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9. Assessment of the awareness and management of sleep apnea syndrome in acromegaly. The COM.E.TA (Comorbidities Evaluation and Treatment in Acromegaly) Italian Study Group

Author

Menis, E., Giustina, A., Colao, A., Degli Uberti, E., Ghigo, E., Minuto, F., Bogazzi, F., Drigo, R., Cattaneo, A., Aimaretti, G., Ambrosio, M. R., Andreani, M., Angeletti, G., Celleno, R., Appetecchia, M. L., Baldelli, R., Armigliato, M., Arosio, M., Babini, A., Baldi, F., Balza, G., Bartalena, L., Tanda, M. L., Battista, C., Beck-Peccoz, P., Boffano, G. M., Martino, E., Borboni, P., Borretta, G., Baffoni, C., Boscaro, M., Arnaldi, G., Buschini, M., Salvatore Cannavo, Caramellino, A., Carani, C., Castelli, A., Pancotti, M., Cavagnini, F., Chiodera, P., Cataldo, S., Chiovato, L., Colombo, M., Crivellaro, C., D Ulizia, M., Mattè, S., Del Monte, P., Delitala, G., Masala, A., Fabbri, A., Piantoni, L., Faustini Fustini, M., Favro, S., Ferone, D., Fidotti, E., Valentini, F., Formoso, G., Frigato, F., Furlani, L., Gargiulo, P., Gasparoni, P., Gazzaruso, C., Giordano, C., Giorgino, F., Grandi, M., Pedersoli, S., Grimaldi, F., Grottoli, S., La Grotta, A., Lanzi, R., Limone, P., Razzore, P., Lio, S., Lo Cascio, V., Francia, G., Davì, M. V., Lo Coco, R., Macinini, E., Mantero, F., Scaroni, C., Marchetti, M., Mariotti, S., Pigliaru, F., Marzullo, P., Monachesi, M., Montini, M., Pagani, G., Muggeo, M., Castello, R., Mulas, G., Nassi, R., Vezzosi, C., Nizzoli, M., Orlandi, F., Pacini, F., Di Cairano, G., Palermo, M., Paoletta, A., Papini, E., Parillo, M., Parisi, G., Pasquali, R., Pagotto, U., Pavoncello, S., Perego, M. R., Peri, A., Piscopello, L., Pivonello, R., Raffa, M., Raggiunti, B., Roiter, I., Tamburrano, G., Terzolo, M., Testa, I., Testori, G., Cerruti, N., Toscano, V., Tota, N., Vailati, A., Lovati, E., Valcavi, R., Vincenzi, V., De Menis, E, Giustina, A, Colao, A, Degli Uberti, E, Ghigo, E, Minuto, F, Bogazzi, F, Drigo, R, Cattaneo, A, Aimaretti, G, Giordano, C, Giustina, Andrea, Italian Study Group, C. O. M. E. T. A., De Menis, E., Giustina, A., Colao, A., Degli Uberti, E., Ghigo, E., Minuto, F., Bogazzi, F., Drigo, R., Cattaneo, A., Aimaretti, G., Ambrosio, M.R., Andreani, M., Angeletti, G., Celleno, R., Appetecchia, M.L., Baldelli, R., Armigliato, M., Arosio, M., Babini, A., Baldi, F., Balza, G., Bartalena, L., Tanda, M.L., Battista, C., Beck-Peccoz, P., Boffano, G.M., Martino, E., Borboni, P., Borretta, G., Baffoni, C., Boscaro, M., Arnaldi, G., Buschini, M., Cannavò, S., Caramellino, A., Carani, C., Castelli, A., Pancotti, M., Cavagnini, F., Chiodera, P., Cataldo, S., Chiovato, L., Colombo, M., Crivellaro, C., D'Ulizia, M., De Mattè, S., Del Monte, P., Delitala, G., Masala, A., Fabbri, A., Piantoni, L., Faustini Fustini, M., Favro, S., Ferone, D., Fidotti, E., Valentini, F., Formoso, G., Frigato, F., Furlani, L., Gargiulo, P., Gasparoni, P., Gazzaruso, C., Giordano, C., Giorgino, F., Grandi, M., Pedersoli, S., Grimaldi, F., Grottoli, S., La Grotta, A., Lanzi, R., Limone, P., Razzore, P., Lio, S., Lo Cascio, V., Francia, G., Davì, M.V., Lo Coco, R., Macinini, E., Mantero, F., Scaroni, C., Marchetti, M., Mariotti, S., Pigliaru, F., Marzullo, P., Monachesi, M., Montini, M., Pagani, G., Muggeo, M., Castello, R., Mulas, G., Nassi, R., Vezzosi, C., Nizzoli, M., Orlandi, F., Pacini, F., Di Cairano, G., Palermo, M., Paoletta, A., Papini, E., Parillo, M., Parisi, G., Pasquali, R., Pagotto, U., Pavoncello, S., Perego, M.R., Peri, A., Piscopello, L., Pivonello, R., Raffa, M., Raggiunti, B., Roiter, I., Tamburrano, G., Terzolo, M., Testa, I., Testori, G., Cerruti, N., Toscano, V., Tota, N., Vailati, A., Lovati, E., Valcavi, R., Vincenzi, V., Colao, Annamaria, and C. O. M. E. T. A. Italian Study G. r. o. u., P.

