| 21. |
- Esposito, Daniela, et al.
(författare)
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Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study
- 2018
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Ingår i: European Journal of Endocrinology. - 0804-4643 .- 1479-683X. ; 178:5, s. 459-469
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Tidskriftsartikel (refereegranskat)abstract
- Context: New therapeutic strategies have developed for the management of acromegaly over recent decades. Whether this has improved mortality has not been fully elucidated. Objective: The primary aim was to investigate mortality in a nationwide unselected cohort of patients with acromegaly. Secondary analyses included time trends in mortality and treatment patterns. Design: A total of 1089 patients with acromegaly were identified in Swedish National Health Registries between 1987 and 2013. To analyse time trends, the cohort was divided into three periods (1987–1995, 1996–2004 and 2005–2013) based on the year of diagnosis. Main outcome measures: Using the Swedish population as reference, standardized mortality ratios (SMRs) were calculated with 95% confidence intervals (CIs). Results: Overall SMR was 2.79 (95% CI: 2.43–3.15) with 232 observed and 83 expected deaths. Mortality was mainly related to circulatory diseases (SMR: 2.95, 95% CI: 2.35–3.55), including ischemic heart disease (2.00, 1.35–2.66) and cerebrovascular disease (3.99, 2.42–5.55) and malignancy (1.76, 1.27–2.26). Mortality decreased over time, with an SMR of 3.45 (2.87–4.02) and 1.86 (1.04–2.67) during the first and last time period, respectively (P=.015). During the same time periods, the frequency of pituitary surgery increased from 58% to 72% (P<0.001) and the prevalence of hypopituitarism decreased from 41% to 23% (P<0.001). Conclusions: Excess mortality was found in this nationwide cohort of patients with acromegaly, mainly related to circulatory and malignant diseases. Although still high, mortality significantly declined over time. This could be explained by the more frequent use of pituitary surgery, decreased prevalence of hypopituitarism and the availability of new medical treatment options. © 2018 European Society of Endocrinology Printed in Great Britain.
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| 22. |
- Esposito, Daniela, et al.
(författare)
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Effect of Diabetes on Morbidity and Mortality in Patients With Acromegaly.
- 2022
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Ingår i: The Journal of clinical endocrinology and metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 107:9, s. 2483-2492
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Tidskriftsartikel (refereegranskat)abstract
- Diabetes is a major risk factor for cardiovascular disease and death but its effect on outcomes in acromegaly is unknown.This work aimed to study whether diabetes affects morbidity and mortality in patients with acromegaly.A nationwide (Sweden), observational, matched-cohort study was conducted. Patients diagnosed with acromegaly between 1987 and 2020 were identified in the Swedish National Patient Registry and those with concomitant type 2 diabetes in the National Diabetes Registry and Drug Registry. The risk of overall mortality, and cardiovascular mortality and morbidity were estimated using Cox regression.The study included 254 patients with acromegaly and concomitant type 2 diabetes (ACRO-DM group) and 532 without diabetes (ACRO group). Mean (SD) age at baseline was 62.6 (11.4) and 60.0 (12.1) years (P=.004) and the mean (SD) duration of acromegaly was 6.8 (8.1) and 6.0 (6.2) years (P=.098) in the ACRO-DM and ACRO groups, respectively. Overall mean follow-up was 9.2 years. The unadjusted overall mortality rate per 1000 person-years was 35.1 (95% CI, 27.2-44.7) and 20.1 (95% CI, 16.5-24.3) in the respective groups. The hazard ratio (HR) for overall mortality adjusted for multiple confounders was 1.58 (95% CI, 1.12-2.23) in the ACRO-DM group compared with the ACRO group. Cardiovascular mortality (HR 2.11; 95% CI, 1.09-4.10) and morbidity (HR 1.49; 95% CI, 1.21-1.82) were also increased in the ACRO-DM group.The presence of diabetes in patients with acromegaly was associated with increased overall mortality as well as increased cardiovascular mortality and morbidity.
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| 23. |
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| 24. |
- Esposito, Daniela, et al.
(författare)
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Incidence of Benign and Malignant Tumors in Patients with Acromegaly is Increased: a Nationwide Population-Based Study.
