Minerva endocrinology最新文献

Background: Overweight and obesity are major public health issues with increasing incidence and prevalence, affecting more than 50% of the population in developed countries. Due to its complex pathophysiology and multifactorial etiology, disease understanding, diagnostic approach and management remain suboptimal. Together with a structured nutritional intervention and physical activity plan, pharmacological treatment has the potential to magnify weight loss and health related benefits. Liraglutide is one of the most effective and frequently prescribed weight loss medication. Its efficacy and safety have been demonstrated in randomized clinical trials, however, real world data in Portugal is scarce. The authors report on the experience of a University Hospital Endocrine Clinic in the management of patients with overweight and obesity with liraglutide on top of lifestyle intervention. The aim of the study was to evaluate the effectiveness of liraglutide in the management of overweight and obesity.

Methods: Retrospective, longitudinal observational study. Inclusion criteria were adult patients (>18 years old) with obesity (BMI>30 kg/m²) or overweight (≥27 kg/m²) with at least one obesity related co-morbidity (hypertension, dyslipidemia, obstructive sleep apnea, non-alcoholic fatty liver disease) with at least three months of liraglutide treatment. Diabetes diagnosis and prior bariatric surgery were exclusion criteria. Demographic and clinical variables were included and weight was recorded before and after at least 3 months of liraglutide treatment.

Results: One hundred forty-eight patients (85.8% females) with a mean age of 48.7±11.9 years were treated with liraglutide. Mean baseline BMI was 33.8±5.2 kg/m² and median follow-up was 13 months. At the last appointment, 85.8% were still taking liraglutide. Among patients still taking liraglutide, mean weight loss was 7.6 kg (7.9%), with significantly greater losses in patients treated for more than 6 months (8.6kg vs. 6.2 kg, P=0.016). Patients with obesity lost significantly more weight than overweight patients (8.3 kg vs. 4.5 kg, P=0.028), despite similar treatment duration. The reasons for liraglutide withdrawal were gastrointestinal intolerance (7), medication cost (2), inefficacy (10) and physician instructions (1).

Conclusions: The present study documents the long-term efficacy of liraglutide in the treatment of patients with overweight and obesity, with a low rate of drug withdrawal. Mean weight loss was significant and more evident from the 6th month of treatment on. Liraglutide, along with lifestyle intervention, is a good option for weight management in the majority of patients with obesity.

Background: The aim of our retrospective study was to describe the immunophenotypic characteristics of neuroendocrine breast neoplasm (BNEN), a peculiar and rare type of breast carcinoma.

Methods: Pathological data from 51 patients affected by BNEN were retrospectively evaluated, and 44 patients were considered eligible (7 patients with incomplete data were excluded). The patients were followed in six different Italian hospitals between 2009 and 2019. The histological samples, collected by biopsies and/or surgery pieces, were analyzed to determine: 1) tumor histology; 2) immunophenotypic pattern; 3) presence of lymphatic infiltration; 4) presence of necrosis.

Results: The median age of the patients included in our analysis was 70 years (67.6±13.7 years). As concerns the histological type we identified 7 cases of well-differentiated neuroendocrine carcinomas (16%), 8 cases of poorly differentiated/small cell neuroendocrine carcinoma (18%), 29 cases of breast carcinomas with neuroendocrine differentiation (66%). From the analysis of breast-specific immunophenotype we identified: 24 cases (54%) of Luminal A pattern; 9 cases (20%) of Luminal B pattern; 8 case (18%) of triple negative pattern. The presence of lymphatic infiltration was assessed in 29 samples and it was observed in 13 cases (45%), necrosis was assessed in 29 samples and was absent in 72% of all cases (21 samples). Neuroendocrine markers expression was heterogeneous with a prevalence of synaptophysin (positivity in 95%); chromogranin A was evaluated in 31 samples and it was positive in 58% of cases.

