| 1. |
- Esposito, Daniela, et al.
(författare)
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Primary Adrenal Insufficiency: Managing Mineralocorticoid Replacement Therapy.
- 2018
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Ingår i: The Journal of clinical endocrinology and metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 103:2
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Tidskriftsartikel (refereegranskat)abstract
- Mineralocorticoid (MC) replacement therapy in patients with primary adrenal insufficiency (PAI) was introduced more than 60 years ago. Still, there are limited data on how MC substitution should be optimized, since MC dosing regimens have only been systematically investigated in a few studies. We review the management of current standard MC replacement therapy in PAI and its plausible impact on outcome.Using PubMed, we conducted a systematic review of the literature from 1939 to 2017, with the following keywords: 'adrenal insufficiency', 'mineralocorticoid deficiency', 'aldosterone', 'cardiovascular disease', 'hypertension', and 'heart failure'.The current standard treatment consists of fludrocortisone (FC) given once daily in the morning, aiming at normotension, normokalemia, and plasma renin activity in the upper normal range. Available data suggest that patients with PAI may be under-replaced with FC as symptoms and signs indicating chronic MC under-replacement, such as salt craving and postural dizziness persist, in many treated PAI patients. Data acquired from large registry-based studies show that glucocorticoid doses for replacement in PAI are higher than those estimated from endogenous production. Glucocorticoid over-replacement may reduce the need of MC replacement but may also be a consequence of inadequate MC replacement.The commonly used MC replacement in PAI may not be adequate in some patients. Insufficient MC substitution may be responsible for poor cardiometabolic outcome and the failure to restore well-being adequately in patients with PAI. Well-designed studies oriented at optimizing MC replacement therapy are urgently needed.
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| 2. |
- Accardo, G., et al.
(författare)
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Management of cardiovascular complications in Klinefelter syndrome patients
- 2019
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Ingår i: Expert Review of Endocrinology and Metabolism. - : Informa UK Limited. - 1744-6651 .- 1744-8417. ; 14:2, s. 145-152
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Klinefelter syndrome (KS), also known as 47, XXY, shows increased mortality when compared with mortality rates among the general population. Cardiovascular, hemostatic, metabolic diseases are implicated. Moreover, cardiac congenital anomalies in KS can contribute to the increase in mortality. Areas covered: In this study, we have systematically reviewed the relationships between KS and the cardiovascular system and the management of cardiovascular complication. In summary, patients with KS display increased cardiovascular risk profile, characterized by increased prevalence of metabolic alterations including dyslipidemia, diabetes mellitus (DM), and abnormalities in biomarkers of cardiovascular disease. KS subjects are characterized by subclinical abnormalities in endothelial function and in left ventricular (LV) systolic and diastolic function, which–when associated with chronotropic incompetence–may negatively influence cardiopulmonary performance. Moreover, KS patients appear to be at a higher risk for cardiovascular disease, due to thromboembolic events with high prevalence of recurrent venous ulcers, venous insufficiency, recurrent venous and arterial thromboembolism leading to deep venous thrombosis or pulmonary embolism. Expert opinion: Considering the unequivocal finding of increased mortality of KS patients, we suggest a periodic cardiovascular follow up in specialized centers with multidisciplinary care teams that comprise endocrinologists and cardiologists dedicated to KS syndrome. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
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| 3. |
- Balercia, G., et al.