- 2021
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Ingår i: The Journal of clinical endocrinology and metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 106:12, s. 3487-3496
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Tidskriftsartikel (refereegranskat)abstract
- Whether cancer risk in acromegaly is increased remains controversial. Also, the risk of benign tumors has been little studied.To investigate the incidence of benign and malignant tumors in acromegaly in a nationwide population-based study.Adult patients diagnosed with acromegaly between 1987 and 2017 were identified in the Swedish National Patient Registry. The diagnoses of benign and malignant tumors were recorded. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for neoplasms with 95% confidence intervals (CIs) were calculated using the Swedish general population as reference.The study included 1296 patients (52% women). Mean (SD) age at diagnosis was 51.6 (14.7) years. Median (range) follow-up time was 11.7 (0-31) years. Overall, 186 malignancies were identified in acromegalic patients compared to 144 expected in the general population (SIR 1.3; 95% CI, 1.1-1.5). The incidence of colorectal and anal cancer (SIR 1.5; 95% CI, 1.0-2.2), and renal and ureteral cancer (SIR 4.0; 95% CI, 2.3-6.5) was increased, whereas the incidence of malignancies of the respiratory system, brain, prostate, and breast was not. Only three cases of thyroid cancer were recorded. Mortality due to malignancies was not increased (SMR 1.1; 95% CI, 0.9-1.4). Incidence of benign tumors was increased more than 2-fold (SIR 2.4; 95% CI, 2.1-2.7).Patients with acromegaly had an increased risk of both benign and malignant tumors including colorectal and anal cancer, and renal and ureteral cancer. Whether this is associated with acromegaly itself or due to more intensive medical surveillance remains to be shown.
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| 25. |
- Esposito, Daniela, et al.
(författare)
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Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management.
- 2019
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Ingår i: Pituitary. - : Springer Science and Business Media LLC. - 1573-7403 .- 1386-341X. ; 22:4, s. 422-434
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Forskningsöversikt (refereegranskat)abstract
- Non-functioning pituitary adenomas (NFPAs) are associated with impaired well-being, increased comorbidities, and reduced long-term survival. Data on optimal management of NFPAs around surgical treatment are scarce, and postoperative treatment and follow-up strategies have not been evaluated in prospective trials. Here, we review the preoperative, perioperative, and early postoperative management of patients with NFPAs.We searched Medline and the Cochrane Library for articles published in English with the following items "Pituitary neoplasms AND Surgery" and "Surgery AND Hypopituitarism". Studies containing detailed analyses of the management of NFPAs in adult patients, including pituitary surgery, endocrine care, imaging, ophthalmologic assessment and long-term outcome were reviewed.Treatment options for NFPAs include active surveillance, surgical resection, and radiotherapy. Pituitary surgery is currently recommended as first-line treatment in patients with visual impairment due to adenomas compressing the optic nerves or chiasma. Radiotherapy is reserved for large tumor remnants or tumor recurrence following one or more surgical attempts. There is no consensus of optimal pre-, peri-, and postoperative management such as timing, frequency, and duration of endocrine, radiologic, and ophthalmologic assessments as well as management of smaller tumor remnants or tumor recurrence.In clinical practice, there is a great variation in the treatment and follow-up of patients with NFPAs. We have, based on available data, suggested an optimal management strategy for patients with NFPAs in relation to pituitary surgery. Prospective trials oriented at drawing up strategies for the management of NFPAs are needed.
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| 26. |
- Esposito, Daniela, et al.
(författare)
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Pituitary dysfunction in granulomatosis with polyangiitis
- 2017
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Ingår i: Pituitary. - : Springer Science and Business Media LLC. - 1386-341X .- 1573-7403. ; 20:5, s. 594-601
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Tidskriftsartikel (refereegranskat)abstract
- Granulomatosis with polyangiitis (GPA) is a multisystem disease, characterized by necrotizing small-vessel vasculitis, which mainly affects the respiratory tract and the kidneys. Pituitary involvement in GPA is rare, present in about 1% of all cases of GPA. To date, only case reports or small case series have been published. Herein we report clinical features, imaging findings, treatment and outcomes in three patients with GPA-related pituitary dysfunction (PD). A retrospective analysis of three cases of GPA-related PD was conducted, followed by systematic review of the English medical literature using PubMed. The three cases include three women aged between 32 and 37 years. PD was the presenting feature in one and two developed PD in the course of the disease. All patients had a pituitary lesion on MRI. Conventional treatment with high doses of glucocorticoids and cyclophosphamide led to resolution or improvement of the MRI abnormalities, whereas it was not effective in restoring PD. A systematic review identified 51 additional patients, showing that GPA can lead to partial or global PD, either at onset or, during the course of the disease. Secondary hypogonadism is the predominant manifestation, followed by diabetes insipidus (DI). Sellar mass with central cystic lesion is the most frequent radiological finding. GPA should be carefully considered in patients with a sellar mass and unusual clinical presentation with DI and systemic disease. Although conventional induction-remission treatment improves systemic symptoms and radiological pituitary abnormalities, hormonal deficiencies persist in most of the patients. Therefore, follow-up should include both imaging and pituitary function assessment.