Conclusions: in our series BNENs mainly affect a post-menopausal population and luminal A pattern is the most frequent immunophenotype. As expected, lymphatic infiltration is most frequently reported in invasive breast cancer with neuroendocrine differentiation; necrosis is absent in well-differentiated neuroendocrine carcinomas. Synaptophysin and chromogranin A are important markers for the diagnosis of BNEN.

Introduction: Several data demonstrated that chemical pollutants can be endocrine disruptors and they have an important role in tumorigenic processes. It has been shown that pollution exposure can affect pituitary cells' function and biology, indeed an increased prevalence of acromegaly has been reported in highly polluted areas.

Evidence acquisition: One transcription factor that has a role in both carcinogenesis and in xenobiotics' detoxification is the aryl hydrocarbon receptor (AHR). Its deregulation could have a pivotal role in pituitary tumors, especially in GH-secreting pituitary tumors. Environmental chemicals affect the expression and function of ncRNAs (miRNA, lncRNA and circRNA) through different mechanisms.

Evidence synthesis: However, to date, few data on the role of the environmental pollutants in the clinical expression and pathogenesis of GH-secreting pituitary tumors are available.

Conclusions: This article presents a summary of the AHR signaling pathways that are triggered by various ligands and emphasizes the significant distinctions between the potential biological and toxicological effects of AHR gene activation. We also deepen the functions of ncRNAs and acromegaly and provide current data on their regulation by the AHR. Overall, more studies are still needed to fully understand the dynamic interplay between the AHR signaling pathway and ncRNAs in GH-secreting pituitary adenomas.

Background: The use of inpatient palliative care (IPC) in advanced cancer patients represents a well-established guideline recommendation. This study examines the utilization rates and patterns of IPC among patients with metastatic adrenocortical carcinoma (mACC).

Methods: Relying on the Nationwide Inpatient Sample database (2007-2019), we tabulated IPC rates in mACC patients. Estimated annual percentage changes (EAPC) analyses as well as multivariable logistic regression models (MLRM) predicting IPC use were fitted.

Results: Of 2040 mACC patients, 238 (12%) received IPC. Overall, the rate of IPC increased from 3.7% to 19.1% between 2007 and 2019 (EAPC +9.6%, P=0.001). During the same period, in-hospital mortality remained unchanged from 12.1 to 13.8% (EAPC 0.1%; P=0.97). Younger age at admission (<60 years; MLRM OR=0.70, P=0.013), solitary metastatic site (OR=0.63; P=0.015), and non-brain metastases (OR=0.62; P=0.033) were all associated with lower IPC use.

Conclusions: In mACC patients, IPC use has increased from a marginal 3.7% to a moderate annual value of 19.1% in the most recent study year. These rates were not driven by a concomitant increase in in-hospital mortality (12.1% to 13.8%; P=0.9). and may be interpreted as an improvement in quality of care. Despite this encouraging increase, some patient characteristics herald lower IPC use. In consequence, younger patients, those with solitary metastatic sites, and non-brain metastases should be carefully considered for IPC to decrease or completely reduce the IPC access barrier maximally.

Background: Treatment-resistant schizophrenia (TRS) is a severe psychiatric disorder that is associated with a high level of psychotic symptoms and cognitive deficit as well as poor functioning, and an increased risk of mortality for cardiometabolic diseases. Some studies suggest that lifestyle, particularly diet, could represent a risk factor for obesity and its metabolic complications in these patients.

Methods: This cross-sectional study aimed to evaluate diet quality and eating habits in individuals with TRS. Seventeen participants (13M/4F aged 37.8±13 years) were recruited to assess dietary composition and food groups consumption by a 7days food record to assess. In addition, demographic and clinical data were collected.

Results: Most of the participants were overweight/obese (82%) and only 35% performed physical activity. As compared to nutritional recommendations, participants presented an insufficient intake of fiber (15.9±3.2 g/day), vitamins (thiamine, riboflavin, vitamin A, D, and E), minerals (calcium, magnesium, selenium, and iron), and polyunsaturated fatty acids (2.11±0.8%), likely triggered by the low consumption plant-based foods (legumes, fruit, vegetables, and nuts) and fish. Participants exceeded the intake of saturated fatty acids (11.6±3.4%) and cholesterol (242±124 mg/day), and simple sugars (15.2±3.9%) which were mainly related to greater consumption of red meat and processed meat, and sweet foods, respectively.

