Micaela Pellegrino

Federico II University Hospital

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Giorgio Borretta

Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo

Laura Gianotti

Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo

F. Tassone

Agostino Gemelli University Polyclinic

Elena Castellano

Spanish National Cancer Research Centre

Claudia Baffoni

Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo

Flora Cesario

Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo

Emanuela Arvat

University of Turin

Roberta Giordano

University of Turin

Ezio Ghigo

University of Turin

Anna Pia

University of Turin

Cooperative Institutions

University of Turin

Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo

Istituti di Ricovero e Cura a Carattere Scientifico

Federico II University Hospital

University of Naples Federico II

Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

University of Milan

University of Gothenburg

University of Padua

Fondazione Ricerca Molinette

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Abstract #1057 Thyroid Diseases in PHPT: A Single Centre Study

Endocrine Practice (2018)

Elena Castellano Adele Latina Micaela Pellegrino Laura Gianotti Flora Cesario

10.1016/s1530-891x(20)47422-1

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Adrenal Incidentalomas are Tied to Increased Risk of Diabetes: Findings from a Prospective Study

The Journal of Clinical Endocrinology & Metabolism (2020)

Giuseppe Reimondo Elena Castellano Maurizio Grosso Roberto Priotto Soraya Puglisi

Abstract Context The frequency of adrenal incidentalomas and their association with comorbid conditions have been assessed mostly in retrospective studies that may be prone to ascertainment bias. Objective The objective of this work is to evaluate the frequency of adrenal incidentalomas and their associated comorbid conditions. Design A prospective cohort study was conducted. Setting This study took place at a radiology department at a public hospital. Participants Unselected outpatients who underwent an abdominal computed tomography (CT) from January 2017 to June 2018. Patients with known or suspected adrenal disease or malignancy were excluded. Exposure All abdominal CT scans were evaluated by an experienced radiologist. Hormonal workup including a 1-mg dexamethasone suppression test was performed in patients bearing adrenal incidentalomas. Main Outcome and Measure Frequency of adrenal incidentalomas in abdominal CT of unselected patients; frequency of comorbid conditions, and hormonal workup in patients bearing adrenal incidentalomas. Results We recruited 601 patients, and in 7.3% of them an adrenal tumor was found serendipitously. The patients bearing an adrenal incidentaloma had higher body mass index (P = .009) and waist circumference (P = .004) and were more frequently diabetic (P = .0038). At multivariable regression analysis, diabetes was significantly associated with the presence of adrenal incidentalomas (P = .003). Autonomous cortisol secretion was observed in 50% of patients who did not suppress cortisol less than 50 nmol/L after 1 mg dexamethasone. Conclusions The frequency of adrenal incidentalomas is higher than previously reported. Moreover, adrenal incidentalomas are tied to increased risk of type 2 diabetes. This finding is free from ascertainment bias because patients with adrenal incidentalomas were drawn from a prospective cohort with the same risk of diabetes as the background population.

Incidentaloma

Dexamethasone suppression test

10.1210/clinem/dgz284

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Citations (102)

Serum Phosphate: A Neglected Test in the Clinical Management of Primary Hyperparathyroidism

The Journal of Clinical Endocrinology & Metabolism (2021)

Elena Castellano Roberto Attanasio Alberto Boriano Micaela Pellegrino Giorgio Borretta

Abstract Background Although the inverse correlation between serum PTH and phosphate (P) levels in patients with primary hyperparathyroidism (PHPT) is well known, the relationship between P levels and the clinical picture of the disease has not been well investigated. This was thus the aim of this paper. Patients A total of 472 consecutive patients with PHPT attending our center were retrospectively evaluated at diagnosis. Results P levels lower than 2.5 mg/dL (HypoP) were found in 198/472 patients (41.9%). HypoP was mild (2-2.5 mg/dL), moderate (1-1.9 mg/dL), and severe (<1 mg/dL) in 168 (84.9%), 30 (15.1%), and 0 cases, respectively. P levels were lower in males than females. Patients with more severe bone density impairment at the radial (but not the vertebral or femoral) site had P levels significantly lower than other patients. PHPT severity was worse in HypoP patients, both clinically (higher prevalence of renal stones, but not of osteoporosis) and biochemically (higher serum calcium and PTH levels). All patients in the moderate HypoP group were either symptomatic or asymptomatic reaching surgical indication according to the latest guidelines. Conclusions We observed a relationship between P levels and biochemical and clinical features of PHPT severity. In asymptomatic PHPT patients, even moderate HypoP is predictive of surgical indication, regardless of age and hypercalcemia severity.