(författare)
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Thyroid function in Klinefelter syndrome: a multicentre study from KING group
- 2019
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Ingår i: Journal of Endocrinological Investigation. - : Springer Science and Business Media LLC. - 0391-4097 .- 1720-8386. ; 42:10, s. 1199-1204
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Tidskriftsartikel (refereegranskat)abstract
- - Purpose: The prevalence and the etiopathogenesis of thyroid dysfunctions in Klinefelter syndrome (KS) are still unclear. The primary aim of this study was to evaluate the pathogenetic role of hypogonadism in the thyroid disorders described in KS, with the scope to distinguish between patients with KS and hypogonadism due to other causes (Kallmann syndrome, idiopathic hypogonadotropic hypogonadism, iatrogenic hypogonadism and acquired hypogonadotropic hypogonadism after surgical removal of pituitary adenomas) called non-KS. Therefore, we evaluated thyroid function in KS and in non-KS hypogonadal patients. Methods: This is a case–control multicentre study from KING group: Endocrinology clinics in university-affiliated medical centres. One hundred and seventy four KS, and sixty-two non-KS hypogonadal men were enrolled. The primary outcome was the prevalence of thyroid diseases in KS and in non-KS. Changes in hormonal parameters were evaluated. Exclusion criterion was secondary hypothyroidism. Analyses were performed using Student’s t test. Mann–Whitney test and Chi-square test. Results: FT4 was significantly lower in KS vs non-KS. KS and non-KS presented similar TSH and testosterone levels. Hashimoto’s thyroiditis (HT) was diagnosed in 7% of KS. Five KS developed hypothyroidism. The ratio FT3/FT4 was similar in both groups. TSH index was 1.9 in KS and 2.3 in non-KS. Adjustment for differences in age, sample size and concomitant disease in multivariate models did not alter the results. Conclusions: We demonstrated in KS no etiopathogenic link to hypogonadism or change in the set point of thyrotrophic control in the altered FT4 production. The prevalence of HT in KS was similar to normal male population, showing absence of increased risk of HT associated with the XXY karyotype. © 2019, Italian Society of Endocrinology (SIE).
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| 4. |
- Cannizzaro, Gioacchino, et al.
(författare)
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Immediate loading of fixed cross-arch prostheses supported by flapless-placed 5 mm or 11.5 mm long implants: 5-year results from a randomised controlled trial.
- 2018
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Ingår i: European journal of oral implantology. - 1756-2406. ; 11:3, s. 295-306
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Tidskriftsartikel (refereegranskat)abstract
- To compare the outcome of cross-arch prostheses supported either by 5 mm long or 11.5 mm long implants placed flapless and immediately restored with a metal-resin screw-retained cross-arch prostheses.Thirty patients with edentulous or to-be- rendered edentulous mandibles, and 30 with edentulous maxillas, having sufficient bone to allow the placement of four and six implants respectively, of at least 11.5 mm long, were randomised according to a parallel group design into two equal groups and received either 5 mm or 11.5 mm long implants at one centre. Implants had a diameter of 5 mm, were to be placed flapless, and with an insertion torque of at least 50 Ncm. Mandibles received four implants between the mental foramina. Implants were to be immediately loaded with metal-resin definitive prostheses the same day as implant placement. Patients were followed to 5 years post-loading and the outcome measures were: prosthesis and implant failures, complications, and peri-implant marginal bone level changes.Four patients per group dropped out. Two prostheses were remade, one on short maxillary implants and one on long mandibular implants (difference in proportions = 0; 95% CI: -0.15 to 0.15; P = 1.000). Three patients lost six short implants vs three patients who lost four long implants (difference in proportions = 0; 95% CI: -0.19 to 0.19; P = 1.000). Four short implant patients were affected by complications vs five patients with long implants (difference in proportions = 0.04; 95% CI: -0.17 to 0.25; P = 1.000). There were no statistically significant differences for prostheses failures, implant failures and complications. Patients with mandibular short implants lost on average 0.22 mm of peri-implant bone at 5 years while patients with long mandibular implants lost 0.83 mm. Patients with maxillary short implants lost on average 0.30 mm of peri-implant bone at 5 years and patients with long maxillary implants lost 0.89 mm. Short implants showed less bone loss when compared with long implants and the differences up to 5 years were statistically significant both in maxillae (mean difference = 0.59 mm, 95% CI: 0.33 to 0.86 mm, P < .0001) and in mandibles (mean difference = 0.61 mm, 95% CI: 0.36 to 0.86 mm, P < 0.0001).Flapless-placed 5 mm long implants achieved similar results as 11.5 mm long implants when supporting immediately loaded cross-arch prostheses both in maxillae and mandibles up to 5 years after loading. These results must be confirmed by other trials, and 10 years post-loading data is necessary before making reliable recommendations.
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| 5. |
- Cannizzaro, Gioacchino, et al.
(författare)
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Immediate loading of one (fixed-on-1) versus two (fixed-on-2) implants placed flapless supporting mandibular screw-retained cross-arch fixed prostheses: 10-month results from an explanatory randomised controlled trial.
