Il trattamento a lungo termine con GH del deficit di GH dell'adulto: sicurezza (safety).

La terapia sostitutiva con ormone somatotropo (rhGH) del paziente adulto con deficit di GH (GHD) rappresenta ancora oggi una sfida per l\u2019endocrinologo clinico e la sua realizzazione costante nella pratica quotidiana presenta ancora numerose difficolt\ue0 e incertezze. Essa va iniziata con dosi assai basse di GH ricombinante e monitorata sulla base dei livelli di IGF-I e sulla risposta clinica. La sensibilit\ue0 al GH biosintetico presenta una spiccata variabilit\ue0 inter-individuale e ci\uf2 spiega perch\ue9 le dosi di mantenimento dell\u2019ormone siano assai variabili. In accordo con le linee guida \ue8 consigliabile iniziare il trattamento con dosi basse di rhGH pari a 0,15-0,30 mg/die. La terapia deve essere intrapresa solo quando i concomitanti trattamenti sostitutivi di eventuali altri deficit endocrini siano gi\ue0 stati ottimizzati. Raggiunti i livelli normali di IGF-I, il trattamento andr\ue0 controllato a intervalli semestrali. Deve essere sottolineato che un dosaggio eccessivo di rhGH determina frequentemente effetti collaterali che ricordano i sintomi riscontrabili nei pazienti con ipersecrezione di GH (in particolare artralgie ed edemi declivi), mentre un trattamento sostitutivo adeguato assai raramente presenta effetti collaterali. La presenza di residui di neoplasia ipofisaria stabili nel tempo non costituisce una controindicazione al trattamento sostitutivo con rhGH, anche se, in queste condizioni, \ue8 raccomandato un controllo con esami appropriati di imaging della regione ipofisaria, a intervalli inizialmente semestrali e successivamente annuali. \uc8 infatti provato che il trattamento sostitutivo con rhGH non determina un aumento della massa tumorale ipofisaria, n\ue9 induce un\u2019insorgenza significativamente maggiore di neoplasie de novo rispetto alla popolazione generale. Le evidenze derivanti dagli studi rivelano che il rischio di sviluppare iperglicemia o diabete mellito nella popolazione di GHD trattati non \ue8 differente da quello della popolazione generale e maggior rischio potrebbe essere presente nei pazienti obesi. Sebbene non esistano prove certe che il trattamento con rhGH possa indurre o favorire la progressione del diabete o delle sue complicanze oculari (retinopatia diabetica), questo trattamento viene sconsigliato nei pazienti con diabete mellito scompensato e con retinopatia diabetica proliferante gi\ue0 in att

Unusual metastases from tall cell variant of papillary thyroid cancer

Background: TCV is considered more aggressive than classical variant of PTC. Distant metastases are more common among this variant and affect survival. Little is known about the molecular pattern of this histotype. Methods: We reported 2 cases of unusual metastases from TCV, BRAF V600E positive. Results: A 38-years-old-woman developed subcutaneous metastases during short term follow-up; at medium term follow-up, patient showed detectable stimulated serum Thyroglobulin without disease evidence at imaging. A 33 years-old-man, presented incidental thymic metastases at time of surgical treatment; this is the first case of not-ectopic thymic metastases from PTC. Conclusions: TCV may present with unusual metastases already during early follow-up. The more aggressive behavior could be linked to the higher prevalence of BRAF point mutations, but only a long-term follow-up might clarify if this association could worsen the prognosis. Moreover, skin metastases have been predictive factors of worse outcome in our patient, while not thymic metastates

Clinical-pathological changes in differentiated thyroid cancer (DTC) over time (1997-2010): data from the University Hospital "Maggiore della Carit\ue0" in Novara.

Differentiated thyroid cancer (DTC) is an important clinical entity in our population (Novara, Piedmont, Italy) which is characterized by important environmental influences, as iodine deficiency (ID) and subsequent supplementation, thyroiditis and occupational exposure. To evaluate the features of DTC in our population 20 years after the iodine-prophylaxis pondering the effects of the introduction of the new guidelines for diagnosis and management of DTC after 2005. 322 patients [244 females, age: mean (\ub1SD) 53.8 \ub1 15.8 years] treated for DTC in a tertiary care center between 1997 and 2010 were retrospectively evaluated. Medical history, demographics, and pathological features were considered. Patients were subdivided into two groups: A (n = 139, diagnosis 1997-2005) and B (n = 183, diagnosis 2006-2010). The population of group A showed a mild ID, while normal iodine status was recorded in group B. A significant increase in histological tumor-associated thyroiditis was found from group A to B (p = 0.021). Recurrent or persistent diseases were found to be correlated with lymph nodes metastases and/or a distant disease at diagnosis, stimulated thyroglobulin levels at the first follow-up and an additional radioiodine therapy. Twenty percent of our patients were females employed in textile industries. The tumor-related inflammation and the occupational exposure should be considered as important factors in the pathogenesis of DTC. Further studies are required in order to confirm our findings

Thyroid incidentaloma identified by \ub9\u2078F-fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT): clinical and pathological relevance.

OBJECTIVE: The percentage of patients with thyroid cancer incidentally diagnosed during a (18) F-fluorodeoxyglucose Positron Emission Tomography with computed tomography (CT) (FDG-PET/CT) for nonthyroid diseases ranges between 26% and 50%. DESIGN: Retrospective assessment of the clinical and pathological features of thyroid incidentalomas at FDG-PET/CT, aiming to identify potential predictors of malignancy. PATIENTS: Fifty-two patients with incidental thyroid uptake at FDG-PET/CT were retrospectively included [38 W, age 64\ub71 \ub1 12\ub75 years (mean \ub1 SD)]. An arbitrary cut-off level of 5\ub70 for the 'maximum standardized uptake value' (SUV max) was chosen to differentiate benign from malignant tumours. Complete thyroid function, neck ultrasonography (US) features, and cyto-histological results were reported for all cases. RESULTS: In our institution, the prevalence of incidental thyroid (18) F-fluorodeoxyglucose ((18) F-FDG) uptake was nearly 1\ub776%. The prevalence of focal uptake correlated with greater risk of malignancy (P 5\ub70 (P < 0\ub70001) were associated with the diagnosis of thyroid cancer. Diffusely increased FDG-PET/CT uptake in the thyroid was related to benign conditions. CONCLUSIONS: The presence of focal uptake with high SUV max and euthyroidism correlate with high likelihood of malignancy. Performing a neck US would have to be recommended in all patients with euthyroidism and an incidental FDG-PET/CT focal thyroid uptake. We do not suggest to use FDG-PET/CT as a screening tool for thyroid cancer in the general population, because of both its high cost and low incidence of thyroid incidentaloma at FDG-PET/CT