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6. Clinical management of older, frail patients with atrial fibrillation. The proposal of a multidisciplinary working group

Author

Marchionni, N, Fumagalli, S, Bo, M, Boccanelli, A, Boriani, G, Rubboli, A, Violi, F, Di Pasquale, G, Beer, B, Colonna, P, Manetti, L, Pilleri, A, Purificato, F, Ruotolo, G, Sciacqua, A, Taberini, L, Turcato, E, Bozzato, S, Catanzariti, D, Felici, M, Florio, C, Fontana, F, Giomi, A, Masala, R, Mascia, G, Nassiacos, D, Nesti, M, Okoye, C, Pestelli, G, Bassi, V, Curci, S, D'Avino, M, Doimo, S, Faustino, M, Gemmiti, M, Pignatelli, P, Sarli, G, Stefanoni, P, Ciccone, M, Diemberger, I, Gragnano, F, Serafini, F, Marchionni N., Fumagalli S., Bo M., Boccanelli A., Boriani G., Rubboli A., Violi F., Di Pasquale G., Beer B., Colonna P., Manetti L. L., Pilleri A., Purificato F., Ruotolo G., Sciacqua A., Taberini L., Turcato E., Bozzato S., Catanzariti D., Felici M., Florio C., Fontana F., Giomi A., Masala R., Mascia G., Nassiacos D., Nesti M., Okoye C., Pestelli G., Bassi V., Curci S., D'Avino M., Doimo S., Faustino M., Gemmiti M. P., Pignatelli P., Sarli G., Stefanoni P., Ciccone M., Diemberger I., Gragnano F., Serafini F., Marchionni, N, Fumagalli, S, Bo, M, Boccanelli, A, Boriani, G, Rubboli, A, Violi, F, Di Pasquale, G, Beer, B, Colonna, P, Manetti, L, Pilleri, A, Purificato, F, Ruotolo, G, Sciacqua, A, Taberini, L, Turcato, E, Bozzato, S, Catanzariti, D, Felici, M, Florio, C, Fontana, F, Giomi, A, Masala, R, Mascia, G, Nassiacos, D, Nesti, M, Okoye, C, Pestelli, G, Bassi, V, Curci, S, D'Avino, M, Doimo, S, Faustino, M, Gemmiti, M, Pignatelli, P, Sarli, G, Stefanoni, P, Ciccone, M, Diemberger, I, Gragnano, F, Serafini, F, Marchionni N., Fumagalli S., Bo M., Boccanelli A., Boriani G., Rubboli A., Violi F., Di Pasquale G., Beer B., Colonna P., Manetti L. L., Pilleri A., Purificato F., Ruotolo G., Sciacqua A., Taberini L., Turcato E., Bozzato S., Catanzariti D., Felici M., Florio C., Fontana F., Giomi A., Masala R., Mascia G., Nassiacos D., Nesti M., Okoye C., Pestelli G., Bassi V., Curci S., D'Avino M., Doimo S., Faustino M., Gemmiti M. P., Pignatelli P., Sarli G., Stefanoni P., Ciccone M., Diemberger I., Gragnano F., and Serafini F.

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in elderly people. Older patients with AF have several comorbidities and should be treated with complex therapeutic schemes. Arrhythmia complications are also common at an advanced age. Accordingly, AF can be considered a marker of frailty. Few indications can be found concerning the management of frail older subjects in current guidelines. The Frailty in Atrial Fibrillation Survey Study (FAST) was designed to overcome the gap of knowledge about this extremely vulnerable subset of patients. A multidisciplinary team composed by cardiologists, geriatricians and internists participated in the project. In a first phase, a survey was conducted aiming at clarifying specialty-related differences in definition and oral anticoagulant therapy (OAT) management of frail individuals. In the second phase, specific chapters were prepared about AF and frailty epidemiology, the network for the management of the arrhythmia, the diagnostic strategies for AF (including a minimum data set of tools derived from the geriatric multidimensional assessment), OAT and the choice between a rate or a rhythm control strategy. For each chapter, up-to-date evidence and current guideline recommendations were presented and discussed among the 47 Italian centers participating in the project. In the last phase of FAST, the results of the survey and the final draft of the chapters were merged into the present document. A lack of homogeneity in frailty definition existed. The integration among cardiologists, geriatricians and internists can represent the most effective tool to get through these differences improving the management of frail older patients.

