المؤلفون: Varaldo, E., Sibilla, M., Bioletto, F., Cuboni, D., Prencipe, N., Bona, C., Ferrari, M., Viglino, F., Aversa, L. S., Grottoli, S., Ghigo, E., Gasco, V., Berton, A. M.

المساهمون: Università degli Studi di Torino

المصدر: Journal of Endocrinological Investigation ; volume 46, issue 12, page 2617-2627 ; ISSN 1720-8386

مصطلحات موضوعية: Endocrinology, Endocrinology, Diabetes and Metabolism

الوصف: Purpose The precise effects of non-steroidal anti-inflammatory drugs on the neuroendocrine hydro-electrolytic regulation are not precisely understood. The aim of this pilot study was to evaluate, in healthy subjects, the neuroendocrine response of the antidiuretic system to intravenous diclofenac infusion. Methods For this single-blinded, cross-over study, we recruited 12 healthy subjects (50% women). Test sessions were divided into three observation times (pre-test; test; 48 h post-test), which were repeated equally on two different occasions, with the administration of diclofenac (75 mg in saline solution 0.9% 100 cc) on 1 day, or placebo (saline solution 0.9% 100 cc) on another day. The night before the test the subjects were asked to collect a salivary cortisol and cortisone sample, which was repeated on the night of the procedure session. Serial urine and blood samples were collected on the test day (for osmolality, electrolytes, ACTH, cortisol, copeptin, MR-proADM, MR-proANP; the last three represent more stable and analytically reliable molecules than their respective active peptides). Moreover, the subjects were evaluated with the bioimpedance vector analysis (BIVA) before and after the test. Forty-eight hours after the end of the procedure urine sodium, urine potassium, urine osmolality, serum sodium and copeptin were revaluated together with BIVA. Results No significant changes in circulating hormone levels were observed; anyway, 48 h after diclofenac, BIVA showed a significant water retention ( p < 0.00001), especially in extracellular fluid (ECF) (16.47 ± 1.65 vs 15.67 ± 1.84, p < 0.001). Salivary cortisol and cortisone tended to increase only the night after placebo administration ( p = 0.054 cortisol; p = 0.021 cortisone). Conclusion Diclofenac resulted in an increased ECF at 48 h, but this phenomenon seems to be associated with a greater renal sensibility to the action of vasopressin rather than with an increase in its secretion. Moreover, a partial inhibitory effect on cortisol ...

الإتاحة: https://doi.org/10.1007/s40618-023-02118-zTest

المؤلفون: Gasco, V., Cuboni, D., Varaldo, E., Bioletto, F., Berton, A. M., Bona, C., Prencipe, N., Ghigo, E., Maccario, M., Grottoli, S.

المساهمون: Università degli Studi di Torino

المصدر: Journal of Endocrinological Investigation ; volume 46, issue 10, page 2175-2183 ; ISSN 1720-8386

مصطلحات موضوعية: Endocrinology, Endocrinology, Diabetes and Metabolism

الوصف: Introduction The proportion of patients with low GH response to provocative tests increases with the number of other pituitary hormone deficiencies, reason why in panhypopituitary patients GH stimulation tests may be unnecessary to diagnose GH deficiency (GHD) Purpose To re-evaluate the diagnostic cut-offs of GH response to GHRH + arginine (ARG) test related to BMI, considering the patients’ pituitary function as the gold standard for the diagnosis of GHD. Methods The GH responses to GHRH + ARG were studied in 358 patients with history of hypothalamic-pituitary disease. GHD was defined by the presence of at least 3 other pituitary deficits (n = 223), while a preserved somatotropic function was defined by the lack of other pituitary deficits and an IGF-I SDS ≥ 0 (n = 135). The cut-off with the best sensitivity (SE) and specificity (SP), was identified for each BMI category using the ROC curve analysis. To avoid over-diagnosis of GHD we subsequently searched for the cut-offs with a SP ≥ 95%. Results The best GH cut-off was 8.0 μg/l (SE 95%, SP 100%) in lean, 7.0 μg/l (SE 97.3%, SP 82.8%) in overweight, and 2.8 μg/l (SE 84.3%, SP 91.7%) in obese subjects. The cut-off with a SP ≥ 95% was 2.6 μg/l (SE 68.5%, SP 96.6%) in overweight and 1.75 μg/l (SE 70.0%, SP 97.2%) in obese subjects. Conclusions This is the first study that evaluates the diagnostic cut-offs of GH response to GHRH + ARG related to BMI using a clinical definition of GHD as gold standard. Our results suggest that with this new approach, the GHRH + ARG cut-offs should be revised to avoid GHD over-diagnosis.

