Search Results
Search for other papers by Filippo Ceccato in
Google Scholar
PubMed
Search for other papers by Elisa Selmin in
Google Scholar
PubMed
Search for other papers by Chiara Sabbadin in
Google Scholar
PubMed
Search for other papers by Miriam Dalla Costa in
Google Scholar
PubMed
Search for other papers by Giorgia Antonelli in
Google Scholar
PubMed
Search for other papers by Mario Plebani in
Google Scholar
PubMed
Search for other papers by Mattia Barbot in
Google Scholar
PubMed
Search for other papers by Corrado Betterle in
Google Scholar
PubMed
Search for other papers by Marco Boscaro in
Google Scholar
PubMed
Search for other papers by Carla Scaroni in
Google Scholar
PubMed
Introduction and Aim
The purpose of replacement therapy in adrenal insufficiency (AI) is mimicking endogenous cortisol levels as closely as possible: dual release hydrocortisone (DR-HC) has been introduced to replicate the circadian cortisol rhythm. Multiple daily saliva collections could be used to assess the cortisol rhythm during real life: our aim was to study the salivary cortisol profile in AI.
Materials and Methods
We prospectively evaluated, in an observational study, 18 adult outpatients with AI (11 primary and 7 secondary AI), switched from conventional treatment (conv-HC, 25 mg/day) to the same dose of DR-HC. We collected six samples of saliva in a day, measuring cortisol (F) and cortisone (E) with LC-MS/MS. Forty-three matched healthy subjects served as controls.
Results
F levels were similar in the morning (and higher than controls) in patients treated with conv-HC or DR-HC; otherwise F levels and exposure were lower in the afternoon and evening in patients with DR-HC, achieving a cortisol profile closer to healthy controls. Daily cortisol exposure, measured with area under the curve, was lower with DR-HC. Morning F and E presented sensitivity and specificity >90% to diagnose AI (respectively threshold of 3 and 9.45 nmol/L). Total cholesterol and HbA1c levels reduced with DR-HC.
Conclusions
Salivary cortisol daily curve could be used as a new tool to assess the cortisol profiles in patients treated with conv-HC and DR-HC. A lower daily cortisol exposure was achieved with DR-HC (despite the same HC dose), especially in the afternoon-evening.
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
Department of Neuroscience DNS, University of Padova, Padova, Italy
Search for other papers by Filippo Ceccato in
Google Scholar
PubMed
Search for other papers by Elisa Selmin in
Google Scholar
PubMed
Laboratory Medicine, University-Hospital of Padova, Padova, Italy
Search for other papers by Giorgia Antonelli in
Google Scholar
PubMed
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
Department of Neuroscience DNS, University of Padova, Padova, Italy
Search for other papers by Mattia Barbot in
Google Scholar
PubMed
Search for other papers by Andrea Daniele in
Google Scholar
PubMed
Search for other papers by Marco Boscaro in
Google Scholar
PubMed
Laboratory Medicine, University-Hospital of Padova, Padova, Italy
Search for other papers by Mario Plebani in
Google Scholar
PubMed
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
Search for other papers by Carla Scaroni in
Google Scholar
PubMed
Context
The low-dose short synacthen test (LDSST) is recommended for patients with suspected central adrenal insufficiency (AI) if their basal serum cortisol (F) levels are not indicative of an intact hypothalamic–pituitary–adrenal (HPA) axis.
Objective
To evaluate diagnostic threshold for salivary F before and 30 min after administering 1 μg of synacthen, performed before 09:30 h.
Design
A cross-sectional study from 2014 to 2020.
Setting
A tertiary referral university hospital.
Patients
In this study, 174 patients with suspected AI, 37 with central AI and 137 adrenal sufficient (AS), were included.
Main outcome measure
The diagnostic accuracy (sensitivity (SE), specificity (SP)) of serum and salivary F levels measured, respectively, by chemiluminescence immunoassay and liquid chromatography-tandem mass spectrometry.
