Purpose
To determine both static and dynamic plantar data of acromegalic subjects while barefoot.
Methods
Seventy acromegalic patients and 48 age-, sex-, weight- and height-matched healthy controls ...were included. Plantar variables were measured using the footscan gait system. The data included the width and length of each foot, relative force distribution in each quadrant, mean force applied to each foot and maximum pressure while walking. Maximum pressure data were obtained from ten parts of the foot. Injury risk assessments of five different regions were performed. To analyze balance, center of pressure (CoP) measurements were performed. The patients with acromegaly were compared with the controls. Furthermore, a comparison of patients with active and controlled acromegaly was performed.
Results
The foot was wider in acromegalic patients. The mean force on each foot was higher in cases of acromegaly (acromegaly: 1027 ± 180 N, control: 908 ± 180 N, p = 0.001). In the acromegalic individuals, the maximum pressure in the midfoot was higher, while the medial heel maximum pressure was lower (midfoot maximum pressure acromegaly: 11.3 ± 3.5 N/cm
2
, control: 8.9 ± 3.7 N/cm
2
, p = < 0.001). Injury risk was similar. CoP measurements elicited intact balance. In terms of static and dynamic plantar data, there was no difference between patients with active and controlled acromegaly.
Conclusions
This is the first study to demonstrate that compared with healthy controls, patients with acromegaly experience great force on their feet while standing and high pressure in the midfoot during walking. Podiatric evaluation, custom molded orthotics and individualized rehabilitation programs for acromegalic patients may provide better force and pressure distribution throughout the foot and improve gait and skeletal symptoms.
Abstract
Objectives
The thymus is an important immunological organ where T cell maturation takes place, especially in the early stages of life. Animal studies have shown that the structure and ...functions of the thymus are controlled by hormones. Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) stimulate both thymic epithelial cells and thymocytes. This causes an increase in the number of cells and the secretion of cytokines. These effects of GH and IGF-1 on the thymus have not yet been confirmed in humans. We have hypothesized that, acromegaly with chronic GH and IGF-1 elevation, may change the volume and the functions of the thymus. In this study, we have examined the thymus volume in patients with acromegaly.
Materials and Methods
In this single center study, 393 patients with acromegaly were retrospectively evaluated to identify patients who underwent chest CT for any reason before and/or after pituitary surgery. Since 64 patients in the acromegaly group had chest CT, we also selected 64 patients as an age- and sex-matched control group among trauma patients without any known disease who admitted to the emergency department. All chest CT images were reassessed by a radiologist to detect the thymus gland and calculate its volume (if visible) who was unaware of clinical data. The frequencies and volumes of visible thymus glands were compared between acromegaly and control groups.
Results
Mean (±SD) age was 49.9±13.8 years in acromegaly group and 51.7±14.1 years in control group(p= 0.32). Twenty-seven patients (42.2%) from each group were female. Median (IQR) GH levels were 10. 0 (21.1) ng/mL and mean±SD IGF-1 levels were 729.5±283.5 ng/mL. While 51 patients (79.7%) had a visible thymus gland at chest CT in acromegaly group, only 29 patients (45.3%) had a visible thymus gland in control group (p<0. 001). Median (IQR) values for the volumes of visible thymus glands in acromegaly and control groups were 13. 0 (9.4) cm 3 and 10.3 (7.6) cm 3, respectively (p=0. 014). There was no correlation between thymus gland volume and GH(r=-0. 02; p= 0.91) and IGF-1(r=0.11; p=0.49) levels. In acromegaly group, six patients had a visible thymus gland on both preoperative and postoperative chest CTs. After surgery, hormonal remission was achieved in four patients and thymus gland volume decreased in three of them (Patient 1: 15.26 to 17.23, Patient 2: 22.66 to 15.88, Patient 3: 19. 00 to 11.80 and Patient 4: 17.78 to 12. 07 cm 3). Volume increase was observed in two uncontrolled patients (Patients 5: 12.45 to 15.42, Patient 6: 6. 05 to 19.59 cm 3).
Conclusion
This study has firstly shown that, the thymus is enlarged in patients with acromegaly. Effective control of the disease reduces thymus volume. Further research is needed to elucidate this association and its putative clinical implications.