الإتاحة: https://doi.org/10.1007/s40618-023-02081-9Test

المؤلفون: Bioletto, F., Berton, A. M., Varaldo, E., Cuboni, D., Bona, C., Parasiliti-Caprino, M., Prencipe, N., Ghigo, E., Grottoli, S., Maccario, M., Gasco, V.

المساهمون: Università degli Studi di Torino

المصدر: Journal of Endocrinological Investigation ; volume 46, issue 3, page 535-543 ; ISSN 1720-8386

مصطلحات موضوعية: Endocrinology, Endocrinology, Diabetes and Metabolism

الوصف: Background When evaluating a patient for central adrenal insufficiency (CAI), there is a wide range of morning cortisol values for which no definite conclusion on hypothalamus–pituitary–adrenal (HPA) axis function can be drawn; in these cases, a stimulation test is required. Aim of this study was to develop an integrated model for CAI prediction when morning cortisol is in the grey zone, here defined as 40.0–160.0 μg/L. Methods Overall, 119 patients with history of sellar tumour which underwent insulin tolerance test (ITT) for the evaluation of HPA axis were enrolled. Supervised regression techniques were used for model development. Results An integrated predictive model was developed and internally validated, and showed a significantly better diagnostic performance than morning cortisol alone (AUC 0.811 vs 0.699, p = 0.003). A novel predictive score (CAI-score) was retrieved, on a 5.5-point scale, by considering morning cortisol (0 points if 130.1–160.0 μg/L, 1 point if 100.1–130.0 μg/L, 1.5 points if 70.1–100.0 μg/L, 2.5 points if 40.0–70.0 μg/L), other pituitary deficits (2 points if ≥ 3 deficits), and sex (1 point if male). A diagnostic algorithm integrating CAI-score and ITT was finally proposed, with an overall accuracy of 99%, and the possibility to avoid the execution of stimulation tests in 25% of patients. Conclusions This was the first study that proposed an integrated score for the prediction of CAI when morning cortisol is in the grey zone. This score might be helpful to reduce the number of patients who need a stimulation test for the assessment of HPA axis function.

الإتاحة: https://doi.org/10.1007/s40618-022-01926-zTest

المؤلفون: Bona, C., Prencipe, N., Berton, A. M., Bioletto, F., Parasiliti-Caprino, M., Gasco, V., Ghigo, E., Grottoli, S.

المساهمون: Università degli Studi di Torino

المصدر: Journal of Endocrinological Investigation ; volume 45, issue 10, page 1955-1965 ; ISSN 1720-8386

مصطلحات موضوعية: Endocrinology, Endocrinology, Diabetes and Metabolism

الوصف: Purpose This study aims to compare the accuracy of mean GH profile (GHP) < 2.5 ng/ml and single fasting GH (SGH) < 1 ng/ml in the evaluation of disease control in acromegaly patients during somatostatin receptor ligands (SRLs) therapy. Methods We retrospectively enrolled 100 acromegaly patients, 68 responder, and 32 partial responder to SRLs. Controlled disease has been defined as IGF-I levels within age-related normal limits, while partial response as pathological IGF-I values despite a reduction ≥ 50%. In all patients, GHP, SGH, IGF-I, and IGFBP-3 were evaluated. Results Median GHP levels (1.2 ng/ml, IQR 0.5–2.3 ng/ml) were lower ( p = 0.001) than SGH (1.9 ng/ml, IQR 1.0–3.6 ng/ml). Accuracy of GHP was 81%, whereas that of SGH was 55%, with a Kappa index of 0.520 and 0.237, respectively. In multivariable analysis GHP ( p = 0.002) and IGFBP-3 ( p = 0.004), but not SGH, were independently associated with normal IGF-I levels. At receiver–operator characteristic curve (ROC) analysis GHP cut-off sensitivity and specificity were 94.1% and 50.0%, respectively, while SGH sensitivity and specificity were 35.3% and 93.7%, respectively. Finally, in obese patients the GH cut-off level (both as SGH and GHP) associated to good disease control was significantly different with respect to not obese ones. Conclusions GHP associates with IGF-I (and therefore with appropriate control of disease) with higher accuracy than SGH. When GH evaluation is needed, the measurement of mean GHP should be preferred and use of BMI-related cut-offs is suggested.

الإتاحة: https://doi.org/10.1007/s40618-022-01830-6Test

المؤلفون: Bioletto, F., Prencipe, N., Berton, A. M., Bona, C., Varaldo, E., Gasco, V., Ghigo, E., Grottoli, S.

المصدر: Journal of Endocrinological Investigation ; volume 45, issue 5, page 981-987 ; ISSN 1720-8386

مصطلحات موضوعية: Endocrinology, Endocrinology, Diabetes and Metabolism

الإتاحة: https://doi.org/10.1007/s40618-021-01731-0Test