Clinical characteristics and treatment outcomes in acromegaly, a retrospective single-center case series from Thailand

Introduction: acromegaly, an overproduction of growth hormone (GH), is associated with high rate of morbidity and mortality particularly in case of delayed in diagnosis and treatment. A wide variation of clinical presentations, treatment outcomes and morbidities have been reported. Methods: a retrospective study was conducted to review clinical characteristics and treatment outcomes of patients with acromegaly treated in King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 2006 and 2018. Results: eighty-four patients (31 males and 53 females) were reviewed, mean age at diagnosis was 45.7 ± 12.6 years (±SD), mean time of disease onset was 7.6 ± 6.4 years and mean follow-up period was 7.8 ± 5.3 years. The most common presenting symptoms were maxillofacial change (96.8%) and acral enlargement (94.7%). Hypertension (39.3%), diabetes mellitus (28.6%) and dyslipidemia (23.8%) were prevalent co-existing conditions. Four patients were identified having cancer at presentation; however, no additional malignancy was reported during the follow up. Most patients harbored macroadenomas, only 10 were found to have microadenomas. The outcomes of treatment were controlled disease in 70% of microadenoma and 64.9% of macroadenoma. Permanent loss of pituitary function was found in about 21.3% and there was one case reported of mortality. The logistic regression analysis for controlled disease outcome showed the IGF-I index after surgery was associated with controlled disease outcome with statistically significant result (P-value=0.006).==Replace this with the results section of the abstract== Conclusion: our study offers descriptive clinical data of case series of acromegalic patients, which had favorable outcomes comparable with previous reports. In addition, IGF-I index after surgery is a predictive parameter for outcome of treatment

Clinical Characteristics and Treatment Outcomes in Endogenous Cushing’s Syndrome: A 15-Year Experience from Thailand

The most common subtype of endogenous Cushing’s syndrome (CS) is Cushing’s disease (CD), with higher proportions of adrenal CS reported from Asia, compared to other continents. However, little was known about CS in this territory. This study was to investigate the distribution, clinical characteristics, and treatment outcomes of CS in a single tertiary hospital in Thailand. We performed a retrospective evaluation of 82 patients with endogenous CS during 2001–2015. The most common subtype was CD, followed by adrenal CS and ectopic ACTH syndrome (EAS), respectively. Weight gain was the most common presentation. Normal body mass index (BMI), Asian cutoff, was observed in 33% of patients. Specific features of CS (plethora, muscle weakness, bruising, and/or wide purplish striae) were documented in less than half of patients. The median age, adrenocorticotropic hormone (ACTH), and urinary free cortisol (UFC) concentrations were significantly different among 3 subtypes of CS and were highest among patients with EAS. An initial remission rate after transsphenoidal surgeries in CD was 62%, with higher rates in pituitary microadenomas compared to macroadenomas. All patients with unilateral adrenal disease achieved CS remission after adrenal surgeries. Patients with EAS achieved CS remission mostly from bilateral adrenalectomy. The highest mortality rate was observed in the EAS group. These findings were consistent with previous studies in Asia, with more proportions ACTH-independent CS

Acylation stimulating protein, complement C3 and lipid metabolism in ketosis-prone diabetic subjects.

Ketosis-prone diabetes (KPDM) is new-onset diabetic ketoacidosis without precipitating factors in non-type 1 diabetic patients; after management, some are withdrawn from exogenous insulin, although determining factors remain unclear.Twenty KPDM patients and twelve type 1 diabetic patients (T1DM), evaluated at baseline, 12 and 24 months with/without insulin maintenance underwent a standardized mixed-meal tolerance test (MMTT) for 2 h.At baseline, triglyceride and C3 were higher during MMTT in KPDM vs. T1DM (p<0.0001) with no differences in non-esterified fatty acids (NEFA) while Acylation Stimulating Protein (ASP) tended to be higher. Within 12 months, 11 KPDM were withdrawn from insulin treatment (KPDM-ins), while 9 were maintained (KPDM+ins). NEFA was lower in KPDM-ins vs. KPDM+ins at baseline (p = 0.0006), 12 months (p<0.0001) and 24 months (p<0.0001) during MMTT. NEFA in KPDM-ins decreased over 30-120 minutes (p<0.05), but not in KPDM+ins. Overall, C3 was higher in KPDM-ins vs KPDM+ins at 12 months (p = 0.0081) and 24 months (p = 0.0019), while ASP was lower at baseline (p = 0.0024) and 12 months (p = 0.0281), with a decrease in ASP/C3 ratio.Notwithstanding greater adiposity in KPDM-ins, greater NEFA decreases and lower ASP levels during MMTT suggest better insulin and ASP sensitivity in these patients

Clinical and biochemical characteristic of KPDM and T1DM at baseline.

