150 results on '"Vassiliadi, Dimitra A."'
Search Results
102. Visceral adiposity index for the diagnosis of nonalcoholic fatty liver disease in premenopausal women with and without polycystic ovary syndrome
- Author
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Vassilatou, Evangeline, primary, Lafoyianni, Sophia, additional, Vassiliadi, Dimitra Argyro, additional, Ioannidis, Dimitrios, additional, Paschou, Stavroula A., additional, Mizamtsidi, Maria, additional, Panagou, Maria, additional, and Vryonidou, Andromachi, additional
- Published
- 2018
- Full Text
- View/download PDF
103. Urine steroid metabolomics as a diagnostic tool for detection of adrenocortical malignancy - a prospective test validation study
- Author
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Bancos, Irina, primary, Taylor, Angela, additional, Chortis, Vasileios, additional, Sitch, Alice, additional, Lang, Katharina, additional, Prete, Alessandro, additional, Terzolo, Massimo, additional, Fassnacht, Martin, additional, Quinkler, Marcus, additional, Kastelan, Darko, additional, Vassiliadi, Dimitra, additional, Beauschlein, Felix, additional, Ambroziak, Urszula, additional, Biehl, Michael, additional, Deeks, Jonathan, additional, and Arlt, Wiebke, additional
- Published
- 2018
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104. Diagnosis and Management of Primary Adrenal Macronodular Hyperplasia
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Vassiliadi, Dimitra Argyro, primary
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- 2018
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105. Proteolytically cleaved forms of corticosteroid-binding globulin with low steroid-binding affinity are not present in human plasma
- Author
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Hill, Lesley, primary, Vassiliadi, Dimitra, additional, and Hammond, Geoffrey, additional
- Published
- 2018
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- View/download PDF
106. DIAGNOSIS OF ENDOCRINE DISEASE: The role of the desmopressin test in the diagnosis and follow-up of Cushing’s syndrome
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Vassiliadi, Dimitra Argyro, primary and Tsagarakis, Stylianos, additional
- Published
- 2018
- Full Text
- View/download PDF
107. Adipose Tissue Lactate Clearance but Not Blood Lactate Clearance Is Associated with Clinical Outcome in Sepsis or Septic Shock during the Post-Resuscitation Period
- Author
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Ilias, Ioannis, primary, Apollonatou, Sofia, additional, Vassiliadi, Dimitra-Argyro, additional, Nikitas, Nikitas, additional, Theodorakopoulou, Maria, additional, Diamantakis, Argyris, additional, Kotanidou, Anastasia, additional, and Dimopoulou, Ioanna, additional
- Published
- 2018
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108. Mild autonomous cortisol excess in adrenal incidentalomas - metabolic disease burden and urinary steroid metabolome in 1201 prospectively recruited patients
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Prete, Alessandro, primary, Taylor, Angela E, additional, Sitch, Alice J, additional, Gilligan, Lorna C, additional, Vassiliadi, Dimitra, additional, Ambroziak, Urzula, additional, Lang, Katharina, additional, Kastelan, Darko, additional, Tabarin, Antoine, additional, Dennedy, M Conall, additional, Ueland, Grethe AEstrom, additional, Quinkler, Marcus, additional, Masjkur, Jimmy Rusdian, additional, Fassnacht, Martin, additional, Ivovic, Miomira, additional, Terzolo, Massimo, additional, Beuschlein, Felix, additional, Manolopoulos, Konstantinos, additional, Tsagarakis, Stylianos, additional, Shackleton, Cedric H L, additional, Deeks, Jonathan J, additional, Bancos, Irina, additional, and Arlt, Wiebke, additional
- Published
- 2017
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109. The natural history of adrenal incidentaloma - results from the international prospective multi-centre EURINE-ACT study
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Bancos, Irina, primary, Chortis, Vasileios, additional, Lang, Katharina, additional, Prete, Alessandro, additional, Terzolo, Massimo, additional, Fassnacht, Martin, additional, Quinkler, Marcus, additional, Kastelan, Darko, additional, Vassiliadi, Dimitra, additional, Beuschlein, Felix, additional, Ambroziak, Urszula, additional, Sitch, Alice, additional, Deeks, Jonathan, additional, and Arlt, Wiebke, additional
- Published
- 2017
- Full Text
- View/download PDF
110. Diagnostic performance of non-invasive markers for the presence of nonalcoholic fatty liver disease in premenopausal women with and without polycystic ovary syndrome
- Author
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Vassilatou, Evangeline, primary, Lafoyianni, Sophia, additional, Vassiliadi, Dimitra-Argyro, additional, Ioannidis, Dimitrios, additional, Paschou, Stavroula, additional, Mizamtzidi, Maria, additional, and Vryonidou, Andromachi, additional
- Published
- 2017
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111. Urine Steroid Metabolomics as a Novel Tool for Detection of Recurrent Adrenocortical Carcinoma
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Chortis, Vasileios, Bancos, Irina, Nijman, Thomas, Gilligan, Lorna C, Taylor, Angela E, Ronchi, Cristina L, O’Reilly, Michael W, Schreiner, Jochen, Asia, Miriam, Riester, Anna, Perotti, Paola, Libé, Rosella, Quinkler, Marcus, Canu, Letizia, Paiva, Isabel, Bugalho, Maria J, Kastelan, Darko, Dennedy, M Conall, Sherlock, Mark, Ambroziak, Urszula, Vassiliadi, Dimitra, Bertherat, Jerome, Beuschlein, Felix, Fassnacht, Martin, Deeks, Jonathan J, Biehl, Michael, and Arlt, Wiebke
- Published
- 2020
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112. Response to Letter to the Editor: "Prevention of Adrenal Crisis: Cortisol Response to Major Stress Compared to Stress Dose Hydrocortisone Delivery".
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Prete, Alessandro, Taylor, Angela E, Bancos, Irina, Smith, David J, Foster, Mark A, Kohler, Sibylle, Fazal-Sanderson, Violet, Komninos, John, O'Neil, Donna M, Vassiliadi, Dimitra A, Mowatt, Christopher J, Mihai, Radu, Fallowfield, Joanne L, Annane, Djillali, Lord, Janet M, Keevil, Brian G, Wass, John A H, Karavitaki, Niki, and Arlt, Wiebke
- Subjects
HYDROCORTISONE ,RESEARCH ,RESEARCH methodology ,ADRENAL insufficiency ,MEDICAL cooperation ,EVALUATION research ,COMPARATIVE studies ,ACUTE diseases ,ADRENOCORTICOTROPIC hormone - Published
- 2021
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113. Demographics of adrenal incidentaloma - results from an international prospective multi-centre study in 2190 patients
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Bancos, Irina, primary, Chortis, Vasileios, additional, Lang, Katharina, additional, Terzolo, Massimo, additional, Fassnacht, Martin, additional, Quinkler, Marcus, additional, Kastelan, Darko, additional, Vassiliadi, Dimitra, additional, Beuschlein, Felix, additional, Ambroziak, Urszula, additional, Deeks, Jonathan, additional, and Arlt, Wiebke, additional
- Published
- 2016
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114. Visceral adiposity index as a marker of hepatic steatosis in overweight and obese premenopausal women
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Vassilatou, Evangeline, primary, Vassiliadi, Dimitra, additional, Lazaridou, Helen, additional, Koutsomitopoulos, Nikitas, additional, Kelekis, Nikolaos, additional, Hadjidakis, Dimitrios, additional, and Dimitriadis, George, additional
- Published
- 2016
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115. Urine steroid metabolomics is a highly sensitive tool for post-operative recurrence detection in adrenocortical carcinoma
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Chortis, Vasileios, primary, Bancos, Irina, additional, Sitch, Alice J, additional, Taylor, Angela E, additional, O'Neil, Donna, additional, Lang, Katharina, additional, Quinkler, Marcus, additional, Terzolo, Massimo, additional, Mannelli, Massimo, additional, Vassiliadi, Dimitra, additional, Ambroziak, Urszula, additional, Dennedy, M. Conall, additional, Sherlock, Mark, additional, Bertherat, Jerome, additional, Beuschlein, Felix, additional, Fassnacht, Martin, additional, Deeks, Jonathan J, additional, Biehl, Michael, additional, and Arlt, Wiebke, additional
- Published
- 2016
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116. Discrepant GH and IGF-I values in the evaluation of treated acromegalic patients; an ongoing challenge. A meta-analysis
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Kanakis, George, primary, Chrisoulidou, Alexandra, additional, Bargiota, Alexandra, additional, Efstathiadou, Zoe, additional, Papanastasiou, Lamprini, additional, Theodoropoulou, Anastasia, additional, Tigas, Stylianos, additional, Vassiliadi, Dimitra, additional, Tsagarakis, Stylianos, additional, and Alevizaki, Maria, additional
- Published
- 2016
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117. Endothelial protein C receptor polymorphisms and risk of severe sepsis in critically ill patients
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Vassiliou, Alice G. Maniatis, Nikolaos A. Kotanidou, Anastasia and Kallergi, Marina Karystinaki, Foteini S. Letsiou, Eleftheria and Glynos, Constantinos Kopterides, Petros Vassiliadi, Dimitra and Nikitas, Nikitas Dimopoulou, Ioanna Armaganidis, Apostolos and Orfanos, Stylianos E.
