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Bilavsky E.,Tel Aviv University | Dagan A.,Tel Aviv University | Yarden-Bilavsky H.,Tel Aviv University | Davidovits M.,Tel Aviv University | And 11 more authors.
Pediatric Transplantation | Year: 2011

The aim of this study was to assess the prevalence and risk factors of AI in pediatric recipients of kidney or liver transplantation admitted because of a physiological stress episode and to identify patients that might be at risk of adrenal crises by clinical and laboratory parameters at admission. Adrenal function was prospectively evaluated by a standard (250 μg) adrenocorticotropin test in 48 recipients. Data on clinical and laboratory parameters were collected. AI was diagnosed in 11 patients: 10/32 (31.3%) children on long-term steroid treatment and 1/16 (6.25%) untreated. The only risk factor for AI was corticosteroids cumulative dose of >0.15 mg/kg/day during the last six months (p = 0.02, OR 6.67; 95% CI: 0.97-45.79). No correlation was found between clinical or laboratory signs of adrenal crisis on admission and the presence of AI. None of the patients with AI who did not receive stress dose (n = 8) developed adrenal crisis. AI is relatively common in children receiving prolonged corticosteroid treatment after kidney or liver transplantation. Clinical parameters on admission could not reliably identify patients with AI. Universal administration of a stress dose during physiological stress might not be required. However, at this point, the only method to identify patients that will benefit from a stress dose is through the ACTH test. © 2011 John Wiley & Sons A/S. Source


Izzo T.,University of Palermo | Lo Dico G.,University of Palermo | Richiusa P.,Endocrinology and Metabolic Diseases Unit
Giornale Italiano di Ostetricia e Ginecologia | Year: 2013

This is a retrospective study of 112 patients with GDM. The purpose is to evaluate the relationship between GDM and impaired thyroid function. All the patients were evaluated: TSH, FT4 and glycosy-lated hemoglobin (HbA1c). The normal range for TSH is between 0, 45 and 2, 5 μU/ml; for FT4 is instead between 0, 9 and 1, 8 ng/dl; for HbA1c is less than 6%. Patients with elevated TSH and low levels of free thy-roxine were diagnosed as "hypothyroid"; those with elevated TSH and FT4 in the standard as "subclinical hypothyroid"; pregnant women who had high TSH and low FT4 were diagnosed as "hyperthyroid"; women with low TSH and normal FT4 as "subclinical hyperthyroid". Patients who had normal levels of both thyrotropin and free thyroxine were considered "euthyroid". Based on the values of TSH and FT4 we obtained the following results: 77 patients (68.75%) euthyroid; 18 (16.1%) subclinical hypothyroidism; 12 (10.7%) hypothyroid; 5 patients (4.4%) subclinical hyperthyroidism. Our study confirms the association between thyroid disease and gestational diabetes. In addition, the hypothyroid patients insulin-treated, compared with euthyroid, increased the insulin requirement. The results show that women with GDM have a risk greater for both clinical and sub-clinical hypothyroidism; for this reason it is advisable to carry out a program of screening for thyroid function. © Copyright 2013, CIC Edizioni Internazionali. Source


Rastrelli G.,University of Florence | Giovannini L.,Marche Polytechnic University | Calogero A.E.,University of Catania | Gianfrilli D.,University of Rome La Sapienza | And 12 more authors.
Journal of Endocrinological Investigation | Year: 2016

