Il sol dell’avvenire è un balzo di tigre

L'ultimo film di Nanni Moretti emoziona e fa discutere a sinistra. Facendo la «storia con i se», dà ragione agli insorti di Budapest del '56 e ripara ai torti di Togliatti, rendendo possibile pensare al futuro

L’insorgenza del mutualismo, la convergenza necessaria

Dalla Gkn alle reti che si riconoscono nella ricerca "La pienezza del vuoto" fino alla "Carovana del mutualismo": una radiografica delle forme di solidarietà attiva e la loro politicità

L'iposurrenalismo in pazienti che assumono glucocorticoidi per via inalatoria è molto frequente e la determinazione dei livelli di cortisolo al mattino può guidarne la gestione

n/

Il nuovo conservatorismo ha la solita paura della rivoluzione

L'ideologia della presidente del Consiglio Giorgia Meloni e del suo partito, Fratelli d'Italia, filtra l'eredità fascista e il pensiero conservatore moderno

correlation between endocrinological parameters and acne severity in adult women

Many studies demonstrate increased androgen levels and high prevalence of polycystic ovaries in women affected by acne. We evaluated the relationship between clinical features, ultrasonographic data on polycystic ovaries and hormonal parameters in 129 women w17 years of age with acne. Serum levels of androgens of ovarian and adrenal origin were measured. Menstrual cycle regularity, hirsutism, body mass index and ultrasonographic evaluation of ovaries were recorded. Raised levels of at least one androgen were evident in a majority of our patients. Only 19% of them had polycystic ovary syndrome. Hirsutism and acne severity correlated negatively with serum sex hormone-binding globulin (SHBG) levels ( pv0.05). No correlation between acne severity and hirsutism was found. In post-pubertal women, severity of acne seems to depend on peripheral hyperandrogenism, with a negative relationship between the acne severity and serum SHBG levels. We strongly recommend the evaluation of serum SHBG levels in women with acne in order to select patients who can have a better response to appropriate hormonal regimes. Key words: acne; polycystic ovary; ultrasound examination; sex hormone-binding globulin; sebocyte

The unusual association of Graves' disease, chronic spontaneous urticaria, and premature ovarian failure: report of a case and HLA haplotype characterization

Chronic spontaneous urticaria (CSU), defined as the occurrence of spontaneous wheals for more than six weeks, has been associated with autoimmune diseases. Herein, we report the unusual association of CSU, Graves' disease, and premature ovarian failure. Human leukocyte antigen (HLA) studies were performed. A 36-year-old woman presented symptoms and signs of hyperthyroidism for three months. In the same period, the patient complained of widespread urticarial wheals, intensely itchy, and poorly responsive to therapy with antihistaminic agents. Hyperthyroidism was confirmed biochemically, and treatment with methimazole was started. As hyperthyroidism improved, a marked improvement in her urticaria was also observed. However, the patient continued to complain of amenorrhea. Endocrine evaluation, at the age 38, was consistent with premature ovarian failure. This is the first report of coexistence of GD, CSU, and POF. The genetic background of such unusual association is a specific combination of HLA

Ovarian hyperthecosis coexisting with an incidental adrenal lesion: challenges in the diagnostic approach

Ovarian hyperthecosis is the most common cause of hyperandrogenism in women during postmenopausal age. However, its diagnosis is frequently challenging, since several causes must be ruled out, involving both adrenal glands and ovaries. Herein we describe the case of a 62 years old woman addressed to our Unit after the casual detection of an adrenal mass, compatible with an adenoma. Biochemical evaluation revealed gonadotropins in menopausal range, high testosterone and androstenedione, while the patient had been complaining of androgenetic alopecia and hirsutism for some years. Ultrasound imaging revealed only a small increase in ovarian volume, in relationship to the patient’s age. A GnRHa test was performed, demonstrating gonadotropins suppression and testosterone normalization, thus confirming the suspect of ovarian hyperthecosis. The administration of these agonists, together with the slow progression of symptoms over years, play a fundamental role into excluding an androgen-secreting neoplasia, also limiting the use of ovarian veins catheterization as second line test. Besides, they represent a valid therapeutical option, especially when surgery is contraindicated (or cannot be performed)