Presentation: No date and time listed
Abstract
Objectives
Since the literature about giant (≥40 mm)pituitary somatotroph adenomas is limited to case reports, we aimed to summarize the characteristics of our giant somatotroph pituitary ...adenoma cohort and compare their clinical features and treatment responses with somatotroph macroadenomas.
Materials and Methods
This retrospective study included 16 patients (6 F/10 M) and 57 patients (29 F/28 M) with adenoma sizes ≥40 mm and 20-39 mm, respectively. The patients with <40 mm adenoma size were further divided into subgroups with adenoma size 20-29 mm (26 patients) and 30-39 mm (31 patients). Preoperative and postoperative hormone profiles, imaging and pathological findings, number of surgeries, presence of residual tumor, treatment modalities (including somatostatin receptor ligands, dopamine receptor agonists, pegvisomant, radiotherapy) and remission status were compared between groups.
Results
In giant somatotroph adenomas group, mean value of the preoperative maximal diameter of adenoma was 44.8±10.1 mm (range 40-80 mm). Mean age at diagnosis was 31.8±12.6 years (range 11-55). Mean preoperative GH level was 127.4±257.1 ng/mL. The highest GH level was measured as 951 ng/mL in a female patient having a giant pituitary adenoma with a maximum diameter of 50 mm. Mean baseline IGF-1 level was 2.33±1. 04×ULN (upper limit of normal) for age and sex. Mean number of surgery was 2.4±1.5 (range 1-6) and mean number of treatment modalities applied to achieve hormonal remission postoperatively was 2.1±0.9 (range 1-3). After a mean duration of follow-up of 11.2±6.5 years (range 1-21 years), hormonal remission and partial control were achieved in nine and two patients, respectively. In the group with adenoma size <40 mm, mean value of the preoperative maximal diameter of adenoma was 28.4±5.2 mm (range 20-38 mm) and mean age at diagnosis was 35.8±10.5 years (range 15-62). When we compare the groups, the number of surgeries was significantly higher in giant adenoma group in which 11 of 16 patients (68.8%) underwent repeated surgeries (p=0. 009). The rate of gross total resection tended to decrease as tumor size increases. While radiotherapy was given to 62.5% of the patients with giant adenoma, it was applied to 26.9% and 35.5% of the patients in the groups with adenoma size 20-29 mm and 30-39 mm, respectively (p=0. 068). The total number of treatment modalities applied to achieve hormonal remission postoperatively tended to be higher with increasing adenoma size, although not statistically significant (p=0. 062). Although preoperative GH and IGF-1 levels and Ki-67 index tended to be higher with increasing adenoma size, there was no statistically significant difference between the groups in terms of these variables. Hormonal remission rates were similar between groups.
Conclusion
Giant somatotroph adenomas require an aggressive multimodal treatment approach and advanced care to achieve sustainable hormonal remission.
Presentation: No date and time listed
Woodhouse-Sakati syndrome is a rare genetic syndrome caused by homozygous mutations of the DCAF17 gene. Several endocrine organs may be affected in the course of the disease. We present a new case ...with pituitary iron deposition, cardiac and intestinal anomalies, with a novel mutation in DCAF17 gene. An 18-year-old female was admitted because of delayed puberty and amenorrhea. Hormonal evaluation revealed combined hyper-hypogonadotropic hypogonadism. GH and IGF-1 levels were low without short stature. ACTH levels were high and cortisol levels were supranormal with the lack of clinical findings of cortisol excess or deficiency. Pituitary MRI indicated paramagnetic substance deposition in gland. On follow-ups, non-autoimmune, insulinopenic diabetes mellitus and secondary hypothyroidism emerged. Woodhouse-Sakati syndrome was diagnosed on the basis of consistent clinical context and subsequently a novel mutation in DCAF17 was detected.
To present an overview of the published data on endocrine involvement and endocrine dysfunction in patients with systemic amyloidosis.
We conducted a review of the medical literature using MEDLINE ...data sources, including clinical trials, in vitro studies, and case reports on pituitary, thyroid, parathyroid, pancreatic, adrenal, and gonadal involvement in systemic amyloidosis.