Subjects
Male, Pediatrics, medicine.medical_specialty, medicine.medical_treatment, Endocrinology, Diabetes and Metabolism, Polysomnography, Comorbidity, somatostatin analogs, acromegaly, sleep apnea syndrome, Settore MED/13 - Endocrinologia, Somatostatin analog, Endocrinology, Sleep Apnea Syndromes, Quality of life, Acromegaly, Sleep apnea syndrome, Somatostatin analogs, Physicians, Surveys and Questionnaires, medicine, Prevalence, Humans, Continuous positive airway pressure, medicine.diagnostic_test, business.industry, Sleep apnea, Awareness, Focus Groups, sleep apnea, medicine.disease, Sleep Apnea, Italy, Physical therapy, COM.E.TA, Female, Clinical Competence, business
Abstract

In 2007 the Italian COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) study group started to assess the application in a clinical setting of the Versailles criteria for management of acromegaly complications by a first questionnaire focusing on cardiovascular co-morbidities. A further questionnaire on sleep apnea syndrome (SAS) was delivered by the COM.E.T.A. study group to 107 endocrine centers in Italy. The results of our survey suggest that SAS is a well-known comorbidity even if its estimated prevalence is lower than in the literature. Polysomnography is the preferred tool for diagnosis. Control of SAS is considered relevant both for quality of life and co-morbidities. Continuous positive airway pressure is the cornerstone of therapy, but patients' acceptance may be critical. Control of GH/IGF-I secretion is important to improve SAS. Management of SAS requires cooperation between specialists. ©2011, Editrice Kurtis.

Published
2011

11. Patients with craniopharyngiomas: Therapeutical difficulties with growth hormone

Author

Salvatore Cannavo, Marini, F., and Trimarchi, F.

Subjects
Craniopharyngioma, Databases, Factual, Hormone Replacement Therapy, Human Growth Hormone, Prevalence, Quality of Life, Humans, Pituitary Neoplasms, Middle Aged, Child, Hypopituitarism, Aged, Body Mass Index
Abstract

