AME position statement on adrenal incidentaloma

Abstract OBJECTIVE: To assess currently available evidence on adrenal incidentaloma and provide recommendations for clinical practice. DESIGN: A panel of experts (appointed by the Italian Association of Clinical Endocrinologists (AME)) appraised the methodological quality of the relevant studies, summarized their results, and discussed the evidence reports to find consensus. RADIOLOGICAL ASSESSMENT: Unenhanced computed tomography (CT) is recommended as the initial test with the use of an attenuation value of ≤10 Hounsfield units (HU) to differentiate between adenomas and non-adenomas. For tumors with a higher baseline attenuation value, we suggest considering delayed contrast-enhanced CT studies. Positron emission tomography (PET) or PET/CT should be considered when CT is inconclusive, whereas fine needle aspiration biopsy may be used only in selected cases suspicious of metastases (after biochemical exclusion of pheochromocytoma). HORMONAL ASSESSMENT: Pheochromocytoma and excessive overt cortisol should be ruled out in all patients, whereas primary aldosteronism has to be considered in hypertensive and/or hypokalemic patients. The 1 mg overnight dexamethasone suppression test is the test recommended for screening of subclinical Cushing's syndrome (SCS) with a threshold at 138 nmol/l for considering this condition. A value of 50 nmol/l virtually excludes SCS with an area of uncertainty between 50 and 138 nmol/l. MANAGEMENT: Surgery is recommended for masses with suspicious radiological aspects and masses causing overt catecholamine or steroid excess. Data are insufficient to make firm recommendations for or against surgery in patients with SCS. However, adrenalectomy may be considered when an adequate medical therapy does not reach the treatment goals of associated diseases potentially linked to hypercortisolism

New treatment guidelines on Cushing's disease

It is important to treat patients with Cushing's disease as rapidly as possible to limit its long-term mortality and morbidity. Selective transphenoidal pituitary adenomectomy remains the treatment of choice but, unfortunately, the rate of cure at long-term follow-up is suboptimal and recurrences are high, even in the hands of expert neurosurgeons. Treatment options for persistent or relapsed disease include repeat trasphenoidal pituitary surgery, radiotherapy or bilateral adrenalectomy. Medical treatment, a second-line treatment option, may have either a primary or adjunctive role if the patient cannot safely undergo surgery, if surgery fails, or if the tumor recurs. Cabergoline and pasireotide (SOM230), two pituitary tumor-directed drugs, are the most exciting news in the human pharmacological approach. However, the use of these drugs in clinical practice and their real impact in the management of patients is yet to be determined. The treatment of patients with Cushing's disease is complex and requires a multidisciplinary and individualized approach to patient management using cost-benefit analyses

Ipercortisolismo funzionale e sue possibili conseguenze cliniche

SommarioL'ipercortisolismo funzionale rappresenta una condizione di attivazione cronica dell'asse ipotalamo-ipofisi-surrene che si verifica in condizioni cliniche eterogenee (depressione e altri disordini psichici, disturbi del comportamento alimentare, diabete mellito, obesità, alcolismo, sindrome dell'ovaio policistico, sindrome delle apnee ostruttive notturne, lavoro a turni). Solitamente è un ipercortisolismo di lieve entità e reversibile alla remissione della condizione sottostante. Deve essere distinto dalla Sindrome di Cushing con la quale, però, condivide manifestazioni cliniche, alterazioni biochimiche e problematiche di diagnostica differenziale. Si può ipotizzare che l'ipercortisolismo funzionale abbia comunque un'azione deleteria tessuto-specifica. In questa rassegna verranno illustrati sinteticamente meccanismi ed effetti nocivi dell'ipercortisolismo funzionale

Acromegalia e Ancona: un fil rouge lungo trecento anni, da Amato Lusitano ad Augusto Tamburini