10.1210/clinem/dgab676

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Citations (11)

Abstract #527: Gender Difference in Clinical Presentation of Primary Hyperparathyroidism (PHPT)

Endocrine Practice (2017)

Giorgio Borretta Roberto Attanasio Flora Cesario Micaela Pellegrino Adele Latina

Presentation (obstetrics)

10.1016/s1530-891x(20)44467-2

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Acute Primary Adrenal Insufficiency after Hip Replacement in a Patient with Acute Intermittent Porphyria

Case Reports in Endocrinology (2018)

Adele Latina Massimo Terzolo Anna Pia Giuseppe Reimondo Elena Castellano

Adrenal insufficiency is a potentially life-threatening condition when it occurs acutely, as in adrenal hemorrhage. Generally it is not reversible and requires chronic replacement therapy. Acute intermittent porphyria (AIP) is a rare genetic disease characterized by alterations in heme biosynthesis that result in accumulation of precursors in tissues. A crisis can be triggered by many conditions such as surgery and infections. Symptoms are similar to those of acute hypoadrenalism. Moreover, both conditions are characterized by hyponatremia. We describe the case of a postmenopausal woman known to be affected by AIP who developed after surgery a primary adrenal insufficiency associated with adrenal enlargement; the latter completely reverted in six months.

Primary Adrenal Insufficiency

Adrenal crisis

10.1155/2018/2353172

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Relationship between insulin sensitivity and bone mineral density in primary hyperparathyroidism

Clinical Endocrinology (2014)

Laura Gianotti F. Tassone Claudia Baffoni Micaela Pellegrino Sara Cassibba

Evidence of crosstalk between bone and insulin metabolism has been identified. In primary hyperparathyroidism (PHPT), scant data exist on this relationship.To evaluate the relationship between insulin levels or sensitivity and bone mineral density (BMD) in PHPT.Two hundred and sixty-seven patients with PHPT without known diabetes mellitus were studied. Fasting blood glucose and insulin levels as well as BMD at lumbar spine, femoral neck and forearm were measured. Insulin sensitivity was assessed using Quantitative Insulin Sensitivity Check Index (QUICKI). The same parameters were measured 2 years (interquartile range 2·8 years) after surgery (PTX) in a subgroup of patients (n = 51).In univariate analysis, a positive relationship between insulin levels and BMD (R = 0·17, P < 0·03) or T-score (R = 0·20, P < 0·005) was found at femoral neck level. Consequently, a negative relationship between QUICKI and femoral BMD (R = -0·20, P < 0·01) or T-score (R = -0·21, P < 0·004) was found. In multivariate analysis, when femoral BMD was the dependent variable, age (beta = -0·35, P < 0·000004), BMI (beta = 0·39, P < 0·00001), PTH (beta = -0·18, P < 0·05) and QUICKI (R = -0·15, P < 0·05) had an independent effect (R(2) = 0·29). Insulin levels and QUICKI did not change after PTX. No relationship was found between QUICKI or insulin levels at the time of diagnosis and change in BMD at any site at follow-up.Our data show a weak relationship between insulin levels and/or insulin sensitivity and BMD in PHPT. However, the insulin state does not influence change in bone density after PTX in PHPT.