- Abstract
Endothelial protein C receptor (EPCR) is expressed mainly in endothelial cells and is involved in regulation of the cytoprotective and anticoagulant pathways of protein C. We assessed whether haplotypes in the EPCR gene modify the risk of severe sepsis and/or septic shock (SS/SS) development in critically ill patients. Three polymorphisms in the EPCR gene were genotyped in 389 Caucasian critically ill patients, hospitalized in the intensive care units of two major hospitals in Athens, Greece. Multivariate logistic regression analysis controlling for age, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores, sex, and diagnosis was performed to determine the effect of haplotypes H1 and H3 in the EPCR gene on the development of SS/SS. H2 carriers versus all other genotypes combined had a nonsignificant excess of SS/SS (p = 0.087). SS/SS occurred in 38.8 % of critically ill patients carrying minor alleles belonging to both H1 and H3 haplotypes, in 58.0 % of H1 carriers, 64.3 % of H3 carriers, and 65.2 % of patients carrying all common alleles (H2). Compared with H2 carriers, the odds ratios (OR) for developing SS/SS were 0.34 [95 % confidence interval (CI) 0.16-0.76, p = 0.008] for simultaneous H1 and H3 carriers, 0.65 (95 % CI 0.37-1.13, p = 0.123) for H1 carriers, and 0.82 (95 % CI 0.39-1.70, p = 0.590) for H3 carriers. Our results indicate that simultaneous carriers of minor alleles belonging to both the H1 and H3 haplotypes may be at reduced risk of developing SS/SS in this cohort of critically ill patients.
- Published
- 2013
118. The role of the desmopressin test in the diagnosis and follow-up of Cushing's syndrome.
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Vassiliadi, Dimitra Argyro and Tsagarakis, Stylianos
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CUSHING'S syndrome diagnosis , *DESMOPRESSIN , *FOLLOW-up studies (Medicine) , *VASOPRESSIN regulation , *ADRENOCORTICOTROPIC hormone , *HORMONE therapy - Abstract
Desmopressin is a vasopressin analogue selective for type 2 vasopressin receptors that mediate renal water retention. In contrast to the native hormone arginine vasopressin, a well-known ACTH secretagogue, desmopressin, exerts minimal or no activity on ACTH excretion. However, in a substantial proportion of patients with ACTH-dependent Cushing's syndrome (CS), desmopressin elicits an ACTH and cortisol response, which contrasts with the minimal responses obtained in healthy subjects. The mechanism underlying this paradoxical response involves upregulation of vasopressin type 3 and/or the aberrant expression of type 2 receptors by neoplastic ACTH-producing cells. This makes desmopressin administration a suitable test enabling the distinction between neoplastic from functional (formerly termed 'pseudo-Cushing syndrome') ACTH-dependent cortisol excess. Several studies have now established an adjunctive role of desmopressin in the initial diagnostic workup of CS. Despite some early data indicating that this test may also have a role in distinguishing between Cushing's disease (CD) and ectopic ACTH secretion, subsequent studies failed to confirm this observation. The ability of the paradoxical response to desmopressin to depict the presence of neoplastic ACTH-secreting cells was also exploited in the follow-up of patients with CD undergoing surgery. Loss of the desmopressin response, performed in the early postoperative period, was a good predictor for a favorable long-term outcome. Moreover, during follow-up, reappearance of desmopressin paradoxical response was an early indicator for recurrence. In conclusion, the desmopressin test is a valid tool in both the diagnosis and follow-up of patients with CD and should be more widely applied in the workup of these patients. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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119. Urine steroid metabolomics as a novel diagnostic tool for early detection of recurrence in adrenocortical carcinoma
- Author
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Chortis, Vasileios, primary, Bancos, Irina, additional, Lang, Katharina, additional, Hughes, Beverly, additional, O'Neil, Donna, additional, Taylor, Angela, additional, Fassnacht, Martin, additional, Bertherat, Jerome, additional, Beuschlein, Felix, additional, Quinkler, Marcus, additional, Vassiliadi, Dimitra, additional, Dennedy, M Conall, additional, Mannelli, Massimo, additional, Biehl, Michael, additional, and Arlt, Wiebke, additional
- Published
- 2015
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120. Impact of gsp mutations in somatotroph pituitary adenomas on growth hormone response to somatostatin analogues: a meta-analysis
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Efstathiadou, Zoe A, primary, Bargiota, Alexandra, additional, Chrisoulidou, Alexandra, additional, Kanakis, Georgios, additional, Papanastasiou, Lamprini, additional, Theodoropoulou, Anastasia, additional, Tigas, Stylianos K, additional, Vassiliadi, Dimitra, additional, Alevizaki, Maria, additional, and Tsagarakis, Stylianos, additional
- Published
- 2015
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121. Prevention of adrenal crisis in stress (The PACS Study): serum cortisol during elective surgery, acute trauma and sepsis in comparison to 'stress dose' hydrocortisone administration in adrenal insufficiency
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Taylor, Angela, primary, Karavitaki, Niki, additional, Smith, David, additional, Bancos, Irina, additional, Foster, Mark, additional, Meier, Sibylle, additional, O'Neil, Donna, additional, Komninos, John, additional, Vassiliadi, Dimitra, additional, Mowatt, Christopher, additional, Lord, Janet, additional, Wass, John, additional, and Arlt, Wiebke, additional
- Published
- 2015
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122. Pituitary-adrenal responses following major abdominal surgery
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Dimopoulou, Ioanna Tzanela, Marinella Vassiliadi, Dimitra and Mavrou, Irini Kopterides, Petros Orfanos, Stylianos and Kotanidou, Anastasia Kontogiannopoulou, Styliani Vasdekis, Spyridon Tsangaris, Iraklis Armaganidis, Apostolos Macheras, Anastasios Ilias, Ioannis Kostopanagiotou, Georgia and Tsagarakis, Stylianos
- Subjects
endocrine system ,hormones, hormone substitutes, and hormone antagonists - Abstract
OBJECTIVE: Perioperative pituitary-adrenal responses after major abdominal surgery have not been well characterized. The aim of the present study was to further clarify perioperative pituitary-adrenal responses. DESIGN: Thirty-six patients (20 men), aged 68 +/- 10 years (mean +/- SD), undergoing major abdominal operations were studied. Total cortisol (TC), Adrenocorticotropic Hormone (ACTH), corticosteroid-binding globulin (CBG), dehydroepiandrosterone (DHEA) and its sulphate (DHEAS) were measured preoperatively (PreOp), on the day of surgery (DoS) and on the first and second postoperative days (POD1 and PoD2). The free cortisol index (FCI) was also calculated. In addition, patients underwent a low-dose (1 mu g) ACTH stimulation test, preoperatively and on POD1, to assess adrenal responsiveness to ACTH. RESULTS: TC, FCI, ACTH and DHEA were increased, while DHEAS and CBG declined on DoS compared to PreOp levels. On POD1, plasma ACTH was lower compared to the preoperative levels, FCI remained elevated, DHEA, DHEAS and TC returned to their baseline values, while CBG was still low. On PoD2, ACTH and CBG were low and FCI returned to its PreOp levels. Postoperatively, stimulated FCI was higher compared to the PreOp value. CONCLUSION: At an early phase following major surgery, elevated cortisol is associated with high ACTH. Despite HPA activation and a concomitant rise in DHEA levels, DHEAS declines. Later on, a remarkable dissociation between ACTH (low) and cortisol (high) is observed, which is attributed, at least in part, to increased adrenal responsiveness to ACTH.
