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Porto Alegre, Brazil

Giustina A.,University of Brescia | Mazziotti G.,University of Brescia | Mazziotti G.,Endocrine Unit | Torri V.,Oncology | And 3 more authors.
PLoS ONE | Year: 2012

Background: The long-acting somatostatin analogue octreotide is used either as an adjuvant or primary therapy to lower growth hormone (GH) levels in patients with acromegaly and may also induce pituitary tumor shrinkage. Objective: We performed a meta-analysis to accurately assess the effect of octreotide on pituitary tumor shrinkage. Data Sources: A computerized Medline and Embase search was undertaken to identify potentially eligible studies. Study Eligibility Criteria: Eligibility criteria included treatment with octreotide, availability of numerical metrics on tumor shrinkage and clear definition of a clinically relevant reduction in tumor size. Primary endpoints included the proportion of patients with tumor shrinkage and mean percentage reduction in tumor volume. Data Extraction and Analysis: The electronic search identified 2202 articles. Of these, 41 studies fulfilling the eligibility criteria were selected for data extraction and analysis. In total, 1685 patients were included, ranging from 6 to 189 patients per trial. For the analysis of the effect of octreotide on pituitary tumor shrinkage a random effect model was used to account for differences in both effect size and sampling error. Results: Octreotide was shown to induce tumor shrinkage in 53.0% [95% CI: 45.0%-61.0%] of treated patients. In patients treated with the LAR formulation of octreotide, this increased to 66.0%, [95% CI: 57.0%-74.0%). In the nine studies in which tumor shrinkage was quantified, the overall weighted mean percentage reduction in tumor size was 37.4% [95% CI: 22.4%-52.4%], rising to 50.6% [95% CI: 42.7%-58.4%] with octreotide LAR. Limitations: Most trials examined were open-label and had no control group. Conclusions: Octreotide LAR induces clinically relevant tumor shrinkage in more than half of patients with acromegaly. © 2012 Giustina et al.

Gan E.H.,Northumbria University | Gan E.H.,Endocrine Unit | Pattman S.,Clinical Biochemistry | H. S. Pearce S.,Northumbria University | Quinton R.,Northumbria University
Clinical Endocrinology | Year: 2013

Context Testosterone replacement therapy is the standard treatment for male hypogonadism. There has lately been increased marketing in the medical media promoting testosterone replacement for men with erectile dysfunction or for older men with low serum testosterone, despite the lack of long-term safety and efficacy data. Therefore, we aimed to examine trends in testosterone prescribing in UK primary care over the last 10 years. Methods Data about the use of testosterone preparations from the Departments of Health Prescription Cost Analysis for community pharmacies 2001-2010, for England, Scotland and Wales, were collated. Community requests for serum total testosterone assay in men to the Biochemistry Department at the Newcastle upon Tyne Hospitals Trust were also examined over the same time period. Results The number of prescriptions for testosterone preparations increased by nearly 90% from 157 602 to 298 134 dispensed items annually, over a 10-year period. However, due to a particularly significant (fivefold) increase in prescribing of (more expensive) transdermal preparations, the cost to the NHS showed a 267% escalation, from £3·2 to £11·7 million, annually over the same period. Local requests from primary care in the Newcastle and North Tyneside area for serum testosterone measurement in men also increased, from 347 requests in 2000 to 823 requests in 2010, a 137% increase. However, the number of men with likely unequivocal hypogonadism (testosterone less than 6·0 nm) remained constant at 5·2% in 2000 and 6·3% in 2010. Conclusion Many men in the UK might be receiving testosterone replacement therapy with neither clearly established indications nor robustly diagnosed hypogonadism. A national registry for men treated with testosterone and further evidence to improve current guidance (national and/or international) on the indications for testosterone replacement would be beneficial. © 2013 John Wiley & Sons Ltd.