Published
2021

10. Prevention of Breast Cancer: Focus on Chemoprevention

Author

Costa, A., Bonanni, B., Manetti, L., Gonzaga, A. Guerrieri, Torrisi, R., Decensi, A., Schlag, P. M., editor, Senn, H.-J., editor, Diehl, V., editor, Parkin, D. M., editor, Rajewsky, M. F., editor, Rubens, R., editor, Wannenmacher, M., editor, Senn, Hans-Jörg, editor, Gelber, Richard D., editor, Goldhirsch, Aron, editor, and Thürlimann, Beat, editor

Published
1998
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15. Conventional and Nuclear Medicine Imaging in Ectopic Cushingʼs Syndrome: A Systematic Review

Author

Isidori, Andrea M., Sbardella, Emilia, Zatelli, Maria Chiara, Boschetti, Mara, Vitale, Giovanni, Colao, Annamaria, Pivonello, Rosario, Albiger, N., Ambrogio, A., Arnaldi, G., Arvat, E., Berardelli, R., Boscaro, M., Boschetti, M., Cannavò, S., Cavagnini, F., Colao, A., Corsello, S. M., Cozzolino, A., De Leo, M., Di Somma, C., Esposito, K., Ferone, D., Foresta, C., Gatto, F., Giordano, C., Giugliano, D., Graziadio, C., Isidori, A. M., Loli, P., Manetti, L., Mannelli, M., Marzullo, P., Mantero, F., Minuto, F., Paragliola, R. M., Giraldi, F. Pecori, Pivonello, R., Reimondo, G., Scaroni, C., Scillitani, A., Simeoli, C., Stigliano, A., Terzolo, M., Tortora, F., Trementino, L., Vitale, G., and Zatelli, M. C.

Published
2015

27. Measurement of urinary free cortisol by LC–MS–MS: adoption of a literature reference range and comparison with our current immunometric method. (Saba A., Agretti P., co-last authors)

Author

Bianchi, L., Campi, B., Sessa, M. R., De Marco, G., Ferrarini, E., Zucchi, R., Marcocci, C., Vitti, P., Manetti, L., Saba, A., and Agretti, P.

Subjects
Diabetes and Metabolism, Endocrinology, Antibody cross-reactivity, Interference from steroid similar molecules, LC–MS–MS, Reference range, Immunometric assay, Urinary free cortisol, Endocrinology, Diabetes and Metabolism
Published
2019

34. Treatment of skeletal impairment in patients with endogenous hypercortisolism: when and how?

Author

Scillitani A, Mazziotti G, Di Somma C, Moretti S, Stigliano A, Pivonello R, Giustina A, Colao A, Albiger N, Ambrogio A, Arnaldi G, Arvat E, Baldelli R, Berardelli R, Boscaro M, Cannavò S, Cavagnini F, Corsello SM, Cozzolino A, De Bartolomeis A, De Leo M, Di Minno G, Esposito K, Fabbrocini G, Ferone D, Foresta C, Galderisi M, Giordano C, Grimaldi F, Isidori AM, Jannini E, Lombardo F, Manetti L, Mannelli M, Mantero F, Marone G, Nazzari E, Paragliola RM, Pasquali R, Pecorelli S, Pecori Giraldi F, Pivonello C, Reimondo G, Scaroni C, Simeoli C, Toscano V, Trementino L, Vitale G, Zatelli M.C.)., ESPOSITO, Katherine, GIUGLIANO, Dario, Scillitani, A, Mazziotti, G, Di Somma, C, Moretti, S, Stigliano, A, Pivonello, R, Giustina, A, Esposito, Katherine, Colao, A, Albiger, N, Ambrogio, A, Arnaldi, G, Arvat, E, Baldelli, R, Berardelli, R, Boscaro, M, Cannavò, S, Cavagnini, F, Corsello, Sm, Cozzolino, A, De Bartolomeis, A, De Leo, M, Di Minno, G, Esposito, K, Fabbrocini, G, Ferone, D, Foresta, C, Galderisi, M, Giordano, C, Giugliano, Dario, Grimaldi, F, Isidori, Am, Jannini, E, Lombardo, F, Manetti, L, Mannelli, M, Mantero, F, Marone, G, Nazzari, E, Paragliola, Rm, Pasquali, R, Pecorelli, S, Pecori Giraldi, F, Pivonello, C, Reimondo, G, Scaroni, C, Simeoli, C, Toscano, V, Trementino, L, Vitale, G, and Zatelli, M. C. ).