- Published
- 2008
123. Causas incomuns da síndrome de Cushing
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Vassiliadi, Dimitra and Tsagarakis, Stylianos
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endocrine system ,Hipersensibilidade aos glicocorticóides ,Ectopic adenomas ,Glucocorticoid hypersensitivity ,Síndrome de Cushing ,Gangliocytomas ,Gangliocitomas ,Cushing's syndrome ,Adenomas ectópicos ,Megestrol ,hormones, hormone substitutes, and hormone antagonists - Abstract
Although in the majority of the patients with Cushing's syndrome (CS), hypercortisolism is due to ACTH hypersecretion by a pituitary tumour or to ectopic ACTH secretion from an extrapituitary neoplastic lesion or to autonomous cortisol secretion by an adrenal tumour, in occasional patients a much rarer entity may be the cause of the syndrome. Herein, we attempted to summarise and categorise these unusual causes according to their presumed aetiology. To this end, we performed a comprehensive computer-based search for unusual or rare causes of CS. The following unusual forms of CS were identified: (i) ACTH hyperesecretion due to ectopic corticotroph adenomas in the parasellar region or the neurohypophysis, or as part of double adenomas, or gangliocytomas; (ii) ACTH hypersecretion due to ectopic CRH or CRH-like peptide secretion by various neoplasms; (iii) ACTH-independent cortisol hypersecretion from ectopic or bilateral adrenal adenomas; (iv) glucocorticoid hypersensitivity; (v) iatrogenic, due to megestrol administration or to ritonavir and fluticasone co-administration. Such unusual presentations of CS illustrate why Cushing's syndrome represents one of the most puzzling endocrine syndromes. Embora na maioria dos pacientes com síndrome de Cushing (SC), o hipercortisolismo se deva à hipersecreção de ACTH resultante de um tumor hipofisário ou de uma fonte ectópica de ACTH por uma lesão neoplásica extra-hipofisária, ou ainda pela secreção autônoma de cortisol por um tumor adrenal, ocasionalmente uma entidade muito mais rara pode ser a causa da síndrome. Nesta revisão, tentaremos sumarizar e categorizar essas causas incomuns de acordo com sua pressuposta etiologia. Para isso, fizemos uma ampla pesquisa por computador em busca dessas causas raras ou não usuais de SC. As seguintes formas não usuais de SC foram identificadas: (i) hipersecreção de ACTH devida a adenomas corticotróficos ectópicos na região parasselar ou na neuro-hipófise, ou como parte de adenomas duplos, ou gangliocitomas; (ii) hipersecreção de ACTH devida à secreção ectópica de CRH ou peptídeo CRH-símile por várias neoplasias; (iii) hipersecreção de cortisol ACTH-independente por adenomas adrenais ectópicos ou bilaterais; (iv) hipersensibilidade aos glicocorticóides; (v) iatrogênica, devida à administração de megestrol ou à co-administração de ritonavir e fluticasona. Essas apresentações incomuns da SC ilustram por que essa síndrome é considerada uma das mais desafiadoras da endocrinologia.
- Published
- 2007
124. Tissue cortisol vs lipolysis in ICU patients
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Ilias, Ioannis, primary, Vassiliadi, Dimitra, additional, Theodorakopoulou, Maria, additional, Nikitas, Nikitas, additional, Tzanela, Marinela, additional, Apollonatou, Sofia, additional, Tsagarakis, Stylianos, additional, and Dimopoulou, Ioanna, additional
- Published
- 2014
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125. The Prevention of Adrenal Crisis in Stress (PACS) study: serum cortisol during elective surgery and acute trauma in comparison to stress dose hydrocortisone in adrenal insufficiency
- Author
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Taylor, Angela, primary, Karavitaki, Niki, additional, Foster, Mark, additional, Meier, Sibylle, additional, O'Neil, Donna, additional, Komninos, John, additional, Vassiliadi, Dimitra, additional, Mowatt, Christopher, additional, Lord, Janet, additional, Wass, John, additional, and Arlt, Wiebke, additional
- Published
- 2014
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126. Longitudinal assessment of adrenocortical responses to low-dose ACTH in critically ill septic patients
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Vassiliadi, Dimitra A, primary, Dimopoulou, Ioanna, additional, Zervou, Maria, additional, Tzanela, Marinella, additional, Tsagaris, Hercules, additional, Augustatou, Callirrhoe, additional, Douka, Evangelia, additional, Livaditi, Olga, additional, Orfanos, Stylianos, additional, Kotanidou, Anastasia, additional, Armaganidis, Apostolos, additional, and Tsagarakis, Stylianos, additional
- Published
- 2013
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127. Differences in adipose tissue lipolysis in critically ill septic patients with and without shock
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Vassiliadi, Dimitra, primary, Ilias, Ioannis, additional, Kopterides, Petros, additional, Nikitas, Nikitas, additional, Theodorakopoulou, Maria, additional, Diamantakis, Argyris, additional, Dimitriadis, George, additional, Boutati, Eleni, additional, Maratou, Irini, additional, and Dimopoulou, Ioanna, additional
- Published
- 2013
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128. Kinetics of Adipose Tissue Microdialysis-Derived Metabolites in Critically Ill Septic Patients
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Dimopoulou, Ioanna, primary, Nikitas, Nikitas, additional, Orfanos, Stylianos E., additional, Theodorakopoulou, Maria, additional, Vassiliadi, Dimitra, additional, Ilias, Ioannis, additional, Ikonomidis, Ignatios, additional, Boutati, Eleni, additional, Maratou, Eirini, additional, Tsangaris, Iraklis, additional, Karkouli, Georgia, additional, Tsafou, Eftichia, additional, Diamantakis, Argyris, additional, Kopterides, Petros, additional, Maniatis, Nikolaos, additional, Kotanidou, Anastasia, additional, Armaganidis, Apostolos, additional, and Ungerstedt, Urban, additional
- Published
- 2011
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129. The effect of body mass index on the diagnosis of GH deficiency in patients at risk due to a pituitary insult
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Tzanela, Marinella, primary, Zianni, Dimitra, additional, Bilariki, Kalliopi, additional, Vezalis, Alexandros, additional, Gavalas, Nikos, additional, Szabo, Andrea, additional, Drimala, Panagiota, additional, Vassiliadi, Dimitra, additional, and Vassilopoulos, Charalambos, additional
- Published
- 2010
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130. Increased 5α-Reductase Activity and Adrenocortical Drive in Women with Polycystic Ovary Syndrome
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Vassiliadi, Dimitra A., primary, Barber, Thomas M., additional, Hughes, Beverly A., additional, McCarthy, Mark I., additional, Wass, John A. H., additional, Franks, Stephen, additional, Nightingale, Peter, additional, Tomlinson, Jeremy W., additional, Arlt, Wiebke, additional, and Stewart, Paul M., additional
- Published
- 2009
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131. Unusual causes of Cushing's syndrome
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Vassiliadi, Dimitra, primary and Tsagarakis, Stylianos, additional
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- 2007
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132. Growth hormone binding protein and acid labile subunit levels in the assessment of acromegaly treatment
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Tzanela, Marinella, primary, Christoforaki, Marieta, additional, Papastathopoulou, Lida, additional, Vassiliadi, Dimitra, additional, Botoula, Effie, additional, Trivizas, Panagiotis, additional, and Thalassinos, Nikos, additional
- Published
- 2005
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133. Response to Letter to the Editor from Chee et al: "Prevention of Adrenal Crisis: Cortisol Response to Major Stress Compared to Stress Dose Hydrocortisone Delivery".