Craniopharyngioma (CP) is a rare and benign tumor of the pituitary region. It is the second cause of hypopituitarism in children and the third in adults. Multiple pituitary deficiencies or panhypopituitarism and diabetes insipidus are very frequent and their prevalence increases significantly after neurosurgery. In patients with GH deficiency (GHD), recombinant GH (rGH) replacement is recommended, after a near complete surgical excision of CP and exclusion of tumor progression. The risk of CP recurrence or progression due to rGH therapy is unproven. Treatment with rGH improves significantly the quality of life (QoL), although body composition and lipid abnormalities are not modified. At the data lock 2003, in the Hypopituitary Control and Complications Study (HypoCCS) Italian Database 90 patients with CP were included. Adulthood onset (AO) hypopituitarism had been diagnosed in two/thirds of them. They had worse QoL than their childhood onset (CO)-counterpart. During 3-yr rGH treatment mean body mass index, fat mass percentage, and both hip and waist circumferences decreased significantly only in CO patients. Accordingly, total cholesterol and triglycerides decreased, and HDL-cholesterol increased significantly in CO- but not in AO-patients. Analysis of dose titration showed that CO- were treated with higher rGH doses than AO-patients.

Published
2008

12. A novel point mutation in the ligand-binding domain of the human glucocorticoid receptor (hGR) in a patient with glucocorticoid resistance

Author

Salvatore Cannavo, Karl, M., Santarpia, L., Facchiano, A., Marabotti, A., Trimarchi, F., and Benvenga, S.

Subjects
Glucocorticoid, menstrual abnormalities, glucocorticoid hormone resistance, Glucocorticoid, glucocorticoid receptor mutations, glucocorticoid hormone resistance, hirsutism, menstrual abnormalities, glucocorticoid receptor mutations, hirsutism
Published
2007

13. First-line therapy of acromegaly: A statement of the A.L.I.C.E. (Acromegaly primary medical treatment Learning and Improvement with Continuous Medical Education) Study Group

Author

Colao, A., Martino, E., Cappabianca, P., Cozzi, R., Scanarini, M., Ghigo, E., Angeletti, G., Anile, C., Arnaldi, G., Arosio, M., Attanasio, R., Auriemma, R., Baldelli, R., Billeci, D., Borretta, G., Boscaro, M., Salvatore Cannavo, Cavagnini, F., Cirillo, S., D Arrigo, C., D Azzò, G., Marinis, L., Menis, E., Degli Uberti, E., Esposito, F., Ferone, D., Formoso, G., Gasco, V., Gasperi, M., Giordano, E., Giustina, A., Grottoli, S., La Notte, M., Lasio, G., Lombardi, G., Losa, M., Mantero, F., Mariotti, S., Marzullo, P., Mazzatenta, D., Minuto, F., Montini, M., Pacini, F., Pezzino, V., Pivonello, R., Ronchi, C., Sicolo, N., Sinisi, A., Spada, A., Tamburrano, G., Terzolo, M., Tita, P. M. B., Vigo, M. T., Colao, A., Martino, E., Cappabianca, P., Cozzi, R., Scanarini, M., Ghigo, E., Angeletti, G., Anile, C., Arnaldi, G., Arosio, M., Attanasio, R., Auriemma, R., Baldelli, R., Billeci, D., Borretta, G., Boscaro, M., Cannavò, S., Cavagnini, F., Cirillo, S., D'Arrigo, C., D'Azzò, G., De Marinis, L., De Menis, E., degli Uberti, E., Esposito, F., Ferone, D., Formoso, G., Gasco, V., Gasperi, M., Giordano, E., Giustina, A., Grottoli, S., La Notte, M., Lasio, G., Lombardi, G., Losa, M., Mantero, F., Mariotti, S., Marzullo, P., Mazzatenta, D., Minuto, F., Montini, M., Pacini, F., Pezzino, V., Pivonello, R., Ronchi, C., Sicolo, N., Sinisi, A., Spada, A., Tamburrano, G., Terzolo, M., Tita, P. M. B., and Vigo, M. T.

Subjects
Adenoma, medicine.medical_specialty, Pediatrics, Cabergoline, Medical treatment, business.industry, Statement (logic), Endocrinology, Diabetes and Metabolism, Guidelines, Guideline, medicine.disease, Acromegaly, Treatment, First line therapy, Endocrinology, Dopamine Agonists, Physical therapy, medicine, Ergolines, Humans, Somatostatin, business
Published
2006

14. Therapy for the syndromes of GH excess

Author

Arosio, M., Salvatore Cannavo, Epaminonda, P., Ronchi, C., Chiodini, I., and Adda, G.

