affiliation(s)
- Maria Concetta Trovato
- Department of Clinical and Experimental Medicine, Policlinico Universitario, Consolare Valeria 1, Messina, Italy
| | - Daniele Andronico
- Istituto Nazionale di Geofisica e Vulcanologia (INGV), Osservatorio Etneo, Sezione di Catania, Piazza Roma 2, Catania, Italy
| | - Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, Rome, Italy
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, Rome, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Policlinico Universitario, Consolare Valeria 1, Messina, Italy
| | - Isa Picerno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico Universitario, Consolare Valeria 1, Messina, Italy
| | - Angela Di Pietro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico Universitario, Consolare Valeria 1, Messina, Italy
| | - Giuseppa Visalli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico Universitario, Consolare Valeria 1, Messina, Italy
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Marcucci G, Cianferotti L, Parri S, Altieri P, Arvat E, Benvenga S, Betterle C, Bondanelli M, Boscaro M, Camozzi V, Centaro GM, Cetani F, Chiodini I, Ciampolillo A, Colao A, Corbetta S, De Feo ML, Uberti ED, Faggiano A, Fornari R, Gaspari AL, Giorgino F, Giuliani V, Iacobone M, Innaro N, Lamacchia O, Lenzi A, Mantovani G, Marcocci C, Masi L, Migliaccio S, Palmieri S, Pasquali R, Perigli G, Piccini V, Romagnoli E, Ruggeri RM, Rulli F, Samà MT, Tomaino G, Trimarchi F, Zatelli MC, Brandi ML. HypoparaNet: A Database of Chronic Hypoparathyroidism Based on Expert Medical-Surgical Centers in Italy. Calcif Tissue Int 2018; 103:151-163. [PMID: 29511787 DOI: 10.1007/s00223-018-0411-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 12/10/2017] [Accepted: 03/02/2018] [Indexed: 12/20/2022]
Abstract
Hypoparathyroidism is a rare disease characterized by low serum calcium levels and absent or deficient parathyroid hormone level. Regarding the epidemiology of chronic hypoparathyroidism, there are limited data in Italy and worldwide. Therefore, the purpose of this study was to build a unique database of patients with chronic hypoparathyroidism, derived from the databases of 16 referral centers for endocrinological diseases, affiliated with the Italian Society of Endocrinology, and four centers for endocrine surgery with expertise in hypoparathyroidism, to conduct an epidemiological analysis of chronic hypoparathyroidism in Italy. The study was approved by the Institutional Review Board. A total of 537 patients with chronic hypoparathyroidism were identified. The leading etiology was represented by postsurgical hypoparathyroidism (67.6%), followed by idiopathic hypoparathyroidism (14.6%), syndromic forms of genetic hypoparathyroidism (11%), forms of defective PTH action (5.2%), non-syndromic forms of genetic hypoparathyroidism (0.9%), and, finally, other forms of acquired hypoparathyroidism, due to infiltrative diseases, copper or iron overload, or ionizing radiation exposure (0.7%). This study represents one of the first large-scale epidemiological assessments of chronic hypoparathyroidism based on data collected at medical and/or surgical centers with expertise in hypoparathyroidism in Italy. Although the study presents some limitations, it introduces the possibility of a large-scale national survey, with the final aim of defining not only the prevalence of chronic hypoparathyroidism in Italy, but also standards for clinical and therapeutic approaches.
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Affiliation(s)
- Gemma Marcucci
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Luisella Cianferotti
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Simone Parri
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Paola Altieri
- Division of Endocrinology, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum of Bologna, Bologna, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina School of Medicine, Messina, Italy
| | - Corrado Betterle
- Department of Medicine (DIMED)-Endocrinology, University of Padua, Padua, Italy
| | - Marta Bondanelli
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Boscaro
- Department of Medicine (DIMED)-Endocrinology, University of Padua, Padua, Italy
| | - Valentina Camozzi
- Department of Medicine (DIMED)-Endocrinology, University of Padua, Padua, Italy
| | | | | | - Iacopo Chiodini
- Endocrinology Unit, Fondazione IRCCS Cà Granada Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Ciampolillo
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Federico II di Naples University, Naples, Italy
| | - Sabrina Corbetta
- Endocrinology Unit, Department of Biomedical Sciences for Health, University of Milan, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Ettore Degli Uberti
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Antongiulio Faggiano
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Rachele Fornari
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
| | | | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Valeria Giuliani
- Endocrinology and Diabetology Unit UOSD, Hospital USL 11, Empoli, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Nadia Innaro
- Endocrine Surgery UOC, University College of Catanzaro/Policlinico universitario, Catanzaro, Italy
| | - Olga Lamacchia
- Unit of Endocrinology and Metabolic Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Lenzi
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Cà Granada Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudio Marcocci
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
| | - Laura Masi
- Bone Metabolic Diseases Unit, University Hospital of Florence, Florence, Italy
| | - Silvia Migliaccio
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University "Foro Italico" of Rome, Rome, Italy
| | - Serena Palmieri
- Endocrinology Unit, Fondazione IRCCS Cà Granada Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Renato Pasquali