Results
Low basal serum or salivary F levels could predict AI. For the LDSST, the best ROC-calculated threshold for serum F to differentiate AI from AS was 427 nmol/L (SE 79%, SP 89%), serum F > 500 nmol/L reached SP 100%. A salivary F peak > 12.1 nmol/L after administering synacthen reached SE 95% and SP 84% for diagnosing central AI, indicating a conclusive reduction in the likelihood of AI. This ROC-calculated threshold for salivary F was similar to the 2.5th percentile of patients with a normal HPA axis, so it was considered sufficient to exclude AI. Considering AS those patients with salivary F > 12.1 nmol/L after LDSST, we could avoid unnecessary glucocorticoid treatment: 99/150 subjects (66%) had an inadequate serum F peak after synacthen, but salivary F was >12.1 nmol/L in 79 cases, who could, therefore, be considered AS.
Conclusions
Salivary F levels > 12.1 nmol/L after synacthen administration can indicate an intact HPA axis in patients with an incomplete serum F response, avoiding the need to start glucocorticoid replacement treatment.
Search for other papers by Soraya Puglisi in
Google Scholar
PubMed
Search for other papers by Paola Perotti in
Google Scholar
PubMed
Search for other papers by Mattia Barbot in
Google Scholar
PubMed
Search for other papers by Paolo Cosio in
Google Scholar
PubMed
Search for other papers by Carla Scaroni in
Google Scholar
PubMed
Search for other papers by Antonio Stigliano in
Google Scholar
PubMed
Search for other papers by Pina Lardo in
Google Scholar
PubMed
Search for other papers by Valentina Morelli in
Google Scholar
PubMed
Search for other papers by Elisa Polledri in
Google Scholar
PubMed
Search for other papers by Iacopo Chiodini in
Google Scholar
PubMed
Search for other papers by Giuseppe Reimondo in
Google Scholar
PubMed
Search for other papers by Anna Pia in
Google Scholar
PubMed
Search for other papers by Massimo Terzolo in
Google Scholar
PubMed
Objective
Metyrapone has been approved for the treatment of patients with Cushing’s syndrome (CS), but only few retrospective clinical studies are available. The aim of our study was the prospective assessment of metyrapone as pre-operative treatment.
Design and methods
Before adrenalectomy, seven patients with ACTH-independent CS due to adrenal adenoma were prospectively treated with metyrapone for 3 months in three tertiary academic centers, with endocrine work-up and clinical evaluation at screening and at predefined evaluation time points (Days 14, 31, 48, 65, 82).
Results
In all patients, UFC levels decreased up to normal range from baseline to Day 82 (609 (188–1476) vs 69 (28–152) nmol/24 h, P < 0.02), with a reduction of serum and salivary cortisol levels, and no significant increase of plasma ACTH and serum DHEAS levels. Clinical improvement was reported on quality of life (+16.7 (+4.2; +52.00) points, P < 0.04) and pressure control (systolic pressure, −25 (−52; −10) mmHg, P < 0.01; diastolic pressure, −16 (−50; +2 mmHg), P < 0.03). No significant change in weight, electrolytes, glycemic and lipid profile was reported. Although in women a significant increase of testosterone and androstenedione was reported, no worsening of clinical hyperandrogenism was observed. All drug-related adverse events (nausea, fatigue, low grade fever, edema of lower limbs and facial rash) were grade 1 or 2 and generally transient.
Conclusions
This prospective pilot study demonstrated that metyrapone is effective in normalizing biochemical and clinical parameters in patients with CS due to adrenal adenoma before surgical intervention, with minimal side effects.