- 2019
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Ingår i: International journal of oral implantology (New Malden, London, England). - 2631-6439. ; 12:1, s. 89-102
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the outcome of one (fixed-on-1, Fo1) versus two (fixed-on-2, Fo2) implants placed flapless in fully edentulous mandibles and immediately restored with metal-resin screw-retained cross-arch prostheses.Twenty patients with edentulous or to be rendered edentulous mandibles were randomised to the Fo1 group (10 patients who received three intraforaminal implants but only the mesial implant was actually loaded) and to the Fo2 group (10 patients who received two intraforaminal implants) according to a parallel-group design. To be immediately loaded implants had to be inserted with a minimum torque of 60 Ncm. Outcome measures were prosthesis and implant failures, complications and patient satisfaction for function and aesthetics evaluated up to 10 months post-loading.Flaps were raised in three patients of the Fo1 group and one of the Fo2 group. Two prostheses in each group were delayed loaded at 2 and 3 months, because implants could not be inserted with a torque superior to 60 Ncm. Patients of the Fo2 group received prostheses with 12 teeth whereas Fo1 patients with 8 or 10 teeth. Ten months after loading no drop-out or implant failure occurred, but one Fo2 prosthesis had to be remade because the patient complained it was too short (risk difference = 0.1; 95% CI: -0.19 to 0.40; Fisher's exact test P = 1.000). Three patients were affected by complications in each group (risk difference = 0.0; 95% CI: -0.359 to 0.359; Fisher's exact test; P = 1.000). There were no statistically significant differences for prosthetic failures and complications between groups. Four months after loading, patients of the Fo1 group were less satisfied for function than those of the Fo2 group (difference between the medians [Hodges-Lehmann estimation] = 1; 95% CI: 0 to 2; P = 0.043). No differences were observed for aesthetics (difference between the medians [Hodges-Lehmann estimation] = 0; 95% CI: -1 to 0; P = 0.481), and two Fo1 patients would not undergo the same procedure again (difference in proportions: 0.2; 95% CI: -0.11 to 0.51; P = 0.474).Preliminary results suggest that immediately loaded cross-arch screw-retained fixed prostheses with 8 to 10 teeth can be supported by only one dental implant at least up to 10 months post-loading; however, the clinical application and usefulness of such a procedure remains questionable.
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| 6. |
- Cannizzaro, Gioacchino, et al.
(författare)
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Immediate loading of three (fixed-on-3) vs four (fixed-on-4) implants supporting cross-arch fixed prostheses: 1-year results from a multicentre randomised controlled trial.
- 2018
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Ingår i: European journal of oral implantology. - 1756-2406. ; 11:3, s. 323-333
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the outcome of three (fixed-on-3 = Fo3) vs four (fixed-on-4 = Fo4) implants immediately restored with metal-resin screw-retained cross-arch prostheses in fully edentulous jaws.Forty-eight edentulous or to be rendered edentulous patients were randomised in six centres (eight patients per centre) to the Fo3 group (24 patients: 12 maxillae and 12 mandibles) and to the Fo4 group (24 patients: 12 maxillae and 12 mandibles) according to a parallel group design. To be immediately loaded, implants had to be inserted with a minimum torque of 40 Ncm. Outcome measures were prosthesis and implant failures, complications and peri-implant marginal bone level changes evaluated up to 1 year post-loading.One maxillary prosthesis per group was delayed loaded because implants could not be placed with a torque of at least 40 Ncm. Ten patients in the Fo3 group and four in the Fo4 group had implants placed flapless. One year after loading no drop out occurred. One patient of the Fo3 group lost three implants vs three patients of the Fo4 group who lost four implants, the difference being no statistically significant (risk difference = -0.08; 95% CI: -0.27 to 0.10; Fisher's exact test P = 0.609). One mandibular Fo3 and one maxillary Fo4 prosthesis failed. Six Fo3 patients were affected by complications vs three Fo4 patients (risk difference = 0.12; 95% CI: -0.10 to 0.34; Fisher's exact test; P = 0.461). Both groups lost marginal bone in a statistically significant way (0.22 ± 0.20 mm for Fo3 patients and 0.40 ± 0.21 mm for Fo4 patients), with Fo3 group showing less marginal peri-implant bone loss than Fo4 group (estimate of the difference = -0.18 (standard error: 0.06) mm; 95% CI: -0.30 to -0.06; P = 0.005). There were no differences in clinical outcomes between the six operators.These preliminary results suggest that immediately loaded cross-arch prostheses of both jaws can be supported by only three dental implants at least up to 1 year post-loading, though longer follow-ups are definitively needed.