Purpose: Management of late onset hypogonadism (LOH) is not homogenous. The aim of the study is to observe the management of patients with low testosterone (T) in highly specialized Italian centres. Methods: The SIAMO-NOI is an observational longitudinal disease registry for the evaluation of the clinical management of patients with low T levels (total T < 12 nmol/L, calculated free T < 225 pmol/l or already in treatment) in 15 Italian centers members of the Italian Society for Andrology and Sexual Medicine (SIAMS). Clinical and biochemical data were collected for four visits during 12 months of observation. Results: 432 patients (mean age 50.9 ± 14.9 years) were enrolled. Of them, 247 men were receiving androgen therapy, whereas 145 were naive. After the first visit (V0), 80 men started androgen therapy, whereas 55 remained untreated during the entire observation. Younger age [odds ratio (OR) 0.57 (0.35–0.92)], total T < 8 nmol/l [OR 4.69 (1.59–13.81)], complaining at least one sexual symptom [OR 11.55 (2.01–66.35)] and reporting more severe lower urinary tract symptoms [OR 1.27 (1.01–1.60)] predicted starting an androgen therapy. Sixty-four men started therapy immediately after V0 and maintained it until the observation end. When compared to V0, they reported an increase in all the domains of the International Index of Erectile Function-15 (IIEF-15), in the sexual and physical subdomains of the Aging Male Scale as well as in the International Prostate Symptom Score. Conversely, the untreated group reported a significant improvement, although lower than the treated group, only in the erectile function domain of the IIEF-15. Conclusions: Management of LOH in SIAMS centres is in line with the international guidelines and the newest knowledge about the role of T on prostate health. Androgen therapy is associated with an improvement in all the aspects of sexual life and in the perception of physical strength. © 2016, Italian Society of Endocrinology (SIE). Source


Sharony R.,Genetic Institute | Sharony R.,Tel Aviv University | Bental Y.A.,Neonatal Unit | Bental Y.A.,Technion - Israel Institute of Technology | And 8 more authors.
Journal of Clinical Ultrasound | Year: 2012

Background.: A correlation between prenatal and postnatal penile and clitoral sizes has not been reported. These data would substantiate the ability of prenatal ultrasound (US) scan to predict postnatal measurements. The aims were to correlate prenatal and postnatal penile and clitoral measurements and to ascertain the possible advantage of using prenatal penile width rather than length to predict postnatal measurements. Methods.: This was a longitudinal study. Fetal penis and clitoris were measured by high-resolution US between gestational weeks 14 and 29. Postnatal measurements of external genitalia were performed during the first postnatal week. All measurements were performed twice consecutively. A correlation between the measurements sets was sought. Results.: Paired prenatal and postnatal measurements were performed on 46 males and 48 females. Prenatal penile and clitoral length values correlated significantly with postnatal length at p < 0.05 each. Conclusions.: Prenatal US findings appear to be reliable indicators of postnatal penile and clitoral length measurements. Penile width measurement did not add new information. © 2012 Wiley Periodicals, Inc. Source


De Bellis A.,The Second University of Naples | Bellastella G.,Endocrinology and Metabolic Diseases Unit | Maiorino M.I.,Endocrinology and Metabolic Diseases Unit | Aitella E.,The Second University of Naples | And 6 more authors.
European Journal of Endocrinology | Year: 2016

Background: Some cases of apparently idiopathic GH deficiency (GHD) may be caused by pituitary autoimmunity. Objective: To study the variations in pituitary function and antipituitary antibodies (APA) from childhood to transition age in patients with apparently idiopathic GHD. Design: We conducted a longitudinal study. Patients and methods: Pituitary function and APA detection by immunofluorescence were investigated in 24 childhood patients with isolated GHD before starting recombinant GH therapy and after the stopping of this therapy in transition age. Sera of patients positive for APA were processed by double immunofluorescence to identify their pituitary target. Results: At diagnosis, 16 out of 24 patients were APA positive targeting only somatotrophs (group 1), while the remaining eight were APA negative (group 2). When retested off therapy, 12 out of 16 patients in group 1 persisted being APA positive, while the remaining four became negative with recovery of pituitary function. All patients in group 2 persisted being APA negative but still showing GHD. Of the 12 patients persistently APA positive, eight with confirmed GHD showed APA still targeting somatotrophs, whereas four showed APA targeting only gonadotrophs associated with isolated hypogonadotropic hypogonadism (HH). Conclusion: Patients with APA at middle but not at high titer in childhood may show a remission of autoimmune GHD in childhood after GH replacement therapy. As APA may shift their target in transition period, an early characterization of APA by double immunofluorescence is advisable in APA positive GHD patients showing delayed puberty, to allow an early diagnosis and an appropriate therapy, thus preventing the progression toward HH. © 2016 European Society of Endocrinology Printed in Great Britain. Source

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