Subjects
Adenoma, Hormone Antagonists, Radiotherapy, Human Growth Hormone, Acromegaly, Dopamine Agonists, Neurosurgery, Humans, Pituitary Neoplasms, Insulin-Like Growth Factor I, Somatostatin
Abstract

This short review summarizes the results of treatments now available in Italy for the management of GH and IGF-I excess due to primary pituitary somatotroph adenoma, which accounts for over 99% of cases of acromegaly. Goals of treatment of acromegaly should now include, in addition to the reduction of tumor bulk and symptomatic relief, the lowering of GH circulating concentrations to below a critical level (2.5 microg/l, "safe" GH), the normalization of serum IGF-I concentrations according to age, improvement (or at least not worsening) of co-morbidities (diabetes mellitus, hypertension, cardiomyopathy, sleep-apnea), the decrease of the risk of premature mortality. Surgery, radiation (fractionated conventional radiotherapy and radiosurgery) and medical treatments with dopamine agonists and somatostatin analogs are the available options that are discussed in detail. The treatment of acromegaly must be tailored to the needs of the individual patient. Age, tumor size and invasiveness, GH concentrations, the patient's general medical conditions, presence and severity of co-morbidities, availability of local resources such as an expert neurosurgeon or gamma-knife radiosurgery, and of course the informed wishes of the patient are all factors that must be taken into account. For most patients the treatment will be multimodal. However, despite criteria and guidelines based on continuously emerging information about the management of acromegaly, patient outcomes are still less than desirable, with 10 to 20% of patients with uncontrolled disease, despite the use of all available therapies. This underscores the need for the quick introduction in clinical practice of the new therapies.

Published
2004

15. Pituitary enlargement in post-surgical hypothyroidism misdiagnosed as thyrotroph neoplasia. Report of a case

Author

Salvatore Cannavo, Li Calzi, L., and Trimarchi, F.

Subjects
Adult, Diagnosis, Differential, Hypothyroidism, Pituitary Diseases, Thyroidectomy, Humans, Female, Diagnostic Errors, Tomography, X-Ray Computed
Abstract

Primary hypothyroidism may be associated with enlargement of the sella turcica, due to thyrotroph hyperplasia, in its turn due to the lack of feedback control by thyroid hormones. It may develop independently of the severity or of the duration of thyroid failure. A 42-year-old woman was referred to us. She presented us with a CT scan compatible with a pituitary microadenoma, in the left part of the sella. The patient showed obvious signs of myxedema, due to subtotal thyroidectomy which had been performed 14 months before, because of the presence of multinodular goiter. After operation, the patient has been discontinuously and inappropriately treated with desiccated thyroid. She complained of headache, nausea, galactorrhea without amenorrhea. Serum T4 (0.8 micrograms/dl), serum T3 (47 ng/dl) and TSH (174.5 +/- 60.1 mU/l: M +/- SD of 4 assays) were compatible with primary hypothyroidism as confirmed by TSH hyper-response to i.v. TRH (200 micrograms) and i.v. domperidone (10 mg), and by the normal TSH decrease after orally administered 2.5 mg bromocriptine or 90 min continuously infused 800 micrograms GHIRH. Moreover, an abnormal GH response to TRH was observed, whereas basal and appropriately stimulated PRL levels were normal. Serum alpha-subunit was marginally high (5.92 ng/ml), but alpha-subunit/TSH molar ratio fell within the normal range (0.1 molar ratio). Complete suppression of basal and TRH stimulated TSH values was achieved after a 14-day L-T3 (120 micrograms per day) and 4-month L-T4 (200 micrograms per day) administration. L-T4 treatment, first administered at suppressive doses (200 micrograms per day for 4 months) and subsequently at substitutive doses (150 micrograms per day for 2 months), induced complete remission of symptoms along with normalization of the CT scan picture.

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