- Author
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Prete, Alessandro, Taylor, Angela E, Bancos, Irina, Smith, David J, Foster, Mark A, Kohler, Sibylle, Fazal-Sanderson, Violet, Komninos, John, O'Neil, Donna M, Vassiliadi, Dimitra A, Mowatt, Christopher J, Mihai, Radu, Fallowfield, Joanne L, Annane, Djillali, Lord, Janet M, Keevil, Brian G, Wass, John A H, Karavitaki, Niki, and Arlt, Wiebke
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HYDROCORTISONE ,GLUCOCORTICOIDS ,DELIVERY (Obstetrics) ,MEDICAL research ,CRISES ,ADRENAL insufficiency ,ENDOCRINE diseases ,ADRENOCORTICOTROPIC hormone ,ACUTE diseases - Published
- 2021
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134. Interstitial cortisol obtained by microdialysis in mechanically ventilated septic patients: Correlations with total and free serum cortisol.
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Argyro Vassiliadi, Dimitra, Ilias, Ioannis, Tzanela, Marinella, Nikitas, Nikitas, Theodorakopoulou, Maria, Kopterides, Petros, Maniatis, Nikolaos, Diamantakis, Argyris, Orfanos, Stylianos E., Perogamvros, Ilias, Armaganidis, Apostolos, Keevil, Brian G., Tsagarakis, Stylianos, and Dimopoulou, Ioanna
- Subjects
SEPTICEMIA treatment ,ADIPOSE tissues ,APACHE (Disease classification system) ,ARTIFICIAL respiration ,HUMAN body composition ,CORTISONE ,CRITICAL care medicine ,DIALYSIS (Chemistry) ,CLINICAL drug trials ,HYDROCORTISONE ,INTENSIVE care units ,LONGITUDINAL method ,MORTALITY ,SCALES (Weighing instruments) ,STATISTICS ,DATA analysis ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Purpose: The aim of this study was to measure subcutaneous tissue cortisol obtained by microdialysis (MD) in 35 mechanically ventilated septic patients. Materials and Methods: Upon intensive care unit admission, an MD catheter was inserted into the subcutaneous tissue of the thigh. Cortisol (CORT) was determined in a 5:00 to 9:00 AM microdialysate sample collected within 72 hours. Concurrently, serum total (T-CORT) and free CORT (F-CORT) were measured. The Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment scores were calculated. Both T-CORT less than 10 μg/dL and F-CORT less than 0.8 μg/dL were considered as indicating critical illness-related corticosteroid insufficiency. Adrenal adequacy was defined as T-CORT greater than 20 μg/dL or F-CORT greater than 2.0 μg/dL. Results: Total CORT correlated significantly with F-CORT (r
s =+0.8, P < .0001).Microdialysis CORT had a lower correlation with T-CORT (rs = +0.6, P < .0001) and F-CORT (rs = +0.7, P < .0001) and a weak correlation with APACHE II score (rs =+0.4, P < .01). On the basis of MD-CORT, the patients were divided in quartiles. Although the median F-CORT and T-CORT levels were significantly different (P < .001) among the MD-CORT quartiles, there was a considerable overlap between the subgroups. All patientswith T-CORT less than 10 μg/dL and all but 3 patients with F-CORT less than 0.8 μg/dL had tissue CORT in the lower quartile. However, only 50%and 58% of patients with adequate T-CORT and F-CORT levels, respectively, had concordant MD-CORT in the highest quartile. Conclusions: Microdialysis CORT levels correlate moderately with circulating T-CORT and F-CORT. Of note, several patients presented with discrepant measurements between interstitial and circulating CORT concentrations. Thus, interstitial CORT measurements represent an additional tool to investigate the tissue CORT availability in critically ill patients. [ABSTRACT FROM AUTHOR]- Published
- 2013
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135. Lymphocytic hypophysitis
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Tsagarakis, Stylianos, Vassiliadi, Dimitra, Malagari, Katerina, Kontogeorgos, George, and Thalassinos, Nicolaos
- Abstract
Abstract: Lymphocytic hypophysitis (LH) is an inflammatory disease of the anterior pituitary. The varying clinical presentation and the short-term outcome of LH have been extensively described in several case reports or small cohort studies. However, little is known about the long-term outcome of this disease. It is currently believed that if left untreated it may run a self-limited course followed by full resolution of the mass with or without persisting pituitary failure. We describe a 29-yr-old female who presented with secondary amenorrhea, headaches, visual defects, and a pituitary mass, which was removed by transsphenoidal surgery. Histology was consistent with the diagnosis of LH. Following surgery the patient demonstrated a gradual recovery of gonadotroph function with restoration of menses and a successful pregnancy. However, 3 yr after delivery and 6 yr following her initial presentation she developed amenorrhea, headaches, and a pituitary mass. Institution of steroid therapy resulted in resolution of the pituitary mass. In summary, this case illustrates that similarly to many other disorders of autoimmune origin LH may run a fluctuating course and late recurrence is possible even after the successful removal of the inflammatory mass, thus necessitating long-term follow-up of these patients.
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- 2004
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136. A Prospective Study on Neural Biomarkers in Patients with Long-COVID Symptoms.
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Vrettou, Charikleia S., Vassiliou, Alice G., Keskinidou, Chrysi, Mourelatos, Panagiotis, Asimakos, Andreas, Spetsioti, Stavroula, Diamantopoulos, Aristidis, Jahaj, Edison, Antonoglou, Archontoula, Katsaounou, Paraskevi, Vassiliadi, Dimitra A., Kotanidou, Anastasia, and Dimopoulou, Ioanna
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POST-acute COVID-19 syndrome , *GLIAL fibrillary acidic protein , *TAU proteins , *LONGITUDINAL method , *SYMPTOMS , *POST-traumatic stress disorder - Abstract
Background: this prospective observational study aims to assess serum levels of glial fibrillary acidic protein (GFAP), s100b, and total Tau in long-COVID patients, exploring correlations with symptoms, cognitive decline, mental health, and quality of life. Methods: Long-COVID patients visiting our outpatient clinic (February 2021–December 2022) were screened alongside age- and sex-matched controls. GFAP, s100b, and total Tau in serum were measured with ELISA. Cognitive function, depression, anxiety, post-traumatic stress disorder, and quality of life were evaluated using MoCA, HADS (depression and anxiety), IES-R, and SF-36, respectively. Results: Sixty-five long-COVID patients and 20 controls were included. GFAP levels were significantly higher in long-COVID patients (p = 0.031), though not correlating with the presence of long-COVID symptoms. S100b and total Tau showed no significant differences between patients and controls. Nervous system-related symptoms were reported in 47% of patients. High rates of cognitive decline (65.9%), depression (32.2%), anxiety (47.5%), and post-traumatic stress disorder (44.1%) were observed. Over 80% of the study population scored below normative cutoffs for SF-36, indicating a significant impact on quality of life. Conclusions: in this long-COVID cohort with substantial psychological and cognitive symptoms, GFAP levels were elevated compared to controls, though not correlating with the presence of long-COVID symptoms. [ABSTRACT FROM AUTHOR]
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- 2024
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137. Post-Thyroidectomy Development of Posterior Reversible Encephalopathy Syndrome (PRES) Due to Calcium Over-Replacement.