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| 27. |
- Esposito, Daniela, et al.
(författare)
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Prolonged Diagnostic Delay in Acromegaly is Associated with Increased Morbidity and Mortality.
- 2020
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Ingår i: European journal of endocrinology. - 1479-683X. ; 182:6
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Tidskriftsartikel (refereegranskat)abstract
- Clinical features of acromegaly develop insidiously. Its diagnosis may therefore be delayed.Our aim was to study diagnostic delay and its impact on morbidity and mortality in a nationwide cohort of patients with acromegaly.Adult patients diagnosed with acromegaly between 2001 and 2013 were identified in the Swedish National Patient Registry. Diagnostic codes for predefined comorbidities associated with acromegaly were recorded between 1987 and 2013. Diagnostic delay was calculated as the time between the first registered comorbidity and the diagnosis of acromegaly.A total of 603 patients (280 men, 323 women) with acromegaly were included. Mean (SD) diagnostic delay was 5.5 (6.2) years [median (minimum, maximum) 3.3 (0.0-25.9)]. Diagnostic delay was 1-<5 years in 23% patients; 5-<10 years in 17%; and ≥10 years in 24%. No delay was recorded in 36% of patients. Overall, mean (SD) number of comorbidities was 4.1 (2.5) and was higher in patients with longer diagnostic delay (P < 0.0001). Overall, observed number of deaths was 61 (expected 42.2), resulting in a standardized mortality ratio (SMR) of 1.45 (95% CI: 1.11-1.86). Increased mortality was only found in patients with the longest diagnostic delay (1.76, 95% CI: 1.12-2.65). In the other groups, no statistically significant increase in mortality was recorded, with the numerically lowest SMR observed in patients without diagnostic delay (1.18; 95% CI: 0.68-1.92).The diagnosis of acromegaly is delayed in most patients. Prolonged diagnostic delay is associated with increased morbidity and mortality.
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| 28. |
- Esposito, Marco, 1965, et al.
(författare)
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Conventional drills vs piezoelectric surgery preparation for placement of four immediately loaded zygomatic oncology implants in edentulous maxillae: results from 1-year split-mouth randomised controlled trial.
- 2017
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Ingår i: European journal of oral implantology. - 1756-2406. ; 10:2, s. 147-158
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Tidskriftsartikel (refereegranskat)abstract
- To compare the outcome of site preparation for zygomatic oncology implants using conventional preparation with rotary drills or piezoelectric surgery with dedicated inserts for placing two zygomatic implants per zygoma according to a split-mouth design.Twenty edentulous patients with severely atrophic maxillas not having sufficient bone volume for placing dental implants and less than 4mm of bone height subantrally had their hemi-maxillas randomised according to a split-mouth design into implant site preparation with conventional rotational drills or piezoelectric surgery. Two zygomatic oncology implants (unthreaded coronal portion) were placed in each hemi-maxilla. Implants that achieved an insertion torque superior to 40Ncm were immediately loaded with screw-retained metal reinforced acrylic provisional prostheses. Outcome measures were: prosthesis and implant failures, any complications, time to place the implants, presence of post-operative haematoma, and patient's preference by independent assessors. All patients were followed up to 1 year after loading.In two patients drills had also to be used at the piezoelectric surgery side to enable implant sites to be prepared. One implant for the conventional drill group did not achieve an insertion torque superior to 40Ncm since it fractured the zygoma. No patients dropped out and two distal oncology implants failed in the same patient (one per group), who was not prosthetically rehabilitated. Six complications occurred at drilled sites and three at piezoelectric surgery sites (two patients had bilateral complications), the difference being not statistically significant (P (McNemar's test)=0.375; odds ratio=4.00; 95% CI of odds ratio: 0.45 to 35.79). Implant placement with convention drills took on average 14.35±1.76min and with piezoelectric surgery 23.50±2.26min, implant placement time being significantly shorter with conventional drilling (difference=9.15±1.69min; 95%CI: 8.36 to 9.94min; P<0.001). Post-operative haematomas were more frequent at drilled sites (P=0.001), and 16 patients found both techniques equally acceptable, while four preferred piezoelectric surgery (P=0.125).Both drilling techniques achieved similar clinical results, but conventional drilling required 9min less and could be used in all instances, although it was more aggressive. These results may be system-dependent, therefore they cannot be generalised to other zygomatic systems with confidence. Conflict-of-interest statement: This study was partially supported by Southern Implants (Irene, South Africa), the manufacturer of the zygomatic implants and the conventional drills evaluated in this study. However, data property belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of its results. Drs Felice and Pistilli developed the piezoelectric surgery zygomatic insert used in the present study.