Search for other papers by Carla Scaroni in
Google Scholar
PubMed
Search for other papers by Nora M Albiger in
Google Scholar
PubMed
Search for other papers by Serena Palmieri in
Google Scholar
PubMed
Search for other papers by Davide Iacuaniello in
Google Scholar
PubMed
Search for other papers by Chiara Graziadio in
Google Scholar
PubMed
Search for other papers by Luca Damiani in
Google Scholar
PubMed
Search for other papers by Marialuisa Zilio in
Google Scholar
PubMed
Search for other papers by Antonio Stigliano in
Google Scholar
PubMed
Search for other papers by Annamaria Colao in
Google Scholar
PubMed
Search for other papers by Rosario Pivonello in
Google Scholar
PubMed
Search for other papers by the Altogether to Beat Cushing’s Syndrome (ABC) study group in
Google Scholar
PubMed
The distinction between pseudo-Cushing’s states (PCS) and Cushing’s syndrome (CS) poses a significant clinical challenge even for expert endocrinologists. A patient’s clinical history can sometimes help to distinguish between them (as in the case of alcoholic individuals), but the overlap in clinical and laboratory findings makes it difficult to arrive at a definitive diagnosis. We aim to describe the most common situations that can give rise to a condition resembling overt endogenous hypercortisolism and try to answer questions that physicians often face in clinical practice. It is important to know the relative prevalence of these different situations, bearing in mind that most of the conditions generating PCS are relatively common (such as metabolic syndrome and polycystic ovary syndrome), while CS is rare in the general population. Physicians should consider CS in the presence of additional features. Appropriate treatment of underlying conditions is essential as it can reverse the hormonal abnormalities associated with PCS. Close surveillance and a thorough assessment of a patient’s hormone status will ultimately orient the diagnosis and treatment options over time.
Department of Neuroscience DNS, University of Padova, Padova, Italy
Search for other papers by Filippo Ceccato in
Google Scholar
PubMed
Nuclear Medicine Unit, Department of Medicine – DIMED, University-Hospital of Padova, Padova, Italy
Padova Neuroscience Center PNC, University of Padova, Padova, Italy
Search for other papers by Diego Cecchin in
Google Scholar
PubMed
Search for other papers by Michele Gregianin in
Google Scholar
PubMed
Search for other papers by Giacomo Ricci in
Google Scholar
PubMed
Department of Mathematics ‘Tullio Levi-Civita’ DM, University of Padova, Padova, Italy
Search for other papers by Cristina Campi in
Google Scholar
PubMed
Search for other papers by Filippo Crimì in
Google Scholar
PubMed
Search for other papers by Marta Bergamo in
Google Scholar
PubMed
Search for other papers by Annibale Versari in
Google Scholar
PubMed
Search for other papers by Carmelo Lacognata in
Google Scholar
PubMed
Search for other papers by Federico Rea in
Google Scholar
PubMed
Search for other papers by Mattia Barbot in
Google Scholar
PubMed
Search for other papers by Carla Scaroni in
Google Scholar
PubMed
Introduction and aim
Ectopic ACTH secretion (EAS) is mostly secondary to thoracic/abdominal neuroendocrine tumours (NETs) or small cell-lung carcinoma (SCLC). We studied the diagnostic accuracy of CT with 68Ga-Dota derivatives (68Ga-SSTR) PET in localizing ACTH-secreting tumor in patients with EAS.
Materials and methods
68Ga-SSTR-PET/CT was performed and compared with the nearest enhanced CT in 18 cases (16 primary and 2 recurrent neoplasms). Unspecific, indeterminate and false-positive uptakes were assessed using conventional imaging, follow-up or histology.
Results
We diagnosed 13 thoracic (9 primary and 2 recurrent bronchial carcinoids, 2 SCLCs) and 1 abdominal (pancreatic NET) tumors. Eight ACTH-secreting tumors were promptly identified at EAS diagnosis (’overt’, four pulmonary carcinoids with two recurrences and two SCLC); six EAS have been discovered during the subsequent follow-up (’covert’, five bronchial carcinoids and one pancreatic NET). At the time of EAS diagnosis, imaging was able to correctly detect the ACTH-secreting tumour in 8/18 cases (6 new diagnosis and 2 recurrences). During the follow-up, six out of initially ten ‘occult’ cases became ‘covert’. At last available follow-up, CT and 68Ga-SSTR-PET/CT were able to diagnose 11/18 and 12/18 ACTH-secreting tumours, respectively (11/14 and 12/14 considering only overt and covert cases, respectively). Four cases have never been localized by conventional or nuclear imaging (’occult EAS’), despite an average follow-up of 5 years.
Conclusion
The 68Ga-SSTR-PET/CT is useful in localizing EAS, especially to enhance positive prediction of the suggestive CT lesions and to detect occult neoplasms.
