THE CLINICAL ACTIVITY SCORE IN MANAGEMENT OF GRAVES’ OPHTHALMOPATHY: CORRELATION WITH ORBITAL MR IMAGING.

Our aime was to investigate the correlation between GO ocular parameters obtained by MRI with contrast administration and the well-know clinical indicators of GO and to examine the relationship between the clinical course of hyperthyroidism and GO severity

Levothyroxine and insulin requirement in autoimmune polyglandular type 3 syndrome: a real-life study

Abstract Purpose To evaluate factors influencing the insulin and levothyroxine requirement in patients with autoimmune polyglandular syndrome type 3 (APS-3) vs. patients with type 1 diabetes mellitus (T1DM) and autoimmune hypothyroidism (AH) alone, respectively. Methods Fifty patients with APS-3, 60 patients with T1DM and 40 patients with AH were included. Anthropometric, clinical and biochemical parameters were evaluated in all patients. Insulin requirement was calculated in patients with APS-3 and T1DM, while levothyroxine requirement was calculated in APS-3 and AH. Results Patients with APS-3 showed higher age (p = 0.001), age of onset of diabetes (p = 0.006) and TSH (p = 0.004) and lowe…

Diversa efficacia clinica e biochimica della terapia con liraglutide in una popolazione di diabetici di tipo 2 in relazione ai valori basali di HbA1c

Background: I criteri AIFA di rimborsabilità dei farmaci ad azione incretino-mimetica limitano notevolmente l’utilizzo degli stessi ad un range molto ristretto di HbA1c alla prima prescrizione(7,5-8,5%), escludendone quindi dal loro utilizzo i pazienti con più severo scompenso glicometabolico. Obiettivi: Valutare la diversa efficacia di liraglutide durante i primi 12 mesi di terapia in relazione ai valori di HbA1c di partenza. Metodi: Sono stati retroattivamente valutati i dati clinici e metabolici di 62 pazienti diabetici di tipo 2 (38 M, 24 F, range età 29-74 aa, range durata di malattia 0-30 aa) trattati in un periodo antecedente l’entrata in vigore dei limiti di rimborsabilità AIFA, in …

More Favorable Metabolic Impact of Three-Times-Weekly versus Daily Growth Hormone Treatment in Naïve GH-Deficient Children

Objective. To evaluate whether two different regimens of weekly injections could lead to similar auxological and metabolic effects in children with growth hormone deficiency (GHD).Design. 32 GHD children (25 males, mean age 10.5 ± 2.2 yr) were randomly assigned to receive daily (group A, 16 patients) or TIW (group B, 16 patients) GHT for 12 months.Methods. Auxological parameters, insulin-like growth factor-I (IGF-I), glucose and insulin during OGTT, glycosylated hemoglobin (HbA1c), lipid profile, the oral disposition index (DIo), the homeostasis model assessment estimate of insulin resistance (Homa-IR), and the insulin sensitivity index (ISI).Results. After 12 months, both groups showed a s…

The metabolic outcomes of growth hormone treatment in children are gender specific

Objective To evaluate the impact of gender on the clinical and metabolic parameters in prepubertal growth hormone deficiency (GHD) children at diagnosis and during GH treatment (GHT). Design The data of 105 prepubertal children (61 males, 44 females, mean age 6.8 ± 0.7 years) affected by idiopathic GHD were retrospectively evaluated. Methods Body height, BMI, waist circumference (WC), IGF-I, HbA1c, lipid profile, fasting and after-OGTT glucose and insulin levels, insulin sensitivity and secretion indices were evaluated at baseline and after 24 months of GHT. Results At baseline, no significant difference was found in all clinical, hormonal and metabolic parameters between males and females…

Corneal thickness in children with growth hormone deficiency: The effect of GH treatment.

Abstract OBJECTIVE: The eye represents a target site for GH action, although few data are available in patients with GH deficiency (GHD). Our aim was to evaluate central corneal thickness (CCT) and intraocular pressure (IOP) values in GHD children to assess the role played by GHD or GH treatment on these parameters. DESIGN: In 74 prepubertal GHD children (51M, 23F, aged 10.4±2.4years) we measured CCT and IOP before and after 12months of treatment. A baseline evaluation was also made in 50 healthy children matched for age, gender and body mass index. The study outcome considered CCT and IOP during treatment and their correlations with biochemical and auxological data. RESULTS: No difference …

The lacrimal gland herniation role in the Graves’ orbitopathy

To evaluate the LG involvement, through the measurement of the LG herniation by of magnetic resonance imaging (MRI), in patients with different GO activity

Clinical and metabolic impact of three-times-weekly versus daily growth hormone (GH) treatment in naïve GH-deficient children

OBJECTIVE: Growth hormone treatment (GHT) is commonly administered daily, although pulsatile GH secretion is unlikely to be achieved. The auxological effect of a three-injections-per-week (TIW) regimen is controversial, while the metabolic effects have been never evaluated in children. The objective was to evaluate whether two different regimens of weekly injections could lead to similar auxological and metabolic effects in children with GH deficiency (GHD). DESIGN: 32 GHD children (25 males, mean age 10.5 ± 2.2 yr) were randomly assigned to receive daily (group A, No 16) or TIW (group B, No 16) GHT for 12 months. METHODS: Auxological parameters, insulin-like growth factor-I (IGF-I), glucos…

RELATIONSHIP BETWEEN GONADAL HOMEOSTASIS AND METABOLIC PARAMETERS IN A POPULATION OF HOSPITALIZED DIABETIC MALES.