Ancona è diventata sede universitaria in tempi recenti, sol- tanto un cinquantennio fa, ma le sue strutture sanitarie, il manicomio e l’ospedale, avevano un rilievo regionale o in- terregionale già nella prima metà del Novecento [29]. Me- dici originari di Ancona, come Augusto Tamburini, sebbene abbiano costruito altrove la loro carriera, hanno comunque contribuito allo sviluppo della città e delle sue istituzioni, e la biblioteca dell’ex-manicomio a lui intitolata costituisce uno strumento prezioso per lo studio della psichiatria, della neurologia e, più in generale, della medicina tra fine Otto- cento e primo Novecento, compresa l’acromegalia. Ancona, inoltre, da sempre città di mare, centro di commerci e scam- bi con l’Oriente e il Mediterraneo, ha ospitato seppure per breve tempo, a metà del Cinquecento, uno straordinario me- dico itinerante, l’ebreo portoghese Amato Lusitano, la cui opera conserva memorie altrimenti perdute della città e del suo territorio, tra cui la storia del gigante di Senigallia

Science diplomacy. Foundations and practice

What is science diplomacy? Why is it important in a world marked by global challenges such as climate change and confrontation between great powers? What knowledge can be mobilised to study this emerging field of practice and research? The chapters in this volume provide initial answers to these questions, examining different aspects of science diplomacy, both from a theoretical point of view and by presenting real world case studies. The intent of the book is to offer an introduction to an increasingly important theme in the relations between science, society and politics. Consequently, it is addressed to all those (students, researchers, decision-makers) who are approaching science diplomacy for the first time

The promising approach of 3D bioprinting for diabetic foot ulcer treatment: A concise review of recent developments

Diabetic foot ulcer (DFU), one of the most significant complications of diabetes, is a condition that causes anatomical and functional alterations of the foot resulting in an important social and economic impact, related to disability and health care costs. Recently, three-dimensional bioprinting - which allows the fabrication of complex and biocompatible structures - has been identified as a promising approach in the field of regenerative medicine to promote the healing of chronic wounds, such as DFU. In this concise review we highlight the most relevant and recent attempts of using 3D bioprinted constructs in vivo - both on animals and people - in order to treat non-healing diabetic ulcers and prevent their worsening. Finally, we briefly focus on the future implications of bioprinting, suggesting its forthcoming importance not only for DFU treatment but also for other areas of clinical care

La diplomazia scientifica. Fondamenti e pratiche

Cos’è la diplomazia scientifica? Qual è la sua importanza in un mondo segnato da sfide globali come il cambiamento climatico e il confronto fra grandi potenze? Quali saperi si possono mobilitare per studiare questo campo emergente di pratica e ricerca? I capitoli di questo volume offrono alcuni spunti per iniziare a rispondere a queste domande, ciascuno esaminandone un aspetto diverso, sia da un punto di vista teorico che presentando dei casi di studio sulla diplomazia scientifica «in azione». L’intento è di offrire una prima introduzione a un tema sempre più importante nelle relazioni fra scienza, società e politica, rivolgendosi a tutti coloro (studenti, ricercatori, decisori) che ad esso si avvicinano per la prima volta

Using temperament and character dimensions (TCI) to analyze the personality profiles of adults and older adults with cancer managed in outpatient settings

Introduction This study aimed to investigate profiles of personality evaluated by temperament and character dimensions (TCI) in 638 adult and older adult patients (CP) who had recently been diagnosed with breast, colon, lung, and other kinds of cancer (female and male subjects were assessed). Tests: Temperament and Character Inventory (TCI). Statistical analysis: cluster K-means analysis for personality traits. Results Two different personality profiles emerged: "Low self-determination and pessimism" (Profile 1) and "Self-determination and self-caring (medium)" (Profile 2). The following significant differences were observed in the TCI dimensions between the two profiles: Temperament-Novelty-Seeking (NS) (p 0.001); Self-Transcendence (ST) (p < 0.001). No differences in the two profiles were found between adult and elderly patients. Profile 1 - "Low self-determination and pessimism": Patients with this profile present low resistance to frustration, poor search for novelty and solutions (NS), anxiety and pessimism (medium HA), high social attachment and dependence on the approval of others (medium-high RD), and low self-determination (PS) as temperament dimensions; and medium-low self-direction, low autonomy and ability to adapt (SD-medium-low), medium cooperativeness (C), and low self-transcendence (ST) as character dimensions. Profile 2 - "Self-determination and self-caring (medium)": Patients with this profile have resistance to frustration, ability to search for novelty and solutions (medium-NS), low anxiety and pessimism (HA), low social attachment and dependence on approval (medium-low-RD), and determination (medium-high PS) as dimensions of temperament; and autonomy and capacity for adaptation and self-direction (SD), capacity for cooperation (high-CO), and self-transcendence (medium-high-ST) as character dimensions. Conclusion Personality screening allows a better understanding of the difficulties of the individual patient and the planning of targeted psychotherapeutic interventions that promote quality of life and good adaptation to the disease course

