Innovative Approaches to Active and Healthy Ageing: Campania Experience to Improve the Adoption of Innovative Good Practices

The demographic projections on the European population predict that people aged over 60 will increase by about two million/year in the next decades. Since 2012, the Campania Reference Site of the European Innovation Partnership on Active and Healthy Ageing supports the innovation of the Regional Health System, to face up demographic changes and sustainability. Campania Reference Site provides the opportunity to connect loco-regional stakeholders in social and health care services (universities, healthcare providers, social services, local communities and municipalities), with international organizations, in order to adopt and scale up innovative solutions and approaches. This paper describe…

Endothelial abnormalities in young women with PCOS: correlations with insulin resistance and decreased levels of serum adiponectin

Abstract PURPOSE: Polycystic ovary syndrome (PCOS) is an extremely prevalent disorder in which elevated blood markers of cardiovascular risk and altered endothelial function have been found. This study was designed to determine if abnormal carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) in young women with PCOS may be explained by insulin resistance and elevated adipocytokines. METHODS: A prospective study in 50 young women with PCOS (age: 25.2 +/- 1 years; body mass index [BMI]: 28.7 +/- 0.8) and 50 matched ovulatory controls (age: 25.1 +/- 0.7 years; BMI: 28.5 +/- 0.5) was performed. Carotid IMT, brachial FMD, and blood for fasting glucose, insulin, leptin, …

The adipose visceral dysfunction plays an important role in diabetes in Cushing disease.

Background: Cushing disease (CD) is associated with increased morbidity and mortality caused by cardiometabolic alterations. Visceral Adiposity Index (VAI) expresses impaired adipose distribution and function which are related to the cardiometabolic risk. Aim: To evaluate in a cohort of CD patients the correlation between VAI and other parameters, such as gender, etiology, age, cortisol values measured in the morning (8 am) and at the midnight, urinary free cortisol (24h sample of urine, average of three samples) and glucose tolerance as normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG+IGT and diabetes mellitus. Materials and methods: We …

Neuroendocrine neoplasms in the context of inherited tumor syndromes: a reappraisal focused on targeted therapies

Purpose Neuroendocrine neoplasms can occur as part of inherited disorders, usually in the form of well-differentiated, slow-growing tumors (NET). The main predisposing syndromes include: multiple endocrine neoplasias type 1 (MEN1), associated with a large spectrum of gastroenteropancreatic and thoracic NETs, and type 4 (MEN4), associated with a wide tumour spectrum similar to that of MEN1; von Hippel-Lindau syndrome (VHL), tuberous sclerosis (TSC), and neurofibromatosis 1 (NF-1), associated with pancreatic NETs. In the present review, we propose a reappraisal of the genetic basis and clinical features of gastroenteropancreatic and thoracic NETs in the setting of inherited syndromes with a s…

Visceral adiposity index and metabolic profile in adult patients with congenital adrenal hyperplasia: hydrocortisone versus prednisone treatment.

Background: Patients with Congenital Adrenal Hypeplasia (CAH) due to 21-hydroxylase deficiency need a life-long therapy with glucocorticoids (GCs) and tend to have a cluster of metabolic risk factors, which are consistent with metabolic syndrome (MS). Most frequently used GCs are Hydrocortisone (HC) and Prednisone (P), different for both pharmacodynamic and pharmacokynetic characteristics. Aim: The aim of this study was to evaluate the impact of HC and P on VAI, a new indicator of visceral fat function, and on metabolic profile in CAH patients long term treated with GC. Materials and Methods: Thirty-two patients (22 F, 10 M, 18-46 yrs), among which 16 (11 F, 5 M) treated with HC (dose 10-45…

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

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 endoge…

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Abstract Background Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairmen…

EFFECT OF SWITCH FROM CONVENTIONAL GLUCOCORTICOIDS TO “DUAL RELEASE HYDROCORTISONE” (DR-HC) ON METABOLIC PROFILE AND QUALITY OF LIFE IN ADULT PATIENTS WITH SECONDARY ADRENAL INSUFFICIENCY (SAI): RESULTS OF THREE MONTHS FOLLOW-UP

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

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 a…

EFFECTS OF CABERGOLINE TREATMENT ON METABOLIC SYNDROME AND VISCERAL ADIPOSITY INDEX IN PATIENTS WITH HYPERPROLACTINEMIA.

Introduction: Hyperprolactinemia is reportedly associated with an impaired metabolic profile, particularly in patients with concomitant hypogonadism. The current study aimed at investigating the effects of short (12 months) and long (60 months) treatment with cabergoline (CAB) on metabolic complications, metabolic syndrome (MS) prevalence and visceral adiposity index (VAI) in hyperprolactinemic patients (pts). Patients and Methods: Seventy-one pts (51 F, 20 M, aged 35.4±11.7 yrs), including 36 with microprolactinomas, 32 with macroprolactinomas and 3 with non-tumoral hyperprolactinemia, entered the study. In all pts, PRL and metabolic parameters (BMI, waist circumference, lipid and glucose …