Reports of endocrine involvement in systemic amyloidosis seem to consist primarily of small-samplesize clinical trials or case reports, probably because of the rarity of the disease itself. Systemic amyloidosis mainly involves and causes functional impairment in the thyroid and testes in the endocrine system. Evaluation of adrenal function necessitates special consideration because amyloid infiltration of the adrenal glands resulting in failure may be a life-threatening condition. Amyloid deposition commonly seen in the pituitary gland and the pancreas of patients with Alzheimer disease and type 2 diabetes mellitus, respectively, is generally classified as local amyloidosis and should not be confused with systemic involvement. Additionally, detection of amyloid deposition in the thyroid and testes may have a diagnostic role in patients with suspected systemic or renal amyloidosis.
Published data suggest that systemic amyloidosis frequently involves the endocrine system, and endocrine dysfunction seems to be not as rare as previously thought. A rapidly growing goiter or symptoms and signs of adrenal or gonadal dysfunction should raise suspicion of amyloid infiltration. Involvement of pituitary, parathyroid, and pancreatic sites in systemic amyloidosis still remains to be clarified. Further studies with larger sample sizes are needed for complete characterization of the effect of systemic amyloidosis on the endocrine system.
Abstract
Disclosure: I. Eroglu: None. B. Gonul İremli: None. A. Erkoc: None. I. Idilman: None. D. Yuce: None. E. C. Kutukcu: None. D. Akata: None. T. Erbas: None.
Background: Although many ...complications related to high GH exposure develop in patients with acromegaly, musculoskeletal complications are among the most important complications that reduce the quality of life of patients. However, the effects of acromegaly on muscle and bone have not been adequately researched and are still not entirely understood. We aimed to investigate muscle and bone quality in acromegalic patients in this cross-sectional, case-controlled study. Methods: The study consisted of thirty-two (15F/17M) acromegalic patients (n=15 active acromegaly - AA and n=17 controlled acromegaly - CA) and 19 healthy controls (C). Dual energy X-ray absorptiometry (DXA) was used to determine body composition, appendicular skeletal muscle mass (ASM), relative skeletal muscle index (RSMI), and bone mineral density (BMD). The handgrip strength (HGS) and quadriceps muscle strength were measured by hand dynamometer. Magnetic resonans imaging at the L3 level was used to measure total abdominal muscle area (TAMA, cm2) and vertebral fat ratio (VFR). HGS adjusted by ASM (HGS/ASM) was used to define skeletal muscle quality (SMQ). SMQ was regarded “normal” when the HGS/ASM ratio was >1.53, and “weak” when the ratio was ≤1.36 in males and ≤1.35 in women. The SMQ of those with HGS/ASM levels between these ranges was considered “low”. Results: Age, gender, and BMI were similar between groups. The GH and IGF-1 levels in AA was greater than in CA, and C (p<0.001 for all). While lean tissue was higher in AA than CA and C (p=0.038 and p=0.041, resp.), body fat ratio was lower in AA than CA and C (p=0.04 and p=0.042 resp.). ASM, RSMI, TAMA, HGS and quadriceps strength were similar between groups. Median (IQR) HGS/ASM were 1.67 (1.15-1.9) in AA, 1.57 (1.36-1.79) in CA and 1.77 (1.67-1.93) in C. This difference was found to be significant between CA and C (p=0.008). According to skelatal muscle quality, 94.7% of the individuals in the C group were of normal SMQ, while this rate was 60% in the AA and 52.9% in CA. The ratio of those with low/weak SMQ was higher in the AA and CA compared to C (p=0.012 and p=0.013, resp.). Total and vertebra BMD were similar across groups. Pelvic BMD in CA was lower than C (p=0.02). VFR was higher in CA (56.5%) than in AA (43.75%) and C (42.6%) (p=0.04 and p=0.001 resp.). Conclusion: We showed for the first time that patients with acromegaly had lower muscle quality and pelvic BMD, while patients with controlled acromegaly had higher vertebral fat ratio. Even though lean tissue increased in AA patients, regional muscle distributions (ASM and TAMA) were shown to be similar. The increased muscle mass in acromegaly patients is not expressed as muscular strength, and muscle quality is low in these patients. The high vertebral fat ratio seen in patients with CA may be a result of ectopic adiposity with disease control, as well as the reason for the increased frequency of vertebral fractures seen in patients with acromegaly.
Presentation: Thursday, June 15, 2023
Reduced irisin levels in patients with acromegaly Sendur, Suleyman Nahit; Baykal, Gokhan; Firlatan, Busra ...