<p>All values are fasting values for KPDM and T1DM and are expressed as mean ± SD, where significance was evaluated by 2-tailed t test.</p><p>Clinical and biochemical characteristic of KPDM and T1DM at baseline.</p

Comparions of clinical and biochemical characteristics during follow-up between KPDM with insulin withdrawal and KPDM with insulin maintenance.

<p>All values are fasting values for KPDM and T1DM at baseline, 12 and 24 months of follow-up. Results are expressed as mean ± SD, where significance was evaluated by 2-way ANOVA or 1-way ANOVA.</p><p>Comparions of clinical and biochemical characteristics during follow-up between KPDM with insulin withdrawal and KPDM with insulin maintenance.</p

Circulating concentrations of C3.

<p>KPDM subjects with insulin maintenance (white triangles, dotted line) and KPDM subjects with insulin withdrawal (black triangles, solid line) were evaluated at baseline and follow-up. Following a standard mixed meal, C3 was measured from 0 to 120 minutes at baseline (A), 12 months (B), and 24 months (C). In panel D, results are given for calculated area-under-the-curve (ΔAUC) for insulin maintenance (white bars) and insulin withdrawal patients (hatched bars) at the indicated times. Results are expressed as mean ± S.E.M; data are analyzed by two-way ANOVA with Bonferroni post-tests as described in methods, where *P<0.05 and comparisons refer to insulin maintenance vs insulin withdrawal at the same time point, unless otherwise indicated.</p

Circulating concentrations of ASP/C3.

<p>KPDM subjects with insulin maintenance (white triangles, dotted line) and KPDM subjects with insulin withdrawal (black triangles, solid line) were evaluated at baseline and follow-up. Following a standard mixed meal, ASP was measured from 0 to 120 minutes at baseline (A), and 12 months (B). Results are expressed as mean ± S.E.M; data are analyzed by two-way ANOVA with Bonferroni post-tests as described in methods.</p

Circulating concentrations of lipids, C3 and ASP.

<p>KPDM patients (black circles, solid line) and T1DM patients (white squares, dotted line) at baseline ingested a standard mixed meal tolerance test, and results are presented for triglyceride (TG) (A), NEFA (B), complement C3 (C), ASP (D), and %ASP/C3 (E) measured from 0 to 120 minutes. Results are expressed as mean ± S.E.M; data are analyzed by two-way ANOVA with Bonferroni post-tests as described in methods, where *P<0.05, **P<0.01 and ***P<0.001 and statistical comparisons refer to KPDM vs T1DM at the same time point, unless otherwise indicated.</p

Bone mineral density changes among people living with HIV who have started with TDF-containing regimen: A five-year prospective study.

There are limited data regarding long-term BMD changes over time among treatment-naïve people living with HIV (PLHIV) after initiating combined antiretroviral therapy (cART) in Asia. We aimed to study bone mineral density (BMD) changes among treatment-naïve PLHIV started treatment with tenofovir disoproxil fumarate (TDF)- or non-TDF-containing regimen and HIV-uninfected controls in an Asian setting. The study was a five-year prospective study. BMD at lumbar spine (LS) (L1 to L4), total hip (TH), and femoral neck (FN) were measured by dual energy X-ray absorptiometry (DEXA) scans at baseline, months 12, 24 and 60. Multivariate logistic regression models were used to explore factors associated with mean BMD ≥5% reduction after 5 years of cART. A total of 106 PLHIV (75 and 31 started TDF- and non-TDF-containing regimen, respectively) and 66 HIV-uninfected individuals were enrolled. The mean percent changes of BMD were significantly different longitudinally between TDF and non-TDF users (p<0.001 for LS, p = 0.006 for TH and p = 0.02 for FN). HIV-positive status and on TDF-containing regimen was independently associated with BMD loss ≥5% at month 60 (adjusted odds ratio [aOR] 7.0, 95% confidence interval [95%CI] 2.3-21.0, P = 0.001 for LS; aOR 4.9, 95%CI 1.7-14.3, P = 0.003 for TH and aOR 4.3, 95%CI 1.6-11.2, P = 0.003 for FN) compared to HIV-uninfected individuals. In a multivariate model for PLHIV only, TDF use (vs. non-TDF, P = 0.005) and pre-treatment CD4+ count <350 cells/mm3 (vs. ≥350 cells/mm3, P = 0.02) were independently associated with ≥5% BMD loss in TH at month 60. Treatment-naïve PLHIV initiating treatment with TDF-containing regimen have higher BMD loss in a Thai cohort. TDF use and low pre-treatment CD4 count were independently associated with BMD loss at month 60 at TH. Earlier treatment initiation and interventions to prevent bone loss could improve skeletal health among PLHIV. Clinicaltrials.gov: NCT01634607