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Purpose: Data regarding the presence of a prolactin (PRL) threshold above which a pituitary magnetic resonance imaging (MRI) is mandatory in patients with hyperprolactinemia (hyperPRL) are controversial and derived primarily from studies focused on female populations. Aim of our study was to evaluate in a cohort of patients of both sexes with confirmed hyperPRL, the possible correlation between PRL values and the presence of pituitary abnormalities. Methods: We retrospectively analyzed data from patients who underwent serial PRL sampling at our Division between January 2015 and December 2022. Patients diagnosed with monomeric hyperPRL at serial sampling and with subsequent contrast-enhanced MRI results available for the pituitary region were included in the study. Exclusion criteria were prior pituitary disease, severe renal insufficiency, liver cirrhosis, uncompensated primary hypothyroidism and ongoing therapy with hyperprolactinemic drugs. Physiological causes of hyperPRL were also ruled out. Results: Out of the 1253 patients who underwent serial PRL sampling, 139 patients (101 women and 38 men) met the inclusion criteria: 106 (76.3%) patients had some form of pituitary disease, with microlesions observed in 69.8%, macrolesions in 25.5% and other findings in 4.7% of subjects. PRL values showed a modest accuracy in predicting the presence of a pituitary abnormality and the best cut-offs identified were >25 µg/L (AUC 0.767, p= 0.003) and >44.2 µg/L (AUC 0.697, p< 0.001) in men and women, respectively; however, if only patients with PRL values > 500 µg/L were excluded from the analysis, as they were already supposed to harbor a macroprolactinoma, PRL levels were not able to predict the presence of a macrolesion neither in men nor women. Conclusion: Given the high prevalence of pituitary abnormalities in patients of both sexes with hyperPRL at serial sampling, performing a pituitary imaging in all cases of hyperPRL, even if mild, appears to be a cautious choice.

Il corretto riconoscimento dei casi di diabete insipido, in particolar modo parziale, rimane tutt’oggi una sfida per l’endocrinologo. Nuovi test di stimolo, osmotici e non, che prevedono la determinazione plasmatica di copeptina, sono stati proposti negli ultimi anni, modificando irreversibilmente le flow-chart diagnostiche. In questa rassegna sono riportate le principali evidenze in merito a tali procedure, con attenzione particolare all’accuratezza e ai limiti intrinseci di ciascuna di esse.

I distruttori o interferenti endocrini (IE) sono sostanze o miscele di sostanze che interferiscono con il sistema endocrino con implicazioni negative sull’individuo e sulla sua progenie. Nell’ultimo decennio, la ricerca scientifica ha studiato i principali effetti degli IE sulla salute e ancora oggi molti non sono noti. In questa rassegna si descriveranno i principali effetti e i meccanismi di azione di alcuni IE su ipofisi, tiroide, ghiandole surrenaliche e gonadi, e i possibili sviluppi futuri.

Background: SLGT-2 inhibitors have recently been investigated as a promising therapy for syndrome of inappropriate antidiuresis (SIAD). However, to our knowledge, no report has been published about their use for this indication in the long term. Case presentation: We report the case of a 68-year-old male with type 2 diabetes and chronic SIAD, in whom serum sodium levels were not adequately controlled by urea monotherapy. Other treatment options were not viable due to inefficacy or adverse effects. The initiation of empagliflozin, in addition to urea, led to the full normalization of serum sodium. Reduction and subsequent discontinuation of urea were attempted upon patient request, but this resulted in a relapse of hyponatremia. Nevertheless, stable normonatremia was again achieved and maintained for more than 6 months after re-establishing a combination therapy with empagliflozin and urea. Conclusions: SGLT2 inhibitors might represent an effective treatment for SIAD, even in the long term. Specific clinical trials are needed to confirm this result.

Background: In recent years, scientific research has increasingly focused on Endocrine Disrupting Chemicals (EDCs) and demonstrated their relevant role in the functional impairment of endocrine glands. This induced regulatory authorities to ban some of these compounds and to carefully investigate others in order to prevent EDCs-related conditions. As a result, we witnessed a growing awareness and interest on this topic. Aims: This paper aims to summarize current evidence regarding the detrimental effects of EDCs on pivotal endocrine glands like pituitary, thyroid and adrenal ones. Particularly, we directed our attention on the known and the hypothesized mechanisms of endocrine dysfunction brought by EDCs. We also gave a glimpse on recent findings from pioneering studies that could in the future shed a light on the pathophysiology of well-known, but poorly understood, endocrine diseases like hormone-producing adenomas. Conclusions: Although intriguing, studies on endocrine dysfunctions brought by EDCs are challenging, in particular when investigating long-term effects of EDCs on humans. However, undoubtedly, it represents a new intriguing field of science research.

La metanalisi è una tecnica statistica con cui è possibile combinare quantitativamente i risultati di multipli studi scientifici che valutano un medesimo outcome. Una lettura consapevole di uno studio metanalitico non può prescindere dalla conoscenza degli strumenti statistici su cui esso si basa, al fine di poterne valutare più correttamente la appropriatezza metodologica e le implicazioni cliniche.