10.1111/cen.12472

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Citations (7)

Cortisol autonomy is associated with increased risk of cardiovascular events and mortality in patients with adrenal incidentalomas: beneficial effects of a selective use of adrenalectomy

Endocrine Abstracts (2016)

Giuseppe Reimondo Elena Mbachu Micaela Pellegrino Anna Pia Emanuele Pepe

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

10.1530/endoabs.41.oc7.4

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Neuroblastoma in the Elderly and SIADH: Case Report and Review of the Literature

Case Reports in Medicine (2012)

Micaela Pellegrino Laura Gianotti Sara Cassibba Rodolfo Brizio Alberto Terzi

Objective. To report the rare case of a thymic neuroblastoma, in an elderly woman with SIADH at presentation. Methods. Clinical and biochemical data of the patient are presented and the pertinent literature is reviewed. Results. a 79-year-old woman was admitted into our department with worsening asthenia, severe hyponatremia (114.8 mEq/L), low plasma osmolarity (253 mEq/L), and inappropriate urinary sodium concentration (151 mEq/L). CT scan showed an a large solid inhomogeneous mass in the anterior mediastinum. (18)F-FDG-PET/CT showed uptake in the mass. On continuous 3% hypertonic saline infusion, sodium gradually increased without achieving normal values. The patient underwent surgery, followed by full normalization of sodium levels. Tumor cells were positive for neuroendocrine markers. Thymic neuroblastoma with SIADH was diagnosed. Conclusions. Neuroblastoma is an extremely rare tumor in the elderly. Contrary to children and younger adults, neuroblastoma in older adults is typically localized in the anterior mediastinum and is often associated with SIADH. Moreover, it has mainly local aggressiveness in this age group, without metastatic spread; thus radical surgery achieves cure in most cases.

Anterior mediastinum

Hypertonic saline

10.1155/2012/952645

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Citations (16)

Neuroregulation of the Hypothalamus-Pituitary-Adrenal (HPA) Axis in Humans: Effects of GABA-, Mineralocorticoid-, and GH-Secretagogue-Receptor Modulation

The Scientific World JOURNAL (2006)

Roberta Giordano Micaela Pellegrino Andreea Picu Lorenza Bonelli M. Balbo

The hypothalamus-pituitary-adrenal (HPA) axis exerts a variety of effects at both the central and peripheral level. Its activity is mainly regulated by CRH, AVP, and the glucocorticoid-mediated feedback action. Moreover, many neurotransmitters and neuropeptides influence HPA axis activity by acting at the hypothalamic and/or suprahypothalamic level. Among them, GABA and Growth Hormone Secretagogues (GHS)/GHS-receptor systems have been shown to exert a clear inhibitory and stimulatory effect, respectively, on corticotroph secretion. Alprazolam (ALP), a GABA-A receptor agonist, shows the most marked inhibitory effect on both spontaneous and stimulated HPA axis activity, in agreement with its peculiar efficacy in panic disorders and depression where an HPA axis hyperactivation is generally present. Ghrelin and synthetic GHS possess a marked ACTH/cortisol-releasing effect in humans and the ghrelin/GHS-R system is probably involved in the modulation of the HPA response to stress and nutritional/metabolic variations. The glucocorticoid-mediated negative feedback action is mediated by both glucocorticoid (GR) and mineralocorticoid (MR) receptors activation at the central level, mainly in the hippocampus. In agreement with animal studies, MRs seem to play a crucial role in the maintenance of the circadian ACTH and cortisol rhythm, through the modulation of CRH and AVP release. GABA agonists (mainly ALP), ghrelin, as well as MR agonists/antagonists, may represent good tools to explore the activity of the HPA axis in both physiological conditions and pathological states characterized by an impaired control of the corticotroph function.

Secretagogue

Corticotropin-releasing hormone

Hypothalamic–pituitary–adrenal axis

10.1100/tsw.2006.09

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Citations (90)

HYPOTHALAMO-PITUITARY-ADRENAL (HPA) AXIS SENSITIVITY TO THE NEGATIVE FEED-BACK ACTION OF CORTISOL IN HUMANS

Roberta Giordano Matteo Baldi Micaela Pellegrino Fabio Lanfranco M. Balbo

Hypothalamic–pituitary–adrenal axis

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