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Papalou, Olga, Tavernaraki, Ekaterini, Tsagarakis, Stylianos, and Vassiliadi, Dimitra Argyro
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- *
POSTERIOR leukoencephalopathy syndrome , *HYPOPARATHYROIDISM , *SYMPTOMS , *MAGNETIC resonance imaging , *BLOOD pressure , *CALCIUM - Abstract
Posterior reversible encephalopathy syndrome (PRES) represents a distinct neurological entity characterized by a range of neurological signs and symptoms (seizures, headache, visual abnormalities, altered consciousness, and/or focal neurological signs) and typical neuroimaging findings reflecting reversible subcortical vasogenic edema, usually in the setting of blood pressure fluctuations, cytotoxic drugs, autoimmune disorders, and eclampsia. Here we present a case of a 61-year-old woman, with a history of recent total thyroidectomy and postoperative hypoparathyroidism, who was admitted to the Emergency Department with generalized seizures. Although in this clinical setting, hypocalcemia is expected as the most possible underlying pathogenic factor for triggering seizures, the patient was diagnosed with iatrogenic hypercalcemia and milk-alkali syndrome. A brain magnetic resonance imaging (MRI) demonstrated cortical swelling and fluid-attenuated inversion recovery (FLAIR) signal abnormalities in both occipital, parietal, and right frontal lobes, consistent with PRES. The patient's encephalopathy resolved after resolution of hypercalcemia; she had no neurological deficits on discharge, while she was restarted on lower doses of calcium for hypoparathyroidism. This case illustrates the challenges imposed by postoperative hypoparathyroidism and highlights that PRES is a rare but serious complication of hypercalcemia of which endocrinologists should be aware. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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138. The Role of Somatostatin Analogues in the Control of Diarrhea and Flushing as Markers of Carcinoid Syndrome: A Systematic Review and Meta-Analysis.
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Alexandraki, Krystallenia I., Angelousi, Anna, Chatzellis, Eleftherios, Chrisoulidou, Alexandra, Kalogeris, Nikolaos, Kanakis, Georgios, Savvidis, Christos, Vassiliadi, Dimitra, Spyroglou, Ariadni, Kostopoulos, Georgios, Markussis, Vyron, Toulis, Konstantinos, Tsagarakis, Stylianos, and Kaltsas, Gregory A.
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- *
PERCENTILES , *SOMATOSTATIN , *CARCINOID , *CLINICAL trial registries , *DIARRHEA , *SYNDROMES - Abstract
Background: Somatostatin analogues (SSAs) are the cornerstone of treatment for carcinoid syndrome (CS)-related symptoms. The aim of this systematic review and meta-analysis is to evaluate the percentage of patients achieving partial (PR) or complete response (CR) with the use of long-acting SSAs in patients with CS. Methods: A systematic electronic literature search was conducted in PubMed, Cochrane, and Scopus to identify eligible studies. Any clinical trials reporting data on the efficacy of SSAs to alleviate symptoms in adult patients were considered as potentially eligible. Results: A total of 17 studies reported extractable outcomes (PR/CR) for quantitative synthesis. The pooled percentage of patients with PR/CR for diarrhea was estimated to be 0.67 (95% confidence interval (CI): 0.52–0.79, I2 = 83%). Subgroup analyses of specific drugs provided no evidence of a differential response. With regards to flushing, the pooled percentage of patients with PR/CR was estimated to be 0.68 (95% CI: 0.52–0.81, I2 = 86%). Similarly, no evidence of a significant differential response in flushing control was documented. Conclusions: We estimate there is a 67–68% overall reduction in symptoms of CS associated with SSA treatment. However, significant heterogeneity was detected, possibly revealing differences in the disease course, in management and in outcome definition. [ABSTRACT FROM AUTHOR]
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- 2023
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139. Increased Glucocorticoid Receptor Alpha Expression and Signaling in Critically Ill Coronavirus Disease 2019 Patients.
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Vassiliou, Alice G., Athanasiou, Nikolaos, Keskinidou, Chrysi, Jahaj, Edison, Tsipilis, Stamatios, Zacharis, Alexandros, Botoula, Efthimia, Diamantopoulos, Aristidis, Ilias, Ioannis, Vassiliadi, Dimitra A., Tsagarakis, Stylianos, Kotanidou, Anastasia, and Dimopoulou, Ioanna
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- *
COVID-19 , *GLUCOCORTICOID receptors , *ADRENAL insufficiency , *CRITICALLY ill , *LEUCINE zippers , *ADULTS - Abstract
Objectives: Critical illness is characterized by increased serum cortisol concentrations and bioavailability resulting from the activation of the hypothalamic-pituitary-adrenal axis, which constitutes an essential part of the stress response. The actions of glucocorticoids are mediated by a ubiquitous intracellular receptor protein, the glucocorticoid receptor. So far, data on coronavirus disease 2019 and glucocorticoid receptor alpha expression are lacking.Design: Prospective observational study.Setting: One academic multidisciplinary ICU.Subjects: Twenty-six adult coronavirus disease 2019 patients; 33 adult noncoronavirus disease 2019 patients, matched for age, sex, and disease severity, constituted the control group. All patients were steroid-free.Interventions: None.Measurements and Main Results: Glucocorticoid receptor alpha, glucocorticoid-inducible leucine zipper expression, and serum cortisol were measured on ICU admission. In coronavirus disease 2019 patients, glucocorticoid receptor alpha and glucocorticoid-inducible leucine zipper messenger RNA expression were upregulated (4.7-fold, p < 0.01 and 14-fold, p < 0.0001, respectively), and cortisol was higher (20.3 vs 14.3 μg/dL, p < 0.01) compared with the control group.Conclusions: ICU coronavirus disease 2019 patients showed upregulated glucocorticoid receptor alpha and glucocorticoid-inducible leucine zipper expression, along with cortisol levels, compared with ICU noncoronavirus disease 2019 patients. Thus, on ICU admission, critical coronavirus disease 2019 appears to be associated with hypercortisolemia, and increased synthesis of glucocorticoid receptor alpha and induced proteins. [ABSTRACT FROM AUTHOR]- Published
- 2021
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140. The role of kidney biopsy in deciphering diabetic versus non-diabetic origin of kidney disease among patients with type 2 diabetes mellitus and nephrotic range proteinuria: A retrospective study.
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Kardalas E, Paikopoulou A, Vassiliadi DA, Kounatidis D, Vallianou NG, Vourlakou C, Karampela I, Dalamaga M, Tzanela M, and Stratigou T
- Abstract
Background: Diabetes mellitus (DM) is tightly associated with the increased prevalence of diabetic kidney disease (DKD). Nonetheless, severe renal function impairment and/or nephrotic range-proteinuria could also result from non-diabetic renal disease (non-DRD) among patients with DM. The 'Gold standard' for the differential diagnosis between DKD and non-DRD is kidney biopsy, although no real consensus exists. Thus, this study intends to associate the clinical and biochemical profile of patients with DM and renal disease with the histopathological data of kidney biopsy.In addition, we aimed to evaluate the role of kidney biopsy, especially when other causes, other than DM, are highly suspected among patients with DM and kidney disease., Methods: Thirty two patients with T2DM and nephrotic range levels of proteinuria or with co-existing factors pointing towards a non-diabetic origin of kidney disease were studied, retrospectively. All 32 patients underwent kidney biopsy and were classified according to histopathological findings into 3 groups: a) isolated diabetic kidney disease (DKD), b) non-diabetic kidney disease (NDKD) and c) mixed kidney disease (MKD)., Results: Fifteen out of the 32 patients had findings of an isolated DKD, while 17 out of 32 patients suffered from NDKD (13 patients) or MKD (4 patients). DKD patients were younger (p = 0.016) and had a higher HbA1c value (p = 0.069, borderline statistical significance), while the NDKD patients had significantly shorter disease duration (p = 0.04). Furthermore, the incidence of diabetic retinopathy (DR) was lower among the NDKD patients (p < 0.001), who had also significantly less interstitial fibrosis (p = 0.02). Finally, the presence of DR, higher levels of interstitial fibrosis and longer T2DM duration were recognized as factors, which were positively associated with DKD., Conclusion: This study advocates the usefulness of kidney biopsy in patients with T2DM and nephrotic range levels of proteinuria, especially when DR is absent and shorter disease duration is observed., Competing Interests: The authors declare that there is no conflict of interest., (© 2024 The Authors. Published by Elsevier Inc.)
