Endocrine Abstracts

BackgroundThe management of post-operative recurrences of ACC remains controversial, although the current guidelines recommend a surgical approach whenever feasible with radical intent.AimThe aim of our study was to evaluate retrospectively the management of recurrences in patients with ACC. We collected data of 106 patients with ACC followed at the San Luigi Hospital for the management of recurrence. Median ...

Background and objective: Optimization of glucocorticoid (GC) replacement therapy in adrenal insufficiency (AI) is crucial to avoid consequences of under- or overtreatment. Dosing of GC replacement is mainly based on clinical grounds; however, the impact of patient’s characteristics on daily GC requirement is poorly evaluated. The aim of the study is to assess the influence of sex (M/F) and BMI on dosing GC in patients with AI of different etiology....

Introduction: Patients with subclinical Cushing’s syndrome (SCS) present with increased cardiovascular morbidity and mortality, however, the beneficial effect of adrenalectomy on cardiovascular risk factors is uncertain.Objective: Systematic meta-analysis to determine the effect of adrenalectomy vs conservative follow-up on cardiovascular risk factors in patients with adrenal tumors and SCS.Methods: We searched 6 databases thr...

Introduction: Current medical treatment of adrenocortical carcinoma (ACC) is based on mitotane alone or in combination with cytotoxic chemotherapy. However, very little is known about the pharmacokinetic properties of mitotane and dosing schedules are based on clinical experience only. The aim of this study was to investigate the relationship between mitotane dose and plasma concentration comparing two pre-defined treatment regimens. Secondary objectives were to evaluate safet...

Background: Mitotane (o,p’DDD) is the reference therapy for adrenocortical carcinoma (ACC) and should undergo metabolization in o,p’DDE and o,p’DDA to exert its anti-proliferative activity. We have previously shown that there is a link between RRM1 gene expression and o,p’DDD activity in an adjuvant setting. Aim of this study was to assess whether RRM1 gene expression is correlated to the bioavailability and cytotoxic activity of o,p’DDD and its metabo...

Background: No randomized trials have been conducted in adrenocortical carcinoma (ACC) patients. Treatment recommendations for this rare but aggressive disease have been based on data from small phase II trials. We have now performed the first randomized phase III trial, comparing etoposide, doxorubicin, cisplatin, plus mitotane (EDP-M) against streptozotocin plus mitotane (Sz-M).Methods: Three-hundred and four chemotherapy-naive patients with ACC not am...

Mitotane therapy is associated with many side effects, including thyroid function perturbations mimicking central hypothyroidism, possibly due to laboratory test interference or pituitary direct effects of mitotane. Therefore, we aimed at investigating whether increasing concentrations of mitotane in the therapeutic range might interfere with thyroid hormone assays and evaluate the effects of mitotane on a mouse TSH- producing pituitary cell line. TSH, FT4 and FT<su...

Aim of this study is to present preliminary epidemiological data on a population of 1512 acromegalic patients attending 22 tertiary centers in Italy from 1980 to 2002. At our knowledge this is the first large–scale epidemiological Italian study on acromegaly. Gender was 624 (41.2%) men and 888 (58.8%) women. Mean age at diagnosis was 45±13 years, 43±13 for men and 47±13 for women. Median estimated duration of acromegaly before diagnosis was 74 months (range...

The existing follow-up studies on patients with incidentally discovered adrenal adenoma (AA) focused almost exclusively on repeat imaging and endocrine work-up on a short period.Of consecutive 152 patients with AA referred to our center from 1989 to 2003, we have assessed the risk of developing metabolic disorders and vascular complications in the 74 patients who did not underwent surgery (51 women and 23 men, median age 57, range 25–74 years) durin...

Recent guidelines recommend to use the 1-mg DST to screen for subclinical hypercortisolism assuming that a post-DST cortisol >5.0 μg/dl define this condition. However, several experts suggest a more sensitive cut-off at 1.8 μg/dl while others consider mandatory to confirm unsuppressibility with a 8-mg DST. A consecutive series of 64 patients (22 men, 42 women, aged 28–81 years) with clinically inapparent adrenal adenoma were studied between 2005 and 2007. Th...