Conclusions: Individuals with TRS presented low diet quality and did not comply with the nutritional recommendations. These results support the importance of including nutritional assessment in the management of individuals with TRS.

Background: Bariatric surgery (BS) stands as a highly effective intervention for severe obesity; however, limited understanding exists regarding its short to medium-term complications. This study aimed to analyze short-medium term complications in patients undergoing BS in an Ecuadorian hospital.

Methods: A retrospective cohort study included 1132 patients who underwent BS between October 2021 and April 2022, specifically evaluating those with complications needing hospital readmission. Demographic, clinical, surgical, and therapeutic data were collected. The degree of complications was evaluated using the Clavien-Dindo classification.

Results: Out of the 1132 patients, 1.6% experienced early complications requiring hospital readmission within the first six months post-BS. Complications occurred in 7% of patients with revisional surgery, 2% with gastric bypass, and 1.2% with gastric sleeve. The most common complications were stenosis (28%), leaks/fistulas (17%), gallbladder and/or bile duct pathologies (17%), and fever (17%). Management strategies involved conservative treatment (28%), combined endoscopic and surgical approaches (28%), and surgical reintervention alone (33%). According to the Clavien-Dindo classification, 28% presented mild-moderate and 72% serious complications.

Conclusions: BS showed a low incidence of early complications that required readmission. However, a substantial proportion (almost 70%) of patients with early complications experienced severe ones, resulting in prolonged hospital stays. These findings emphasize the need for ongoing monitoring and specialized care in the postoperative period, contributing valuable insights to the safety profile of BS in an Ecuadorian context.

Adrenal cysts are rare lesions that are increasingly discovered incidentally during radiological examinations conducted without suspicion of adrenal disease. Typically benign, hormonally nonfunctional, and asymptomatic, these lesions may occasionally manifest mass effect symptoms such as pain or abdominal discomfort, particularly in large cysts. Management approaches vary from no follow-up to hormonal investigation, imaging follow-up, or adrenalectomy, especially if the cyst is growing or exhibits an atypical appearance. Due to the rarity of adrenal cysts, all new cases should ideally be discussed at an adrenal multidisciplinary team meeting. In this comprehensive review, we illustrate the clinical, radiological and histological features of adrenal cysts by showcasing four typical patient cases, and also summarize the most important take-home messages for optimal clinical management.

Background: Treatment of type 2 diabetes mellitus (T2DM) relies on diverse glucose-lowering medications, championing sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists as viable options to address concurrent cardiovascular risk. An oral formulation of semaglutide (Rybelsus^®, Novo Nordisk) has been recently introduced to clinical use for managing T2DM. Accordingly, there is a paucity of practice evidence while building experience on its combination with SGLT2i.

Methods: In this observational, single-arm, retrospective study, data collected from 142 T2DM patients (66% males, 68% older than 60 years, 85% overweight/obese) treated with oral semaglutide in combination with SGLT2i were analyzed.

Results: After 6.8±2.6 months of treatment, both glycosylated hemoglobin (HbA1c) and fasting plasma glucose levels significantly improved: 39.6% of patients achieved HbA1cDCCT ≤7% (HbA1cIFCC ≤53.0 mmol/mol) and 18.8% experienced both a decrease of HbA1c ≥1% and a weight loss ≥5%. In addition, body weight, body mass index, waist circumference, triglycerides, and total cholesterol levels were significantly reduced. Regarding safety, 94.7% of reported adverse events were non-serious gastrointestinal symptoms and 1 patient experienced hypoglycemia.

Conclusions: The herein presented real-world data suggest that oral semaglutide can be regarded as safe and effective, when used as add-on medication for uncontrolled T2DM on background SGLT2i.