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- 2024
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141. A prospective study on endocrine function in patients with long-COVID symptoms.
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Mourelatos P, Vrettou CS, Diamantopoulos A, Vassiliou AG, Jahaj E, Angelousi A, Pratikaki M, Katsaounou P, Kotanidou A, Vassiliadi DA, and Dimopoulou I
- Subjects
- Adult, Humans, Male, Adrenocorticotropic Hormone, Dehydroepiandrosterone, Fatigue, Hydrocortisone, Post-Acute COVID-19 Syndrome, Prospective Studies, RNA, Viral, SARS-CoV-2, Testosterone, Thyroid Hormones, Thyrotropin, Female, COVID-19, Insulin-Like Growth Factor I
- Abstract
Objective: To investigate hormonal status in patients with long-COVID and explore the interrelationship between hormone levels and long-COVID symptoms., Design: Prospective observational study., Participants: Patients who visited our long-COVID outpatients' clinic due to long-COVID symptoms from February 2021 to December 2022., Measurements: Total triiodothyronine, free thyroxine, thyrotropin, thyroglobulin, anti-thyroperoxidase, and antithyroglobulin autoantibodies were measured for thyroid assessment. Other hormones measured were growth hormone, insulin-like growth factor 1 (IGF-1), adrenocorticotropic hormone (ACTH), serum cortisol, dehydroepiandrosterone sulfate (DHEA-S), total testosterone, plasma insulin, and C-peptide. Blood glucose and glycosylated hemoglobin were also measured. To assess adrenal reserve, an ACTH stimulation test was performed. The fatigue assessment scale (FAS) was used to evaluate fatigue severity., Results: Eighty-four adult patients were included. Overall, 40.5% of the patients had at least one endocrine disorder. These included prediabetes (21.4%), low DHEA-S (21.4%), subclinical hypothyroidism (3.6%), non-specific thyroid function abnormality (7.1%), thyroid autoimmunity (7.1%), low testosterone in males (6.6%), and low IGF-1 (3.6%). All patients had normal adrenal reserve. Long-COVID-19 symptoms were present in all patients and the most commonly reported symptom was fatigue (89.3%). The FAS score was higher than normal (≥ 22) in 42.8% of patients. There were no associations between patients' symptoms and hormone levels. Diabetic patients reported confusion (p = 0.020) and hair loss (p = 0.040) more often than non-diabetics., Conclusions: The evaluation of endocrine function 3 months after a positive SARS-CoV2 test revealed only subclinical syndromes. The vast majority of patients reported mainly fatigue, among other symptoms, which were unrelated, however, to endocrine function., (© 2023. The Author(s), under exclusive licence to Hellenic Endocrine Society.)
- Published
- 2024
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142. High-resolution daily profiles of tissue adrenal steroids by portable automated collection.
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Upton TJ, Zavala E, Methlie P, Kämpe O, Tsagarakis S, Øksnes M, Bensing S, Vassiliadi DA, Grytaas MA, Botusan IR, Ueland G, Berinder K, Simunkova K, Balomenaki M, Margaritopoulos D, Henne N, Crossley R, Russell G, Husebye ES, and Lightman SL
- Subjects
- Humans, Tetrahydrocortisol, Chromatography, Liquid, Steroids, Sleep
- Abstract
Rhythms are intrinsic to endocrine systems, and disruption of these hormone oscillations occurs at very early stages of the disease. Because adrenal hormones are secreted with both circadian and ultradian periods, conventional single-time point measurements provide limited information about rhythmicity and, crucially, do not provide information during sleep, when many hormones fluctuate from nadir to peak concentrations. If blood sampling is attempted overnight, then this necessitates admission to a clinical research unit, can be stressful, and disturbs sleep. To overcome this problem and to measure free hormones within their target tissues, we used microdialysis, an ambulatory fraction collector, and liquid chromatography-tandem mass spectrometry to obtain high-resolution profiles of tissue adrenal steroids over 24 hours in 214 healthy volunteers. For validation, we compared tissue against plasma measurements in a further seven healthy volunteers. Sample collection from subcutaneous tissue was safe, well tolerated, and allowed most normal activities to continue. In addition to cortisol, we identified daily and ultradian variation in free cortisone, corticosterone, 18-hydroxycortisol, aldosterone, tetrahydrocortisol and allo-tetrahydrocortisol, and the presence of dehydroepiandrosterone sulfate. We used mathematical and computational methods to quantify the interindividual variability of hormones at different times of the day and develop "dynamic markers" of normality in healthy individuals stratified by sex, age, and body mass index. Our results provide insight into the dynamics of adrenal steroids in tissue in real-world settings and may serve as a normative reference for biomarkers of endocrine disorders (ULTRADIAN, NCT02934399).
- Published
- 2023
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143. Down-Regulation of the Mineralocorticoid Receptor (MR) and Up-Regulation of Hydroxysteroid 11-Beta Dehydrogenase Type 2 (HSD11B2) Isoenzyme in Critically Ill Patients.
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Vassiliou AG, Vassiliadi DA, Keskinidou C, Jahaj E, Botoula E, Tsagarakis S, Kotanidou A, and Dimopoulou I
- Subjects
- Humans, Critical Illness, Down-Regulation, Hydrocortisone metabolism, Hydroxysteroids, Isoenzymes genetics, Isoenzymes metabolism, Prospective Studies, Renin genetics, Renin metabolism, Up-Regulation, 11-beta-Hydroxysteroid Dehydrogenase Type 2 genetics, 11-beta-Hydroxysteroid Dehydrogenase Type 2 metabolism, Aldosterone, Receptors, Mineralocorticoid genetics, Receptors, Mineralocorticoid metabolism
- Abstract
Objective: The mineralocorticoid receptor (MR) has two ligands, aldosterone and cortisol. Hydroxysteroid 11-beta dehydrogenase (HSD11B) isoenzymes regulate which ligand will bind to MR. In this study we aimed to evaluate the expression of the MR and the HSD11B isozymes in peripheral polymorphonuclear cells (PMNs) in critical illness for a 13-day period. Design: Prospective study Setting: One multi-disciplinary intensive care unit (ICU) Participants: Forty-two critically ill patients Methods: Messenger RNA (mRNA) expression of MR, HSD11B1 , and HSD11B2 , aldosterone levels, and plasma renin activity (PRA) were measured in 42 patients on ICU admission and on days 4, 8, and 13. Twenty-five age and sex-matched healthy subjects were used as controls. Results: Compared to healthy controls, MR expression in critically ill patients was lower during the entire study period. HSD11B1 expression was also lower, while HSD11B2 expression was higher. In patients, PRA, aldosterone, the aldosterone:renin ratio, and cortisol remained unaltered during the study period. Conclusion: Our results suggest that, in our cohort of critically ill patients, local endogenous cortisol availability is diminished, pointing towards glucocorticoid resistance. Aldosterone probably occupies the MR, raising the possibility that PMNs might be useful to study to gain insights into MR functionality during pathological states., Competing Interests: Disclosure: The authors have not reported any financial or personal conflicts of interest related to this research., (Copyright © 2023 Marshfield Clinic Health System.)