Published
2014

35. The hypertension of Cushing's syndrome: Controversies in the pathophysiology and focus on cardiovascular complications

Author

Isidori, Am, Graziadio, C, Paragliola, Rm, Cozzolino, A, Ambrogio, Ag, Colao, A, Corsello, Sm, Pivonello, R, Albiger, N, Arnaldi, G, Arvat, E, Baldelli, R, Berardelli, R, Boscaro, M, Cannavo', Salvatore, Cavagnini, F, De Bartolomeis, A, De Leo, M, Di Minno, G, Di Somma, C, Esposito, K, Fabbrocini, G, Ferone, D, Foresta, C, Galderisi, M, Giordano, C, Giugliano, D, Giustina, A, Grimaldi, F, Jannini, E, Lombardo, F, Manetti, L, Mannelli, M, Mantero, F, Marone, G, Mazziotti, G, Moretti, S, Nazzari, E, Pasquali, R, Pecorelli, S, Pecori Giraldi, F, Pivonello, C, Reimondo, G, Scaroni, C, Scillitani, A, Simeoli, C, Stigliano, A, Toscano, V, Trementino, L, Vitale, G, Zatelli, Mc, Isidori, A, Graziadio, C, Paragliola, R, Cozzolino, A, Ambrogio, A, Colao, A, Corsello, S, Pivonello, R, and Giordano, C

Subjects
Male, antihypertensive treatment, blood pressure, corticosteroids, Cushing's syndrome, hypercortisolism, hypertension, metabolic syndrome, vascular system, Animals, Blood Pressure, Cushing Syndrome, Female, Glucocorticoids, Humans, Hypertension, Metabolic Syndrome, medicine.medical_specialty, Physiology, Hypercortisolism, Reviews, Settore MED/13 - Endocrinologia, Cushing syndrome, Internal medicine, Antihypertensive treatment, Internal Medicine, Medicine, Corticosteroid, Intensive care medicine, S syndrome, business.industry, medicine.disease, Metabolic syndrome, antihypertensive treatment, blood pressure, corticosteroids, Cushing's syndrome, hypercortisolism, hypertension, metabolic syndrome, vascular system, Pathophysiology, Clinical trial, Critical appraisal, Endocrinology, Blood pressure, Vascular system, Corticosteroids, Cardiology and Cardiovascular Medicine, business, Glucocorticoid, medicine.drug
Abstract

Cushing's syndrome is associated with increased mortality, mainly due to cardiovascular complications, which are sustained by the common development of systemic arterial hypertension and metabolic syndrome, which partially persist after the disease remission. Cardiovascular diseases and hypertension associated with endogenous hypercortisolism reveal underexplored peculiarities. The use of exogenous corticosteroids also impacts on hypertension and cardiovascular system, especially after prolonged treatment. The mechanisms involved in the development of hypertension differ, whether glucocorticoid excess is acute or chronic, and the source endogenous or exogenous, introducing inconsistencies among published studies. The pleiotropic effects of glucocorticoids and the overlap of the several regulatory mechanisms controlling blood pressure suggest that a rigorous comparison of in-vivo and in-vitro studies is necessary to draw reliable conclusions. This review, developed during the first ‘Altogether to Beat Cushing's syndrome’ workshop held in Capri in 2012, evaluates the most important peculiarities of hypertension associated with CS, with a particular focus on its pathophysiology. A critical appraisal of most significant animal and human studies is compared with a systematic review of the few available clinical trials. A special attention is dedicated to the description of the clinical features and cardiovascular damage secondary to glucocorticoid excess. On the basis of the consensus reached during the workshop, a pathophysiology-oriented therapeutic algorithm has been developed and it could serve as a first attempt to rationalize the treatment of hypertension in Cushing's syndrome.