- Division of Endocrinology, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum of Bologna, Bologna, Italy
| | - Giuliano Perigli
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Valentina Piccini
- Endocrinology and Diabetology Unit UOSD, Hospital USL 11, Empoli, Italy
| | - Elisabetta Romagnoli
- Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, University "Sapienza" of Rome, Rome, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, University of Messina School of Medicine, Messina, Italy
| | - Francesco Rulli
- Department of Surgical Sciences, Catholic University "Our Lady of Good Counsel", Tirana, Albania
| | - Maria Teresa Samà
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giuseppe Tomaino
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | | | - Maria Chiara Zatelli
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Luisa Brandi
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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Gallo M, Ruggeri RM, Muscogiuri G, Pizza G, Faggiano A, Colao A. Diabetes and pancreatic neuroendocrine tumours: Which interplays, if any? Cancer Treat Rev 2018; 67:1-9. [PMID: 29746922 DOI: 10.1016/j.ctrv.2018.04.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 12/17/2017] [Revised: 04/15/2018] [Accepted: 04/17/2018] [Indexed: 01/15/2023]
Abstract
Pancreatic neuroendocrine tumours (PanNETs) represent an uncommon type of pancreatic neoplasm, whose incidence is increasing worldwide. As per exocrine pancreatic cancer, a relationship seems to exist between PanNETs and glycaemic alterations. Diabetes mellitus (DM) or impaired glucose tolerance often occurs in PanNET patients as a consequence of hormonal hypersecretion by the tumour, specifically affecting glucose metabolism, or due to tumour mass effects. On the other hand, pre-existing DM may represent a risk factor for developing PanNETs and is likely to worsen the prognosis of such patients. Moreover, the surgical and/or pharmacological treatment of the tumour itself may impair glucose tolerance, as well as antidiabetic therapies may impact tumour behaviour and patients outcome. Differently from exocrine pancreatic tumours, few data are available for PanNETs as yet on this issue. In the present review, the bidirectional association between glycaemic disorders and PanNETs has been extensively examined, since the co-existence of both diseases in the same individual represents a further challenge for the clinical management of PanNETs.
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Affiliation(s)
- Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | | | - Genoveffa Pizza
- Unit of Internal Medicine, Landolfi Hospital, Solofra, Avellino, Italy
| | - Antongiulio Faggiano
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
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50
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Campennì A, Giovanella L, Pignata SA, Vento A, Alibrandi A, Sturiale L, Laudicella R, Comis AD, Filice R, Giuffrida G, Stipo ME, Giovinazzo S, Trimarchi F, Ruggeri RM, Baldari S. Undetectable or low (<1 ng/ml) postsurgical thyroglobulin values do not rule out metastases in early stage differentiated thyroid cancer patients. Oncotarget 2018; 9:17491-17500. [PMID: 29707123 PMCID: PMC5915131 DOI: 10.18632/oncotarget.24766] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 12/11/2017] [Accepted: 02/26/2018] [Indexed: 12/16/2022] Open
Abstract
Background Differentiated thyroid cancer (DTC) work-up is based on (near)total-thyroidectomy plus thyroid remnant ablation (TRA) with 131-radioiodine in many patients, and long-life follow-up. 131I-post therapy whole body scan (pT-WBS) and serum thyroglobulin (Tg) are used in identifying metastatic patients. Some authors have evaluated the possibility of using post-surgical Tg (ps-Tg) values in deciding for or against TRA. The aim of our study was to verify the diagnostic accuracy of 131I-pT-WBS and SPECT/CT imaging (post-therapeutic imaging) compared to serum Tg levels in detecting metastases in early stage of DTC patients. Results Post-therapeutic imaging revealed metastases in 82 out of 570 (14.4%) patients. Metastases were successively confirmed by other diagnostic tools or by histology (sensitivity and PPV = 100%). Seventy-three out of 82 patients (90.2%) showed ps-Tg levels ≤1 ng/ml. In fifty-four per cent of patients, serum Tg levels at TRA remained ≤1 ng/ml. Conclusion In conclusion, ps-Tg levels cannot be used in deciding for or against TRA. In early stage of DTC, post-therapeutic imaging (131I-pT-WBS and SPECT/CT) is an accurate method of detecting metastases, also in patients with stimulated serum Tg values ≤1 ng/ml Methods We retrospectively reviewed the records of 570 consecutive patients affected by pT1-pT3 DTC (F = 450, M = 120), referred to our Nuclear Medicine Units in the last five years to perform TRA after (near)-total-thyroidectomy.All patients underwent TRA 3-4 months after thyroid surgery either in euthyroid or in hypothyroid state. Serum Tg values evaluated in post-surgical period and at TRA were matched with post-therapeutic imaging results.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Luca Giovanella
- Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Salvatore Antonio Pignata
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Antonio Vento
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
| | - Letterio Sturiale
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Riccardo Laudicella
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Alessio Danilo Comis
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Rossella Filice
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Giuseppe Giuffrida
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - Maria Elena Stipo
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Salvatore Giovinazzo
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | | | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
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