Liraglutide Improves Cardiovascular Risk as an Add-on to Metformin and Not to Insulin Secretagogues in Type 2 Diabetic Patients: A Real-life 48-Month Retrospective Study.

INTRODUCTION: Although liraglutide is widely recognized to have glycemic and extra-glycemic effects, few studies have compared these effects in relation to hypoglycemic treatment starting from the diagnosis of diabetes. We evaluated the effectiveness of liraglutide in reducing the Framingham risk score (FRS) and visceral adiposity index (VAI) in relation to first-line hypoglycemic treatment from diagnosis of type 2 diabetes, continued without any changes. METHODS: We selected 105 diabetic outpatients who were treated with liraglutide for at least 48 months as an add-on therapy to metformin alone (group A, n = 52) or insulin secretagogues (group B, n = 53) from diagnosis time. RESULTS: Altho…

Correction to: One Year of Dapaglifozin Add-On Therapy Ameliorates Surrogate Indexes of Insulin Resistance and Adiposity in Patients with Type 2 Diabetes Mellitus

This study investigates the effects of dapagliflozin on the visceral adiposity index (VAI), lipid accumulation product (LAP), product of triglycerides and glucose (TyG) and triglycerides to HDL-cholesterol ratio (TG/HDL-C) in patients with type 2 diabetes mellitus (T2D). In this real-life study, dapaglifozin was added to metformin alone (group 1, no. 42) or insulin plus metformin (group 2, no. 58) in 100 T2D patients. In group 1, after 6 months of dapaglifozin addition, a significant decrease in BMI (p < 0.001), waist circumference (WC) (p < 0.001), systolic blood pressure (SBP) (p = 0.009), diastolic blood pressure (DBP) (p = 0.012), mean fasting blood glucose (FBG), post-breakfast glucose…

Gender-specific soluble α-klotho levels as marker of GH deficiency in children: a case-control study.

Abstract Purpose To evaluate circulating soluble α-klotho (sαKL) levels in GHD children before and after 12 months of GH treatment (GHT). Methods Auxological and basal metabolic parameters, oral glucose tolerance test for glucose and insulin levels, insulin sensitivity indices and klotho levels were evaluated before and after 12 months of follow-up in 58 GHD children and 56 healthy controls. Results At baseline, GHD children showed significantly lower growth velocity standard deviation score (SDS) (p &lt; 0.001), bone/chronological age ratio (p &lt; 0.001), GH peak and area under the curve (AUC) after arginine test (ARG) (both p &lt; 0.001) and glucagon stimulation test (GST) (p &lt; 0.001 …

Growth hormone and hematopoiesis: A retrospective analysis on a large cohort of children with growth hormone deficiency

Objective: Few large-scale studies regarding the impact of GH deficiency (GHD) on hematopoiesis in children have been reported. Our aim was to investigate hematopoiesis indices in a large cohort of GHD children at diagnosis and during GH treatment (GHT) and any correlation with hormonal parameters. Design: Clinical and biochemical data of children with idiopathic GHD at diagnosis and annually up to 36 months of GHT were retrospectively evaluated. Overall, 255 children reached 12 months, 140 children 24 months and 86 children 36 months of follow-up during GHT. Results: At baseline, 18.4% of GHD children and 10.1% of controls showed normocytic anemia. GHD children showed lower hemoglobin (Hb)…

Lacrimal gland herniation in Graves ophthalmopathy: a simple and useful MRI biomarker of disease activity

Lacrimal gland (LG) involvement in patients with Graves ophthalmopathy (GO) has been considered as a potential cause of the associated GO symptoms and different studies demonstrated the LG involvement in patients with GO than healthy controls. The aim of this study was to evaluate LG involvement, through measurement of its herniation, using a magnetic resonance imaging (MRI) index, in patients with different GO activities. Thirty-two consecutive Caucasian patients affected by GO were enrolled and grouped in group A (16 with inactive GO, CAS < 3) and B (16 with active GO, CAS ≥ 3) according to their GO activity. All patients underwent clinical-endocrinological assessment, a complete ocular e…

Correlation between adrenal function, growth hormone secretion, and insulin sensitivity in children with idiopathic growth hormone deficiency