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| 29. |
- Fabrazzo, M., et al.
(författare)
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Quality of life in Klinefelter patients on testosterone replacement therapy compared to healthy controls: an observational study on the impact of psychological distress, personality traits, and coping strategies
- 2021
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Ingår i: Journal of Endocrinological Investigation. - : Springer Science and Business Media LLC. - 0391-4097 .- 1720-8386. ; 44:5, s. 1053-1063
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Tidskriftsartikel (refereegranskat)abstract
- Purpose We aimed to verify if 1 year-testosterone-replacement therapy could produce a psychopathological recovery and a satisfactory quality of life in Klinefelter syndrome (KS) patients compared to matched healthy controls. Further, we analyzed personality traits and coping strategies, an issue not yet examined in androgen-treated KS patients. We also enquired whether any of the sociodemographic and psychological variables might predict a patient's general and sexual life satisfaction. Methods The Quality of Life Enjoyment and Satisfaction Questionnaire and the Temperament and Character Inventory-Revised were administered to both 23 KS patients and matched healthy subjects. Psychopathology was investigated by the Symptom Checklist-90-Revised (SCL-90-R) and the Mini-mental State Examination. The COPE Inventory was used to identify cognitive and behavioral strategies to manage disease-related distress. Results In testosterone-treated KS patients, when compared with controls, SCL-90-R subscales analysis evidenced high psychological distress, mainly presented as obsessive thoughts, hanger-hostility, phobias, and psychoticism. Self-directedness and self-transcendence, along with the prevalent use ofemotion-focusedcoping strategies, outlined the personality of our KS patients. Depression and somatization proved to be predictors of general life dissatisfaction. Depression, anger-hostility, and paranoid ideation, instead, emerged as predictors of sexual life dissatisfaction. Conclusion Endocrinologists should cooperate with mental health providers to foster a better outcome of the disease in KS patients.
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| 30. |
- Felice, Pietro, et al.
(författare)
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Five-year results from a randomised controlled trial comparing prostheses supported by 5-mm long implants or by longer implants in augmented bone in posterior atrophic edentulous jaws.
- 2019
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Ingår i: International journal of oral implantology (New Malden, London, England). - 2631-6439. ; 12:1, s. 25-37
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate whether 5-mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10-mm long implants in posterior atrophic jaws.Fifteen patients with bilateral atrophic mandibles (5 to 7 mm bone height above the mandibular canal) and 15 patients with bilateral atrophic maxillae (4 to 6 mm bone height below the maxillary sinus), and bone thickness of at least 8 mm, were randomised according to a split-mouth design to receive one to three 5-mm short implants or at least 10-mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after another 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures, any complication and peri-implant marginal bone level changes.In five augmented mandibles the planned 10-mm long implants could not be placed and shorter implants (7.0 and 8.5 mm) had to be used instead. Five years after loading, six patients, five treated in the mandible and one in the maxilla, dropped out. Three prostheses (one mandibular and two maxillary) failed in the short-implant group versus none in the long-implant group. In mandibles one long implant failed versus two short implants in one patient. In maxillae one long implant failed versus three short implants in two patients. There were no statistically significant differences in implant (n = 26; P = 1.00, difference = 3.85%, 95% CI: -12.95% to 20.64%) and prosthetic (n = 26; P = 0.250, difference = 11.54%, 95% CI: -0.74% to 23.82%) failures. Eleven patients had 16 complications at short implants (one patient accounted for six complications) and 12 patients had 14 complications at long implants. There were no statistically significant differences in complications (n = 28; P = 1.00, difference = -3.57%, 95% CI: -30.65% to 23.51%). Five years after loading, patients with mandibular implants lost on average 1.72 mm at short implants and 2.10 mm at long implants of peri-implant marginal bone. This difference was statistically significant (difference = 0.37 ± 0.43 mm; 95% CI: 0.07 to 0.68 mm; P = 0.022). In maxillae, patients lost on average 1.31 mm at short implants and 1.79 mm at long implants. This difference was statistically significant (difference = 0.48 ± 0.43 mm; 95% CI: 0.22 to 0.74 mm; P = 0.002).Five years after loading, 5-mm short implants achieved similar results to longer implants in augmented bone. The choice of short implants might be preferable to vertical bone augmentation, especially in mandibles, since the treatment is faster and cheaper.
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