Thyroid Autoimmunity and Lichen

Lichen planus (LP) and lichen sclerosus (LS) are cutaneous-mucous diseases with uncertain epidemiology. Current data, which are likely to be underestimated, suggest a prevalence in the general population of 0.1–4% for cutaneous LP, 1.27–2.0% for oral LP, and 0.1–3.3% for LS. While etiology of lichen is still unknown, clinical and histological evidence show an (auto)immune pathogenesis. Association of lichen with autoimmune thyroid disease (AITD) has been investigated in few studies. This association appears better defined in the case of LS, while is more controversial for LP. In both situations, the frequency of the association is higher in females. We review the available literature on the correlation between the different types of lichen and AITD, and the literature on the genetic risk factors which are shared by both conditions. Such data suggest that a common pathogenic mechanism could be the cause for co-occurrence of lichen and AITD, at least in some patients. Additionally, analyzing literature data and in continuity with our previous work on other autoimmune diseases, we suggest that molecular mimicry could trigger both diseases, and thus explain their co-occurrence

Role of imaging and adrenal venous sampling techniques in the diagnosis of primary aldosteronism

Background: Primary aldosteronism (PA) is a rare condition characterized by inappropriately high secretion of aldosterone, independently of the renin-angiotensin system, not suppressed by sodium loading test. PA represents the most common cause of secondary hypertension and its early detection and treatment can help reduce the cardiovascular (CV) risk. Case presentation: We report on a 42-year-old man who was referred to an outpatients’ clinic reporting headache and vomiting associated with hypertension and was discharged with oral antihypertensive medication (irbesartan) and low-sodium diet. Three years later, he underwent further hospitalization for muscle pain in lower limb associated with severe hypokalemia (1.7 mmol/L) and elevated creatine phosphokinase (CPK) levels (2634 U/L). Abdominal CT scan excluded the presence of adrenal lesions. Acute intravenous potassium chloride (KCL) supplementation normalized serum potassium level and the patient was discharged with diagnosis of rhabdomyolysis and hypokalemia and with antihypertensive medication (spironalactone: 100 mg/day and amlodipine: 5 mg/day) and oral KCL supplementation (600 mg/day). After pharmacological washout, an inappropriately high aldosterone concentration (75.10 pg/ml) and very low renin level (1.10 pg/ml) were detected. PA diagnosis was confirmed by oral saline infusion test (SIT). Aldosterone levels did not normalize after dexamethasone suppression testing. Abdominal MRI showed a nodule measuring 6 mm in the right adrenal. A subsequent adrenal venous sampling (AVS) confirmed the unilateral (right) lateralization of the aldosterone hypersecretion. Conclusion: Although invasive, AVS is the gold standard test to differentiate PA subtypes in patients who can be considered ideal candidates for unilateral adrenalectomy

Global incidence and prevalence of differentiated thyroid cancer in childhood: systematic review and meta-analysis

ObjectiveDifferentiated thyroid cancer (DTC) is rare in childhood and adolescence although it represents the most frequent endocrine malignancy in this population. DTC includes both papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). Most pediatric DTCs are PTCs, while FTCs are rare. To date, no systematic reviews on the global epidemiology of pediatric and adolescent DTC have been published. This systematic review and meta-analysis aims to estimate the overall incidence and prevalence of DTCs in patients aged 0–19 years.MethodsThe systematic research was conducted from January 2000 to December 2021 through MEDLINE via PubMed, Cochrane Library, and Embase databases. Two separate meta-analyses were performed for PTC and FTC.ResultsAfter the selection phase, a total of 15 studies (3,332 screened) met the inclusion criteria and are reported in the present systematic review. Five studies were conducted in Europe, five in North America, two in South America, one in Asia, one reported data for 49 countries and territories across the five continents, and one from both the USA and Africa. Most of the studies (n = 14) reported data obtained from national registries, and only one provided information collected from hospital medical records. Beyond the actual trend over time, our study reported a pooled global incidence rate (IR) of PTC and FTC in the pediatric age of 0.46 (95% CI: 0.33–0.59) and 0.07 (95% CI: 0.02–0.12) per 100,000 person-years, respectively. The highest IRs were recorded among Caucasian girls, and the lowest in black or other races/ethnicities.ConclusionOur data confirm that DTC in the pediatric population is a rare condition. The pooled IRs of the studies included in this meta-analysis are ~0.5 for PTC, which is the most common histological type when both genders and all age groups are considered. The implementation of a prospective international registry on pediatric DTC, as part of the wider European Registries for Rare Endocrine Conditions, has been recently proposed. In addition to providing relevant information on the clinical behavior of this rare disease, standardization of data collection will be pivotal to fill current gaps and allow an accurate estimation of the real incidence and risk factors of DTC