Purpose Patients with growth hormone deficiency (GHD) demonstrate an increased cortisol/cortisone ratio which could potentially explain the metabolic features of GHD, while GH treatment (GHT) could increase the cortisol metabolism. Methods In 35 children (27 M, mean age 10.1 years) with idiopathic GHD at baseline and after 12 months of GHT and in 25 controls, in addition to metabolic parameters, we assessed adrenal function by morning serum cortisol, its peak, and its area under the curve (AUCCOR) during insulin tolerance test (ITT). Results A cortisol peak <18 µg/dl was shown in 22 and 31% of GHD children at baseline and after GHT, respectively. At baseline, GHD children had lower fasting …

Efficacy of combined treatment with pasireotide, pegvisomant and cabergoline in an acromegalic patient resistant to other treatments: a case report

Abstract Background The approach to acromegalic patients with persistent acromegaly after surgery and inadequate response to first-generation somatostatin receptor ligands (SRLs) should be strictly tailored. Current options include new pituitary surgery and/or radiosurgery, or alternative medical treatment with SRLs high dose regimens, pegvisomant (PEG) as monotherapy, or combined therapy with the addition of PEG or cabergoline to SRLs. A new pharmacological approach includes pasireotide, a second-generation SRL approved for patients who do not adequately respond to surgery and/or for whom surgery is not an option. No reports on efficacy and safety of combined therapy with pasireotide and p…

Dual-release hydrocortisone improves hepatic steatosis in patients with secondary adrenal insufficiency: A real-life study

Background:Conventional glucocorticoid treatment has a significant impact on liver in patients with adrenal insufficiency. Dual-release hydrocortisone (DR-HC) provides physiological cortisol exposure, leading to an improvement in anthropometric and metabolic parameters. We aimed to evaluate the effects of 12-month DR-HC treatment on the hepatic steatosis index (HSI), a validated surrogate index of hepatic steatosis, in patients with secondary adrenal insufficiency (SAI).Methods:A total of 45 patients with hypopituitarism, 22 with hypogonadism, hypothyroidism, ACTH, and GH deficiencies, and 23 with hypogonadism, hypothyroidism, and ACTH deficiency, on replacement therapy for all the pituitar…

Utility of C-peptide for a reliable estimate of insulin secretion in children with growth hormone deficiency.

OBJECTIVE: GH treatment (GHT) can lead to glucose metabolism impairment through decreased insulin sensitivity and impaired pancreatic β-cell function, which are the two key components of the pathogenesis of diabetes. Therefore, in addition to insulin sensitivity, during GHT it is very important to perform a reliable evaluation of insulin secretion. However, conflicting data exist regarding the insulin secretion in children during GHT. C-peptide provides a more reliable estimate of β-cell function than insulin, but few studies evaluated it during GHT. Our aim was to assess the usefulness of C-peptide in the evaluation of insulin secretion in GH deficiency (GHD) children. DESIGN: In 48 GHD ch…

Valutazione del C-peptide come migliore indice di insulino-secrezione in bambini affetti da deficit di GH

Background: La terapia con GH determina iperinsulinemia sia per effetto diretto del GH sulla β-cellula, sia per effetto controregolatorio indiretto. I dati in letteratura sulla valutazione dell’insulino-secrezione durante terapia con GH, basati prevalentemente su indici surrogati derivati da livelli basali o stimolati di insulinemia, sono piuttosto discordanti tra loro e pochissimi studi hanno considerato i livelli di C-peptide, che sia nei soggetti sani che diabetici rappresentano una stima più accurata della funzione β-cellulare rispetto all’insulinemia. Obiettivi: Valutare l’utilità del C-peptide nello studio dell’insulino-secrezione in bambini GHD durante terapia con GH. Metodi: Abbiamo…

Miglioramento clinico e metabolico in pazienti affetti da diabete mellito tipo 1 associato ad altre endocrinopatie (APS) dopo shift della terapia insulinica basale con glargine a degludec

Background L’utilizzo di insulina degludec, rispetto ad altre insuline basali, sembra associato ad una ridotta incidenza di episodi ipoglicemici e di conseguenza ad una maggiore stabilità glicemica con miglioramento del compenso glicometabolico. Materiali e Metodi Abbiamo analizzato i parametri clinico-metabolici e i profili glicemici di 51 consecutivi pazienti affetti da diabete tipo 1 associato ad altre endocrinopatie (APS) in stabile terapia basale con glargine (in baseline) e suddivisi in 2 gruppi: gruppo A (n.21) a cui è stata confermata la terapia con glargine e gruppo B (n.30) a cui è stata sostituita glargine con degludec per un periodo di 6 mesi. A tutti i pazienti è stato chiesto …

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

The visceral adiposity index, based on anthropometric and metabolic parameters, has been shown to be related to adipose tissue function and insulin sensitivity. We aimed to evaluate the performance of the visceral adiposity index in adult patients with growth hormone deficiency. We enrolled 52 patients(mean age 51 ± 13 years) with newly diagnosed growth hormone deficiency and 50 matched healthy subjects as controls at baseline. At baseline and after 12 and 24 months of treatment we evaluated anthropometric measures, lipid profile, glucose and insulin during an oral glucose tolerance test, hemoglobin A1c, homeostasis model assessment estimate of insulin resistance, quantitative insulin sensi…