Copeptina (CT-proAVP) rappresenta l’affidabile marker di secrezione dell’arginin-vasopressina (AVP) e nella pratica clinica endocrinologica viene impiegata per la diagnosi differenziale della sindrome poliurica-polidipsica. Negli ultimi anni, tuttavia, sono state indagate applicazioni alternative di tale glicopeptide in setting differenti. In questa rassegna sono esaminate, in particolare, le sue più interessanti proposte di utilizzo in ambito cardiovascolare, infettivologico e nefrologico.

I feocromocitomi e paragangliomi (PPGL) sono geneticamente determinati in almeno il 30% dei casi. Le mutazioni identificate più recentemente, in particolare quelle dei geni SDHx, possono favorire, seppur raramente, anche l’insorgenza di tumori stromali gastro-intestinali, carcinomi renali e adenomi ipofisari. Pertanto, in caso di diagnosi di una delle suddette neoplasie, il clinico dovrebbe valutare l’anamnesi personale e familiare alla ricerca di eventuali PPGL, così come in pazienti con PPGL associato a mutazione di SDHx, TMEM127 e MAX si dovrebbe indagare la presenza di neoplasie potenzialmente correlate.

Intracranial tumors of different histologic types infrequently affect patients with pituitary adenomas and no history of head irradiation. The association with craniopharyngioma is extremely rare. Aims of this paper are: (1) to provide a critical literature review of typical features of pituitary adenoma presenting in association with craniopharyngioma; (2) to describe the first documented (clinically, biochemically, histologically, and radiologically) case of aggressive, suprasellar papillary craniopharyngioma presenting with amenorrhea, progressive reduction of visual field, and severe headache in a 38-year-old woman, a decade after surgical cure for microprolactinoma associated with empty sella, during which she had carried two pregnancies; and (3) to discuss common etiopathogenetic mechanisms, in relation to the management of these lesions. Systematic literature search for English literature focusing on the association of craniopharyngioma and pituitary adenoma was performed using PubMed database. Additional relevant articles from references lists were also included. Clinical, laboratory, and radiological examinations performed in our patient for the two brain lesions at diagnosis and follow up were collected. Literature search retrieved nine articles. Typically, craniopharyngioma were of adamantinomatous type, occurred simultaneously to pituitary adenoma, presented with headache and visual loss, and affected men. No case of clearly documented metachronous lesion affecting a woman after pregnancy had been described before. Although very rare and with uncertain etiopathogenesis, second tumors (i.e., craniopharyngioma) should be considered in patients with a history of pituitary adenoma, presenting with suggestive signs and symptoms, even after a long disease-free period, in order to provide proper and prompt treatment.

L’ipopituitarismo post trauma cranico nel soggetto adulto è un evento di frequente riscontro e le disfunzioni ormonali conseguenti al trauma possono contribuire ad una ripresa funzionale meno rapida o non completa del paziente dopo il trauma stesso. I dati relativi all’insorgenza di ipopituitarismo post trauma nell’età pediatrica, invece, sono estremamente disomogenei e ad oggi non è chiaro se le disfunzioni biochimiche evidenziate abbiano un effettivo impatto sulla salute del soggetto.

Si definisce “sella vuota” l’erniazione dello spazio subaracnoideo all’interno del cavo sellare con conseguente appiattimento del parenchima ipofisario, che risulta così addossato al pavimento sellare. La sella vuota si distingue in primaria e secondaria. La patogenesi della forma primaria riconosce come possibili fattori causali l’incompleto sviluppo del diaframma sellare e cause sovrasellari quali un aumento, persistente o intermittente, della pressione intracranica e/o una variazione del volume della ghiandola ipofisaria, come è dato osservare durante la gravidanza. La sella vuota secondaria, invece, riconosce come possibili cause la presenza di un adenoma ipofisario che è andato incontro a necrosi spontanea, cause traumatiche, infettive, vascolari, autoimmuni, o, ancora, interventi chirurgici o radioterapia nella regione ipofisaria. Un’ulteriore classificazione dei quadri di sella vuota, distingue le forme parziali da quelle totali sulla base dell’estensione dell’erniazione dello spazio subaracnoideo all’interno del cavo sellare. Studi autoptici e neuroradiologici riportano una prevalenza di sella vuota variabile tra il 5, 5 e il 35%, con una prevalenza del sesso femminile (rapporto maschi:femmine 1: 4) e dei soggetti obesi. La sella vuota può essere un riscontro radiologico asintomatico o associarsi a diversi quadri clinici che vanno da diversi gradi di ipopituitarismo, a segni di ipertensione endocranica, rinoliquorrea e obesità.

Since antique times, dwarfs have been commonly employed at court, mostly as servants, entertainers, or personal attendants upon noble women and noblemen. Their presence at European Renaissance courts was very common, as demonstrated by their presence alongside to their masters or mistress in several artworks of that period. Aim of our paper is to derive clinical information regarding the type of dwarfism affecting people living and acting at European courts from an overview of paintings dating fifteenth to the eighteenth century.Since antique times, dwarfs have been commonly employed at court, mostly as servants, entertainers, or personal attendants upon noble women and noblemen. Their presence at European Renaissance courts was very common, as demonstrated by their presence alongside to their masters or mistress in several artworks of that period. Aim of our paper is to derive clinical information regarding the type of dwarfism affecting people living and acting at European courts from an overview of paintings dating fifteenth to the eighteenth century.