Sathavarodom N.,Endocrine Unit
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

To demonstrate an apolipoprotein B (apo B) level in type 2 diabetic patients who achieved goal of low density lipoprotein cholesterol (LDL-c) and non-high density lipoprotein cholesterol (non-HDL-c). To identify the percentage of type 2 diabetes patients who achieved goal of apo B level. A cross-sectional study was carried out from 1 October to 31 December 2008. Type2 diabetes patients who attended at diabetes clinics in the Phramongkutklao hospitals have determined the risk for develop cardiovascular diseases (CVD) and set up the goal for lipid level according to consensus statement from the American Diabetes Association (ADA) and the American College of Cardiology (ACC) foundation. Blood test for apo B will be done only the patients who achieved goal of LDL-c and non-HDL-c. 133 of the 162 registered diabetic patients can achieve goal of lipid level In this population, 9.7 percent (%) (n = 13) had a history of CVD. ApoB level in diabetic patients with and without CVD is 61.72 +/- 12.63 and 67.2 +/- 12.92 milligram per deciliter (mg/dL), respectively. Nearly ninety-eight percent of patients without cardiovascular diseases (CVD) have achieved apo B (< 90 mg/dL) goal, and 92.3% of patients with CVD have achieved apo B (< 80 mg/dL) goal. The two most commonly used lipid-lowering agents were statins and fibrates. In patients with type 2 diabetes who achieved goal of LDL-c and non-HDL-c have also achieved apo B level. Thus, apo B measurement in addition to reached LDL-c and non-HDL-c targets may be not necessary especially in diabetic patients who did not previous CVD.

Gheri R.G.,Endocrine Unit
Journal of endocrinological investigation | Year: 2011

To determine the need of total thyrodectomy for patients with follicular nodules of thyroid. From January 2005 through June 2008, 2249 consecutive patients (438 males, 1811 females; mean age 54 yr, range 9-87) with thyroid nodules were submitted to 2518 ultrasound-guided fine-needle aspiration (USgFNA) for cytological examination. USgFNA were performed by experienced surgeon (RP) and endocrinologist (RGG) under ultra- sonographyc guidance, using a 10-MHz linear transducer. Liquid-based cytology was used. All cytological samples were classified in 5 diagnostic classes (THY1, THY2, THY3, THY4, THY5) in agreement with the British Thyroid Association (BTA); 1.4% specimen were classified as THY5, 2.1% as THY4, 7.6% as THY3, 79.5% as THY2 and 9.4% as THY1. In 97% of THY5 patients, malignancy was found. Among THY4 patients, 95.5% were positive for thyroid tumor. Among THY3 patients, malignancy was found in 29.1%. THY3 patients with thyroid tumors were younger than those with benign lesions (46 ± 14.1 yr vs 50 ± 13.8 yr; p<0.05, t test). No statistical difference was found neither in malignancy frequency among men and women nor in mean size of nodules (24 ± 11.8 mm malignant vs 23 ± 9.4 mm benign). this study provides evidence that USgFNA offers a very sensitive and accurate method in reducing THY1 samples and in detecting malignancy (>95% both in THY5 and THY4, and >29% in THY3 lesions). Our proposal is to submit to total thyroidectomy all patients with THY5 and THY4 lesions and THY3 thyroid nodule >1 cm.

Mazziotti G.,University of Brescia | Mazziotti G.,Endocrine Unit | Gazzaruso C.,Clinical Institute Beato Matteo ICBM 27029 | Giustina A.,University of Brescia
Trends in Endocrinology and Metabolism | Year: 2011

Diabetes mellitus is a frequent complication of Cushing syndrome (CS) which is caused by chronic exposure to glucocorticoid excess, either endogenous or exogenous, and that is characterized by several clinical symptoms such as central obesity, purple striae, proximal muscle weakness, acne, hirsutism and neuropsychological disturbances. Diabetes occurs as a consequence of an insulin-resistant state together with impaired insulin secretion which are induced by glucocorticoid excess. The management of patients with CS and diabetes mellitus includes the treatment of hyperglycemia and, when possible, the correction of glucocorticoid excess. This review focuses on the disorders of glucose metabolism in patients exposed to glucocorticoid excess, addressing both the pathophysiological aspects and the clinical and therapeutic implications. © 2011 Elsevier Ltd.

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