Published
2015

36. Treatment of skeletal impairment in patients with endogenous hypercortisolism: when and how?

Author

Scillitani, A, Mazziotti, G, Di Somma, C, Moretti, S, Stigliano, A, Pivonello, R, Giustina, A, Colao, A, Albiger, N, Ambrogio, A, Arnaldi, G, Arvat, E, Baldelli, R, Berardelli, R, Boscaro, M, Cannavo', Salvatore, Cavagnini, F, Corsello, Sm, Cozzolino, A, De Bartolomeis, A, De Leo, M, Di Minno, G, Esposito, K, Fabbrocini, G, Ferone, D, Foresta, C, Galderisi, M, Giordano, C, Giugliano, D, Grimaldi, F, Isidori, Am, Jannini, E, Lombardo, F, Manetti, L, Mannelli, M, Mantero, F, Marone, G, Nazzari, E, Paragliola, Rm, Pasquali, R, Pecorelli, S, Pecori Giraldi, F, Pivonello, C, Reimondo, G, Scaroni, C, Simeoli, C, Toscano, V, Trementino, L, Vitale, G, Zatelli, M. C., Scillitani, A, Mazziotti, G, Di Somma, C, Moretti, S, Stigliano, A, Pivonello, R, Giustina, A, Colao, A, Giordano, C, DI SOMMA, C, Giustina, Andrea, Colao, A., DI SOMMA, Carolina, Pivonello, Rosario, Colao, Annamaria, Abc, Group, and Fabbrocini, Gabriella

Subjects
Oncology, medicine.medical_specialty, FRAX, Endocrinology, Diabetes and Metabolism, Osteoporosis, Hypercortisolism, Adrenal incidentaloma, Cushing's disease, Glucocorticoids, Bone Density Conservation Agents, Cushing Syndrome, Humans, Osteoporotic Fractures, Risk Factors, Endogeny, Disease, adrenal incidentaloma, Bone remodeling, Internal medicine, medicine, glucocorticoids, business.industry, cushing's disease, medicine.disease, osteoporosis, Rheumatology, Endocrinology, CUSHING'S DISEASE, business, Glucocorticoid, medicine.drug
Abstract

Guidelines for the management of osteoporosis induced by endogenous hypercortisolism are not available. Both the American College of Rheumatology and the International Osteoporosis Foundation recommend to modulate the treatment of exogenous glucocorticoid-induced osteoporosis (GIO) based on the individual fracture risk profile (calculated by FRAX) and dose of glucocorticoid used, but it is difficult to translate corticosteroid dosages to different degrees of endogenous hypercortisolism, and there are no data on validation of FRAX stratification method in patients with endogenous hypercortisolism. Consequently, it is unclear whether such recommendations may be adapted to patients with endogenous hypercortisolism. Moreover, patients with exogenous GIO take glucocorticoids since suffering a disease that commonly affects bone. On the other hand, the correction of coexistent risk factors, which may contribute to increase the fracture risk in patients exposed to glucocorticoid excess, and the removal of the cause of endogenous hypercortisolism, may lead to the recovery of bone health. Although the correction of hypercortisolism and of possible coexistent risk factors is necessary to favor the normalization of bone turnover with recovery of bone mass; in some patients, the fracture risk could not be normalized and specific anti-osteoporotic drugs should be given. Who, when, and how the patient with endogenous hypercortisolism should be treated with bone-active therapy is discussed.

Published
2014

45. APOPTOSIS IN A SERIES OF GEP-NET

Author

Russo, D, Raggi, F, Ultimieri, F, Del Chiaro, M, Brogioni, S, Lombardi, M, Funel, Niccola, Campani, Daniela, Manetti, L, Raffaelli, V, Boggi, Ugo, Martino, Enio, and Bogazzi, Fausto

Published
2008

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