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- 2023
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144. Cushing's disease: risk of recurrence following trans-sphenoidal surgery, timing and methods for evaluation.
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Balomenaki M, Vassiliadi DA, and Tsagarakis S
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- Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Deamino Arginine Vasopressin, Retrospective Studies, Pituitary-Adrenal System, Biomarkers, Dexamethasone, Recurrence, Pituitary ACTH Hypersecretion
- Abstract
The treatment of choice for Cushing's disease (CD) is trans-sphenoidal surgery (TSS). However, TSS is not always curative and, even when curative it is associated with a substantial rate of recurrence. Published recurrence rates vary between 5 and 20%; half of these recurrences appear within 5-years and the remaining half within or even after 10 years post-surgery. A low or undetectable cortisol in the immediate post-op period is regarded as the best criterion of remission. However, low post-op cortisol levels do not accurately predict long-term remission. Moreover, there are no other robust predictors providing certainty about the long-term outcomes. Interestingly, several studies have shown that the desmopressin test performed in the early post-op period may have some promise in predicting more precisely the risk of recurrence. In view of the lack of robust ways to predict long-term outcomes, current guidelines suggest that every patient in remission should be monitored for the possibility of recurrence. The methods used to detect recurrence are similar to those used to assess the cortisol secretory status and include assessment of: (i) abnormal circadian rhythm by late night salivary cortisol (LNSC) or midnight serum cortisol; (ii) impaired cortisol feedback by the dexamethasone suppression test and; (iii) increased 24-h bioavailable cortisol by urinary free cortisol. The timing of evaluation begins when HPA axis recovers, and then annually or sooner in case of clinical suspicion. Currently LNSC is regarded as the earliest and most sensitive biochemical alteration in detecting recurrence; a major caveat for LNSC, however, is its great variability. In practice, the diagnosis of recurrence is a challenge due to the fact that recurrence is usually a slow process with apparent clinical manifestations that may be delayed and alterations of classical biomarkers that may be delayed as well., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2022
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145. Current approach of primary bilateral adrenal hyperplasia.
- Author
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Delivanis DA, Vassiliadi DA, and Tsagarakis S
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- Armadillo Domain Proteins genetics, Germ-Line Mutation, Humans, Hyperplasia, Adrenal Hyperplasia, Congenital diagnosis, Adrenal Hyperplasia, Congenital genetics, Tumor Suppressor Proteins genetics
- Abstract
Purpose of Review: To discuss the most recent findings on the pathophysiology, the genetic and molecular causes of primary bilateral adrenal hyperplasia (PBAH). The diagnostic approach of patients with PBAH will also be presented in detail with an emphasis on the emerging diagnostic tools and finally, the treatment of PBAH will be discussed with an emphasis on the newest surgical and medical treatment approaches., Recent Findings: PBAH is a highly heterogeneous condition mostly detected incidentally on abdominal imaging. Based on the size of the nodules, PBAH is subdivided into primary bilateral macronodular adrenal hyperplasia (PBMAH) and micronodular adrenal hyperplasia. A substantial proportion of patients with PBMAH harbor a germline mutation of the armadillo repeat containing 5 tumor suppression gene and therefore genetic testing is strongly recommended. Measurements of plasma or urinary multisteroid profiles show promising results in that PBMAH has a distinctive plasma steroid fingerprint that can help in diagnosis and subtyping of PBMAH. Finally, although surgery is the mainstay of treatment of patients with PBAH, medical therapy is increasingly emerging as an alternative option., Summary: PBAH is a poorly studied and therefore a challenging disease to diagnose and treat. Hopefully with these newest diagnostic and therapeutic tools, a more comprehensive approach will be adopted., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
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146. Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors : A Cross-Sectional Multicenter Study.
- Author
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Prete A, Subramanian A, Bancos I, Chortis V, Tsagarakis S, Lang K, Macech M, Delivanis DA, Pupovac ID, Reimondo G, Marina LV, Deutschbein T, Balomenaki M, O'Reilly MW, Gilligan LC, Jenkinson C, Bednarczuk T, Zhang CD, Dusek T, Diamantopoulos A, Asia M, Kondracka A, Li D, Masjkur JR, Quinkler M, Ueland GÅ, Dennedy MC, Beuschlein F, Tabarin A, Fassnacht M, Ivović M, Terzolo M, Kastelan D, Young WF Jr, Manolopoulos KN, Ambroziak U, Vassiliadi DA, Taylor AE, Sitch AJ, Nirantharakumar K, and Arlt W
- Subjects
- Cross-Sectional Studies, Female, Humans, Hydrocortisone, Male, Adrenal Gland Neoplasms complications, Cardiovascular Diseases complications, Cushing Syndrome complications, Cushing Syndrome diagnosis, Cushing Syndrome pathology, Diabetes Mellitus, Type 2 complications, Hypertension complications
- Abstract
Background: Benign adrenal tumors are commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion (MACS) is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined., Objective: To determine cardiometabolic disease burden and steroid excretion in persons with benign adrenal tumors with and without MACS., Design: Cross-sectional study., Setting: 14 endocrine secondary and tertiary care centers (recruitment from 2011 to 2016)., Participants: 1305 prospectively recruited persons with benign adrenal tumors., Measurements: Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumor [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome [CS] features, definitive MACS [MACS-2]). Net steroid production was assessed by multisteroid profiling of 24-hour urine by tandem mass spectrometry., Results: Of the 1305 participants, 49.7% had NFAT ( n = 649; 64.1% women), 34.6% had MACS-1 ( n = 451; 67.2% women), 10.7% had MACS-2 ( n = 140; 73.6% women), and 5.0% had CS ( n = 65; 86.2% women). Prevalence and severity of hypertension were higher in MACS-2 and CS than NFAT (adjusted prevalence ratios [aPRs] for hypertension: MACS-2, 1.15 [95% CI, 1.04 to 1.27], and CS, 1.37 [CI, 1.16 to 1.62]; aPRs for use of ≥3 antihypertensives: MACS-2, 1.31 [CI, 1.02 to 1.68], and CS, 2.22 [CI, 1.62 to 3.05]). Type 2 diabetes was more prevalent in CS than NFAT (aPR, 1.62 [CI, 1.08 to 2.42]) and more likely to require insulin therapy for MACS-2 (aPR, 1.89 [CI, 1.01 to 3.52]) and CS (aPR, 3.06 [CI, 1.60 to 5.85]). Urinary multisteroid profiling revealed an increase in glucocorticoid excretion from NFAT over MACS-1 and MACS-2 to CS, whereas androgen excretion decreased., Limitations: Cross-sectional design; possible selection bias., Conclusion: A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes., Primary Funding Source: Diabetes UK, the European Commission, U.K. Medical Research Council, the U.K. Academy of Medical Sciences, the Wellcome Trust, the U.K. National Institute for Health Research, the U.S. National Institutes of Health, the Claire Khan Trust Fund at University Hospitals Birmingham Charities, and the Mayo Clinic Foundation for Medical Education and Research.
- Published
- 2022
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147. Approach to patients with bilateral adrenal incidentalomas.