Isolation and characterization of Mesenchymal Stem Cells from pituitary tumours

In the past few years the introduction of the cancer stem cells (CSCs) notion opened new perspectives for the diagnosis and cure of solid tumors. According to this theory, CSCs originate from mutated stem cells, maintaining the self-renewal and differentiative abilities. Therefore, the development of specific therapies targeted at CSCs holds hope for improvement of survival and quality of life of cancer patients. Actually, no informations are available about stem cells and cancer stem cells on pituitary tumours. This work depicts some essential features of stem cells isolated from pituitary adenomas. Six tumour biopsies (3: GH-secreting; 3: non secreting) were collected and cultured with a specific culture medium. Cell growth and morphology were monitored and cells were subjected to analyses for stemness determination (immunophenotype, gene expression and differentiative potential) [1, 2] and GH secretion. Cells showed a stem-like immunophenotype, the expression of Oct-4, Sox-2, Nanog and Klf-4 and the ability to differentiate towards osteogenic, chondrogenic and adipogenic lineages. The hormone secretion ended after two weeks culturing. Even if further studies are needed for the fully comprehension of the specific nature of these cells and on their role on tumour onset and maintenance, this study opens to the possibility of isolation of stem cells from pituitary tumour, allowing a molecular targeting of it. This work was supported by grant FIRB-RBAP10MLK7_003 from Ministero dell’Istruzione, dell’Università e della Ricerca, Rome, Ital

Using temperament and character dimensions (TCI) to analyze the personality profiles of adults and older adults with cancer managed in outpatient settings

Introduction This study aimed to investigate profiles of personality evaluated by temperament and character dimensions (TCI) in 638 adult and older adult patients (CP) who had recently been diagnosed with breast, colon, lung, and other kinds of cancer (female and male subjects were assessed). Tests: Temperament and Character Inventory (TCI). Statistical analysis: cluster K-means analysis for personality traits. Results Two different personality profiles emerged: "Low self-determination and pessimism" (Profile 1) and "Self-determination and self-caring (medium)" (Profile 2). The following significant differences were observed in the TCI dimensions between the two profiles: Temperament-Novelty-Seeking (NS) (p &lt; 0.001); Harm-Avoidance (HA) (p &lt; 0.001); Reward-Dependence (RD) (p &lt; 0.001); Persistence (PS) (p &lt; 0.001); Character-Self-Directness (SD) (p &lt; 0.001); Cooperativeness (C) (p &gt; 0.001); Self-Transcendence (ST) (p &lt; 0.001). No differences in the two profiles were found between adult and elderly patients. Profile 1 - "Low self-determination and pessimism": Patients with this profile present low resistance to frustration, poor search for novelty and solutions (NS), anxiety and pessimism (medium HA), high social attachment and dependence on the approval of others (medium-high RD), and low self-determination (PS) as temperament dimensions; and medium-low self-direction, low autonomy and ability to adapt (SD-medium-low), medium cooperativeness (C), and low self-transcendence (ST) as character dimensions. Profile 2 - "Self-determination and self-caring (medium)": Patients with this profile have resistance to frustration, ability to search for novelty and solutions (medium-NS), low anxiety and pessimism (HA), low social attachment and dependence on approval (medium-low-RD), and determination (medium-high PS) as dimensions of temperament; and autonomy and capacity for adaptation and self-direction (SD), capacity for cooperation (high-CO), and self-transcendence (medium-high-ST) as character dimensions. Conclusion Personality screening allows a better understanding of the difficulties of the individual patient and the planning of targeted psychotherapeutic interventions that promote quality of life and good adaptation to the disease course