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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).


PubMed | Humanitas Research Hospital, University of Padua, Marche Polytechnic University, University of Turin and 11 more.
Type: Journal Article | Journal: Journal of endocrinological investigation | Year: 2016

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.The SIAMO-NOI is an observational longitudinal disease registry for the evaluation of the clinical management of patients with low T levels (total T<12nmol/L, calculated free T<225pmol/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 12months of observation.432 patients (mean age 50.914.9years) 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<8nmol/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.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.


Profka E.,Endocrinology and Metabolic Diseases Unit | Profka E.,University of Milan | Giavoli C.,Endocrinology and Metabolic Diseases Unit | Giavoli C.,University of Milan | And 17 more authors.
Journal of Endocrinological Investigation | Year: 2015

Purpose: Adult patients operated for craniopharyngioma develop more frequently GH deficiency (GHD) than patients operated for non-functioning pituitary adenoma (NFPA). The aim of the study was to compare both short- (1 year) and long-term (5 years) effects of rhGH in 38 GHD adult patients (19 operated for Craniopharyngioma (CP) and 19 for NFPA). Methods: IGF-I levels, body composition (BF %), BMI, lipid profile and glucose homeostasis were evaluated in all patients. Pituitary MRI was performed at baseline and during follow-up, as needed. Results: At baseline no difference between the two groups was observed, apart from a higher prevalence of diabetes insipidus in CP patients (79 vs 21 %). After 12 months, IGF-I SDS normalized and BF % significantly decreased only in the NFPA group. During long-term treatment, decrease in BF % and improvement in lipid profile shown by reduction in total- and LDL-cholesterol were present in NFPA group only, while increase in insulin levels and HbA1c and decrease of QUICKI were observed in CP patients only. Accordingly, after long-term therapy, the prevalence of metabolic syndrome (MS) was significantly higher in CP than in NFPA group (37 % in CP and in 5 % in NFPA group; p < 0.05). Conclusion: The present data suggest that CP patients are less sensitive to the positive rhGH effects on lipid profile and BF % and more prone to insulin sensitivity worsening than NFPA patients, resulting in increased prevalence of MS in CP only. © 2014 Italian Society of Endocrinology (SIE).


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.


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.


PubMed | Endocrinology and Metabolic Diseases Unit
Type: Journal Article | Journal: Journal of endocrinological investigation | Year: 2015

Adult patients operated for craniopharyngioma develop more frequently GH deficiency (GHD) than patients operated for non-functioning pituitary adenoma (NFPA). The aim of the study was to compare both short- (1 year) and long-term (5 years) effects of rhGH in 38 GHD adult patients (19 operated for Craniopharyngioma (CP) and 19 for NFPA).IGF-I levels, body composition (BF%), BMI, lipid profile and glucose homeostasis were evaluated in all patients. Pituitary MRI was performed at baseline and during follow-up, as needed.At baseline no difference between the two groups was observed, apart from a higher prevalence of diabetes insipidus in CP patients (79 vs 21%). After 12 months, IGF-I SDS normalized and BF% significantly decreased only in the NFPA group. During long-term treatment, decrease in BF% and improvement in lipid profile shown by reduction in total- and LDL-cholesterol were present in NFPA group only, while increase in insulin levels and HbA1c and decrease of QUICKI were observed in CP patients only. Accordingly, after long-term therapy, the prevalence of metabolic syndrome (MS) was significantly higher in CP than in NFPA group (37% in CP and in 5% in NFPA group; p < 0.05).The present data suggest that CP patients are less sensitive to the positive rhGH effects on lipid profile and BF% and more prone to insulin sensitivity worsening than NFPA patients, resulting in increased prevalence of MS in CP only.

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