Hormone molecular biology and clinical investigation,
09/2022, Letnik:
43, Številka:
3
Journal Article
Recenzirano
Abstract
Objectives
Several metabolic disturbances are seen in acromegaly however, data regarding the contribution of irisin to these disturbances is currently insufficient. In a cohort of patients ...with acromegaly, we measured serum irisin levels in active and controlled cases and determined independent factors that effect serum irisin including fibronectin type III domain-containing protein 5 (FNDC5) genotyping.
Methods
A cross-sectional case-control study including 46 patients with acromegaly (28 F/18 M, age: 50.3 ± 12.1 year, BMI: 30.7 ± 5.1 kg/m
2
) and 81 age-, gender-, body mass index- and body composition-matched healthy controls was conducted. 15 acromegalic patients (33%) had active disease. Irisin levels were measured by enzyme-linked immunosorbent assay. Three different regions (rs3480, rs1746661, and rs16835198) of FNDC5 were subjected to polymorphism analyses.
Results
Both groups were overweight and had similar body composition. Irisin levels were lower in patients with acromegaly than controls (median IQR: 44.8 41.7–46.7 ng/mL vs. 51.7 45.5–60.1 ng/mL, p≤0.001, respectively). Active and controlled patients had similar irisin levels. Irisin was not correlated with growth hormone (GH), insulin-like growth factor 1 (IGF-1), and IGF-1 index. In multiple linear regression model, somatostatin receptor ligand use (
β
=−20.30, 95% CI −34–−6, p=0.006) was determined as the only independent factor that affect serum irisin.
Conclusions
Serum irisin levels are low in patients with acromegaly who are on somatostatin receptor ligand therapy. Single nucleotide polymorphisms (SNPs) of FNDC5 have no independent effects on circulating irisin levels under somatostatin ligand action. Endocrine muscle functions also seem to be regulated by somatostatin action, which requires further studies.
Purpose
Hypophysitis is a heterogeneous condition that includes inflammation of the pituitary gland and infundibulum, and it can cause symptoms related to mass effects and hormonal deficiencies. We ...aimed to evaluate the potential role of machine learning methods in differentiating hypophysitis from non-functioning pituitary adenomas.
Methods
The radiomic parameters obtained from T1A-C images were used. Among the radiomic parameters, parameters capable of distinguishing between hypophysitis and non-functioning pituitary adenomas were selected. In order to avoid the effects of confounding factors and to improve the performance of the classifiers, parameters with high correlation with each other were eliminated. Machine learning algorithms were performed with the combination of gray-level run-length matrix-low gray level run emphasis, gray-level co-occurrence matrix-correlation, and gray-level co-occurrence entropy.
Results
A total of 34 patients were included, 17 of whom had hypophysitis and 17 had non-functioning pituitary adenomas. Among the 38 radiomics parameters obtained from post-contrast T1-weighted images, 10 tissue features that could differentiate the lesions were selected. Machine learning algorithms were performed using three selected parameters; gray level run length matrix-low gray level run emphasis, gray-level co-occurrence matrix-correlation, and gray level co-occurrence entropy. Error matrices were calculated by using the machine learning algorithm and it was seen that support vector machines showed the best performance in distinguishing the two lesion types.
Conclusions
Our analysis reported that support vector machines showed the best performance in distinguishing hypophysitis from non-functioning pituitary adenomas, emphasizing the importance of machine learning in differentiating the two lesions.
Introduction
Pituitary adenomas with gangliocytic component are rare tumors of the sellar region that are composed of pituitary adenoma cells and a ganglion cell component. Their histogenesis and ...hence nosology is not yet resolved because of the small number of cases reported and lack of large series in the literature.
Methods
Herein we report five cases of pituitary adenoma with gangliocytic component to add knowledge to this rare neoplasm.
Results
Three cases are functional mammosomatotroph adenomas, one case is functional sparsely granulated somatotroph adenoma and the other is functional corticotroph adenoma. Gangliocytic component showed immunohistochemical expression of hormones in three cases. The ganglion cells were prolactin immunoreactive in case 1, GH and TSH immunoreactive in case 5 and showed expression of prolactin, TSH, ACTH and FSH in case 4. Three cases had undergone more than one surgery of which two had gangliocytic cells only in the recurrent tumors whereas the third case showed gangliocytic cells only in the initial tumor.
Discussion
The cases are discussed with clinical and histological features and a brief review of the literature considering the histogenesis is included.
