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- Burman, Pia, et al.
(författare)
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Dual bronchial carcinoids and Cushing's syndrome with a paradoxical response to dexamethasone and a false positive outcome of inferior petrosal sinus sampling
- 2008
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Ingår i: European Journal of Endocrinology. - 0804-4643 .- 1479-683X. ; 159:4, s. 483-8
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Establishing the cause of Cushing's syndrome (CS) can be a considerable challenge, in particular in ectopic adrenocorticotropic hormone (ACTH) syndrome, and often requires a combination of biochemical tests and imaging procedures. SUBJECT: A 27-year-old man presented with signs of CS. P-ACTH levels were three times above the upper limit of normal (ULN) and free urinary cortisol around 2000 nmol/24 h. The work-up showed remarkable results. RESULTS: A 2-day low-dose dexamethasone suppression test demonstrated paradoxical increases in cortisol. Sampling from the bilateral inferior petrosal sinus sampling (BIPSS) showed a central to peripheral ACTH ratio of 4.7 after corticotrophin-releasing hormone (CRH) stimulation, i.e. indicated pituitary disease, but magnetic resonance imaging of the pituitary was normal. Computed tomography (CT) scan of the lungs showed two oval-shaped masses, 1.3 x 1.8 and 1.3 x 2 cm, in the middle lobe. Both were positive at somatostatin receptor scintigraphy, compatible with tumors or inflammatory lesions. Subsequently, (11)C-5-hydroxytryptophan-PET showed distinct uptake in the tumors but not elsewhere. Two carcinoids situated 3 cm apart, both staining for ACTH, were removed at surgery. CONCLUSION: This unique case with dual bronchial carcinoids inducing hypercortisolism illustrates the problems with identifying the source of ACTH in CS. Possibly, an abnormal regulation of ACTH production in response to dexamethasone, or steroid-induced tumor necrosis, explains the paradoxical outcome at dexamethasone suppression, and the false positive result at BIPSS reflects an unusual sensitivity of the pituitary corticotrophs to CRH in this patient. The work-up illustrates the great value of (11)C-5-hydroxytryptophan-PET as a diagnostic procedure when other investigations have produced ambiguous results.
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| 2. |
- Modlin, Irvin M., et al.
(författare)
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Gastroenteropancreatic neuroendocrine tumours
- 2008
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Ingår i: The Lancet Oncology. - 1470-2045 .- 1474-5488. ; 9:1, s. 61-72
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Forskningsöversikt (refereegranskat)abstract
- Gastroenteropancreatic (GEP) neuroendocrine tumours (NETs) are fairly rare neoplasms that present many clinical challenges. They secrete peptides and neuroamines that cause distinct clinical syndromes, including carcinoid syndrome. However, many are clinically silent until late presentation with mass effects. Investigation and management should be highly individualised for a patient, taking into consideration the likely natural history of the tumour and general health of the patient. Management strategies include surgery for cure (which is achieved rarely) or for cytoreduction, radiological intervention (by chemoembolisation and radiofrequency ablation), chemotherapy, and somatostatin analogues to control symptoms that result from release of peptides and neuroamines. New biological agents and somatostatin-tagged radionuclides are under investigation. The complexity, heterogeneity, and rarity of GEP NETs have contributed to a paucity of relevant randomised trials and little or no survival increase over the past 30 years. To improve outcome from GEP NETs, a better understanding of their biology is needed, with emphasis on molecular genetics and disease modeling. More-reliable serum markers, better tumour localisation and identification of small lesions, and histological grading systems and classifications with prognostic application are needed. Comparison between treatments is currently very difficult. Progress is unlikely to occur without development of centers of excellence, with dedicated combined clinical teams to coordinate multicentre studies, maintain clinical and tissue databases, and refine molecularly targeted therapeutics.
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| 3. |
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| 4. |
- Wassélius, Johan, et al.
(författare)
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Assessment of inactive, active and mixed atherosclerotic plaques by 18F-FDG-PET; an age group-based correlation with cardiovascular risk factors
- 2009
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Ingår i: The international journal of cardiovascular imaging. - : Springer Science and Business Media LLC. - 1569-5794 .- 1573-0743 .- 1875-8312. ; 25:2, s. 133-40
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to assess the atherosclerotic plaques in a large asymptomatic population stratified based on age and sex. METHODS: [18F]-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT of 100 men and 100 women, divided in four age groups were examined to assess FDG-accumulating active, calcified inactive and mixed atherosclerotic plaques in eight defined vessel segments. RESULTS: There was a high correlation between the total number of cardiovascular risk factors and the number of FDG-accumulating active plaques as well as the number of calcified inactive plaques. There was a significant difference in the number of plaques between all age-groups except for active plaques in age groups 60-70 and 80-90 years. CONCLUSIONS: There is a correlation between the number of cardiovascular risk factors and the number of FDG-accumulating atherosclerotic lesions in this patient material. Statin-treatment was associated with significantly lower numbers of active plaques.
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