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| 7. |
- Davó, Rubén, et al.
(författare)
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Immediately loaded zygomatic implants vs conventional dental implants in augmented atrophic maxillae: 1-year post-loading results from a multicentre randomised controlled trial.
- 2018
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Ingår i: European journal of oral implantology. - 1756-2406. ; 11:2, s. 145-161
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Tidskriftsartikel (refereegranskat)abstract
- To compare the clinical outcome of immediately loaded cross-arch maxillary prostheses supported by zygomatic implants vs conventional implants placed in augmented bone.In total, 71 edentulous patients with severely atrophic maxillas without sufficient bone volumes for placing dental implants, or when it was possible to place only two implants in the anterior area (minimal diameter 3.5 mm and length of 8 mm) and less than 4 mm of bone height subantrally, were randomised according to a parallel group design to receive zygomatic implants (35 patients) to be loaded immediately vs grafting with a xenograft, followed after 6 months of graft consolidation by placement of six to eight conventional dental implants submerged for 4 months (36 patients). For immediate loading, zygomatic implants had to be inserted with an insertion torque superior to 40 Ncm. Screw-retained metal reinforced acrylic provisional prostheses were provided, to be replaced by definitive Procera Implant Bridge Titanium prostheses (Nobel Biocare, Göteborg, Sweden), with ceramic or acrylic veneer materials 4 months after initial loading. Outcome measures were: prosthesis, implant and augmentation failures, any complications, quality of life (OHIP-14), patients' number of days with total or partial impaired activity, time to function and number of dental visits, assessed by independent assessors. Patients were followed up to 1 year after loading.No augmentation procedure failed. Five patients dropped out from the augmentation group. Six prostheses could not be delivered or failed in the augmentation group vs one prosthesis in the zygomatic group, the difference being statistically significant (difference in proportions = -16.5%; P = 0.045; 95% CI: -0.34 to -0.01). Eight patients lost 35 implants in the augmentation group vs two patients who lost four zygomatic implants, the difference being statistically significant (difference in proportions = -20.1%; P = 0.037; 95% CI: -0.38 to -0.02). A total of 14 augmented patients were affected by 22 complications, vs 28 zygomatic patients (40 complications), the difference being statistically significant (difference in proportions = 34.8%; P = 0.005; 95% CI: 0.12 to 0.54). The 1-year OHIP-14 score was 3.93 ± 5.86 for augmented patients and 3.97 ± 4.32 for zygomatic patients with no statistically significant differences between groups (mean difference = 0.04; 95% CI: -2.56 to 2.65; P = 0.747). Both groups had significantly improved OHIP-14 scores from before rehabilitation (P < 0.001 for both augmented and zygomatic patients). On average, the number of days of total infirmity was 7.42 ± 3.17 for the augmented group and 7.17 ± 1.96 for the zygomatic group, the difference not being statistically significant (mean difference = -0.25; 95% CI: -1.52 to 1.02; P = 0.692). The number of days of partial infirmity were on average 14.24 ± 4.64 for the augmented group and 12.17 ± 3.82 for the zygomatic group, the difference being statistically significant (mean difference = -2.07; 95% CI: -4.12 to -0.02; P = 0.048). The mean number of days that needed to have a functional prosthesis was 444.32 ± 207.86 for augmented patients and 1.34 ± 2.27 for zygomatic patients, the difference being statistically significant (mean difference = -442.98; 95% CI: -513.10 to -372.86; P < 0.001). The average number of dental visits was 19.72 ± 12.22 for augmented patients and 15.12 ± 5.76 for zygomatic patients, the difference not being statistically significant (mean difference = -4.61; 95% CI: -9.31 to 0.92; P = 0.055).Preliminary 1-year post-loading data suggest that immediately loaded zygomatic implants were associated with statistically significantly fewer prosthetic failures (one vs six patients), implant failures (two vs eight patients) and time needed to functional loading (1.3 days vs 444.3 days) when compared to augmentation procedures and conventionally loaded dental implants. Even if more complications were reported for zygomatic implants, they proved to be a better rehabilitation modality for severely atrophic maxillae. Long-term data are absolutely needed to confirm or dispute these preliminary results.
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| 8. |
- 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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| 9. |
- 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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| 10. |
- 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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