Frontiers of hormone research最新文献

Methods to assess quality of life and recovery after endoscopic endonasal surgery (EES) for sellar lesions are limited and often biased by subjective patient-reported assessments. Objective in-situ assessments are lacking. Smartphone-based digital phenotyping has been increasingly studied across a variety of pathologies, utilizing built-in technologies to measure behavioral patterns pertaining to sleep, physical mobility, social interactions, and cognitive functioning, among others. We report our experience with smartphone-based digital phenotyping in two acromegalic patients treated with EES. Beiwe application was applied pre-operatively to passively collect global position system data in the pre- and postoperative period, including daily distance traveled, maximal distance traveled from home, number of separate places visited outside of home, and overall time spent at home. This study demonstrates the feasibility of DP for a small sample of acromegalic patients undergoing EES based on passively collected smartphone global position system data during the peri-operative period. This is part of a larger, ongoing study enrolling surgical patients as well as non-operative controls for comparison aimed at predicting postoperative outcomes with in-situ tool.

Acromegaly is a chronic and progressive disorder caused by growth hormone (GH) and insulin-like growth factor 1 (IGF-1) excess, responsible for the onset of multiple systemic complications. Targets of acromegaly treatment are the normalization of hormonal (GH/IGF-1) parameters, the removal/reduction/stabilization of the pituitary mass, the control of existing conditions, and the prevention of new ones, so to improve quality of life and normalize life expectancy. Patients often require a multimodal therapeutic approach, including surgery, medical therapy, and radiotherapy, that allows disease cure/control in the majority of the cases. However, some pituitary tumors are resistant to treatments and/or recur. Novelties in the field of medical treatment in acromegaly can be summarized as follows: (a) new protocols applied to existing medications; (b) new devices to administer old drugs; (c) new formulations, and (d) new drugs. In this review, we aim at summarizing the current protocols and drugs to treat acromegaly (standard of care), and presenting the new pharmacological options including those drugs that are still being tested and could be released in the market in the next few years.

A fair shred of evidence supports the mutual relationship between the hypothalamus-pituitary testis axis and the growth hormone (GH) pathway. Nevertheless, the role of GH on male sexual function and fertility is controversial, due to conflicting data from literature. The present review summarizes the available andrological consequences of two pathological extremes, i.e., either GH excess or deficiency. GH excess drives different disorders of male sexual health. On one hand, it indirectly favors the onset of erectile dysfunction (40.2% of cases) mostly by its detrimental vascular and metabolic effects, while testosterone levels don't appear as a key factor. On the other hand, GH excess directly impairs fertility, leading to secondary hypogonadism. Of note, compared to controls, this condition adversely affects the main sperm parameters, i.e., sperm concentration (p = 0.00), progressive motility (p = 0.03), and normal morphology (p = 0.02). Although with limited evidence, GH deficiency also fosters erectile dysfunction, while its effect on fertility is still unclear. On the whole, the available literature shows that any GH disorder plays a negative role in both male general and sexual health. Nevertheless, the potential benefit of testosterone replacement therapy in this population has not yet been explored.

The syndrome of growth hormone deficiency (GHD) in adulthood is characterized by adverse changes in body composition, reduced exercise capacity and quality of life, alterations in cardiovascular function as well as in lipid and carbohydrate metabolism. There is enough evidence to support long-term effects of recombinant human GH therapy on fracture risk, lipid metabolism parameters, body composition, and overall quality of life in adults with GHD, with low probability of side effects at currently suggested doses. Nevertheless, the endocrinologist's role in the careful selection of recombinant human GH therapy candidates, based on clinical characteristics, risk factors, degree of quality of life impairment, patient's ability and willingness to adhere to therapy, is of most importance in order to achieve the best efficacy and the greatest therapeutic safety.

Growth hormone deficiency (GHD) is one the most common and early endocrine complications in children and adolescent undergoing surgery for hypothalamic-pituitary neoplasm. Etiological factors include tumor mass effect, hypothalamic/pituitary damage caused by surgery and/or radiation therapy. The diagnosis and treatment of patients with brain tumors is extremely complex and requires close monitoring by a multidisciplinary expert team that must define the most appropriate treatment type and timing according to patient and tumor features, including GH replacement treatment (GH-rT), through the harmonization of the criteria used to define when the neoplastic disease is stable and when and how to start and stop GH-rT, in order to improve patient outcome and quality of life. Despite several proofs of safety, GH-rT remains a matter of debate.

Transition is the time encompassing the achievement of full height and complete somatic development, representing a period of physical, psychological, and social changes. Considering the beginning of social adaptation, the research of independence, and the desire to manage health conditions, the acceptance of chronic care should be poor. Patients affected by growth hormone deficiency (GHD), characterized by heterogeneity in diagnosis, high comorbidity burden, need for daily injections, and lack of biological markers during follow-up, could have a high drop-out rate. Replacement treatment is meaningful because, even if GHD is not life-threatening, it could represent a risk for long-term metabolic, cardiovascular, bone, and psychosocial complications with, eventually, a reduction in quality of life. Moreover, the diagnosis is not always straightforward, since the studies on stimulation tests are limited, or molecules are lacking, cutoffs are often not validated in transition patients, and follow-up requires attention in specific cases (i.e., cancer survivors). The present review aims to describe the features of GHD during transition, focusing on etiologies, pitfalls in diagnosis, GH replacement therapy, and follow-up issues.