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Vassiliadi DA, Partsalaki E, and Tsagarakis S
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- Adrenal Gland Neoplasms diagnosis, Adrenalectomy adverse effects, Adrenalectomy methods, Humans, Practice Guidelines as Topic, Adrenal Gland Neoplasms therapy
- Abstract
Purpose of Review: The current review provides a summary on the most recent developments regarding the cause, work-up and management of bilateral adrenal incidentalomas (BAI)., Recent Findings: The recent ENS@T/ESE guidelines provide comprehensive directions on the evaluation and management of patients with adrenal incidentalomas with special focus on those with bilateral tumours. Intraadrenal ACTH synthesis that may locally stimulate cortisol secretion challenging the traditionally used term 'ACTH-independent'. Inactivating mutations of a new tumour suppressor gene, armadillo repeat containing 5 (ARMC5), are implicated in a number of patients, especially those with multiple macronodules (bilateral macronodular hyperplasia) and evidence of hypercortisolism. Loss-of-function mutations of the glucocorticoid receptor gene (NR3C1) consist a new possible genetic cause of BAIs. Regarding management an increasing number of studies provide data on the benefits and safety of unilateral rather than bilateral adrenalectomy. There is also emerging data on the beneficial use of steroidogenesis inhibitors in a dosing schedule that aims to mimic the normal cortisol rhythm with promising short-term results, but the long-term clinical benefits of this approach remain to be demonstrated., Summary: The diagnostic approach consists of imaging and hormonal evaluation. Imaging characterization should be done separately for each lesion. Hormonal evaluation includes testing for primary aldosteronism, pheochromocytoma and evaluation for autonomous cortisol secretion, using the 1-mg overnight dexamethasone suppression test. Midnight cortisol or 24-h urinary-free cortisol may aid in establishing the degree of cortisol excess. In patients with hypercortisolism ACTH levels should be measured to establish ACTH-independency. The appropriate management of BAI associated with cortisol excess remains controversial. Bilateral adrenalectomy results in lifetime steroid dependency and is better reserved only for patients with overt and severe hypercortisolism. Unilateral adrenalectomy might be considered in selected patients. Medical therapy is not an established approach yet but it may be considered when control of hypercortisolism is desired, but surgery is not an option.
- Published
- 2020
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148. Medical therapy for non-functioning pituitary tumors-a critical approach.
- Author
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Tampourlou M, Karapanou O, Vassiliadi DA, and Tsagarakis S
- Subjects
- Adenoma complications, Adenoma pathology, Adenoma surgery, Chemotherapy, Adjuvant methods, Combined Modality Therapy, Dopamine Agonists therapeutic use, Humans, Hypopituitarism drug therapy, Hypopituitarism etiology, Neoplasm Recurrence, Local drug therapy, Neoplasm Recurrence, Local pathology, Pituitary Neoplasms complications, Pituitary Neoplasms pathology, Pituitary Neoplasms surgery, Receptors, Somatostatin antagonists & inhibitors, Adenoma drug therapy, Antineoplastic Agents therapeutic use, Pituitary Neoplasms drug therapy
- Abstract
Non-functioning pituitary adenomas (NFPAs) are the second most common variant of pituitary tumors. When symptomatic, primary therapy is surgery. Recurrence rates are high. Since many NFPAs express dopamine and somatostatin receptors, medical therapy has been used after surgery in order to prevent recurrence. So far, dopamine agonists have been more widely tested with some promise when introduced immediately after surgery but with less efficacy when introduced later upon tumor regrowth. Currently, the role of medical therapy to prevent tumor regrowth in NFPAs is limited by imprecisions as to final outcome and uncertainties concerning on patient selection, dosing, duration, and side effects.
- Published
- 2019
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149. Evidence of Subcutaneous Tissue Lipolysis Enhancement by Endogenous Cortisol in Critically Ill Patients Without Shock.
- Author
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Ilias I, Tzanela M, Nikitas N, Vassiliadi DA, Theodorakopoulou M, Apollonatou S, Tsagarakis S, and Dimopoulou I
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Hydrocortisone blood, Intensive Care Units, Male, Microdialysis methods, Middle Aged, Respiration, Artificial, Sepsis blood, Sepsis metabolism, Critical Illness, Hydrocortisone metabolism, Lipolysis, Subcutaneous Fat metabolism, Subcutaneous Fat surgery
- Abstract
Background/aim: Cortisol is involved in in many aspects of adipose tissue metabolism. A positive association between plasma cortisol and lipolysis has been observed. Critically ill patients exhibit 'lipemia of sepsis'. The aim of the present study was to study, in septic ICU patients, adipose tissue lipolysis in relation to tissue cortisol using microdialysis (MD)., Patients and Methods: We studied 17 mechanically-ventilated patients (9 men; mean±SD age=63±19 years) with a diagnosis of severe sepsis. Upon ICU admission, an MD catheter was inserted under sterile conditions into the subcutaneous adipose tissue of the upper thigh. On days 2, 3 and 4, MD samples were collected six times per day for glycerol (used as an index of lipolysis) and tissue cortisol determinations. The mean of these six collections was used for analysis (normal values for adipose tissue glycerol <200 μmol/l). Statistics were carried-out with analysis of covariance (ANCOVA) and linear regression., Results: More than half of the samplings (19/31) indicated accentuated lipolysis with above-normal MD glycerol levels. By ANCOVA, MD glycerol (log values) was associated with MD cortisol (log values) (p=0.012) and was not associated with age or day of sampling. Furthermore, MD glycerol (log values) was positively correlated to MD cortisol (log values) (r=0.490, p=0.012)., Discussion: Changes in interstitial/tissue cortisol may not be reflected in (total) plasma cortisol concentration. Thus, it is interesting that we observed, albeit weak, an association between tissue lipolysis (via MD glycerol levels) and MD cortisol, verifying (although modestly so) the well-known association between lipolysis and cortisol., (Copyright © 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)
- Published
- 2015
150. Increased 5 alpha-reductase activity and adrenocortical drive in women with polycystic ovary syndrome.
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Vassiliadi DA, Barber TM, Hughes BA, McCarthy MI, Wass JA, Franks S, Nightingale P, Tomlinson JW, Arlt W, and Stewart PM
- Subjects
- Adolescent, Adult, Androgens metabolism, Cross-Sectional Studies, Female, Glucocorticoids biosynthesis, Humans, Middle Aged, Obesity metabolism, Cholestenone 5 alpha-Reductase metabolism, Hydrocortisone metabolism, Polycystic Ovary Syndrome metabolism
- Abstract
Context: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, anovulation, and susceptibility to the metabolic syndrome. Altered peripheral cortisol metabolism has been reported in PCOS, but also in simple obesity., Objective: The aim of the study was to describe cortisol metabolism and metabolic characteristics of a large PCOS cohort and to delineate the effect of obesity by comparison to body mass index (BMI)-matched controls., Design and Setting: We conducted an observational, cross-sectional study at outpatient clinics of two secondary/tertiary care centers., Patients or Other Participants: A total of 178 PCOS patients fulfilling Rotterdam criteria and 100 BMI-matched controls participated in the study., Intervention: The study included 24-h urine collection for steroid metabolite excretion and fasting blood samples, followed by an oral glucose tolerance test., Main Outcome Measures: We measured urinary steroid metabolites including glucocorticoids and androgens and the ratios reflecting enzymatic activities involved in peripheral cortisol and androgen metabolism, 5 alpha-reductase, and 11 beta-hydroxysteroid dehydrogenase types 1 and 2. We also measured circulating levels of glucose, insulin, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and testosterone and calculated homeostasis model assessment., Results: Total androgen metabolites were higher in PCOS patients compared to BMI-matched controls (4,105 +/- 2,047 vs. 2,532 +/- 1,610 microg/24 h for the nonobese; 5,547 +/- 2,911 vs. 2,468 +/- 1,794 microg/24 h for the obese; both P < 0.001). Total glucocorticoid metabolites were higher in obese PCOS vs. controls (10,786 +/- 3,852 vs. 8,834 +/- 4,487 microg/24 h; P = 0.001). 5 alpha-Reductase activity correlated with BMI, insulin levels, and homeostasis model assessment. Both obese and nonobese PCOS patients had higher 5 alpha-reductase activity than controls (all P < 0.05). 11 beta-Hydroxysteroid dehydrogenase activities did not differ between PCOS and controls., Conclusions: PCOS is associated with enhanced androgen and cortisol metabolite excretion and increased 5 alpha-reductase activity that cannot be explained by obesity alone. Increased adrenal corticosteroid production represents an important pathogenic pathway in PCOS.
- Published
- 2009
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