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Background: Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective: This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods: The researchers conducted a systematic literature review for each research question on scientific data- bases and surveyed a panel of experts for each therapeutic procedure's specific drivers that contributed to its total cost. Results: The average cost of the first year of treatment was euro2,558.91 and euro3,287.40 for subjects with micro- prolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after ini- tial treatment were euro798.13 and euro1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of euro3,201.15 compared to bromocriptine, based on a willingness-to-pay of euro40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic sur- gery was more cost-effective than cabergoline, with an ICER of euro44,846.64. Considering a willingness-to-pay of euro40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions: Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources.

Introduction: This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in adults. However, pregnancy is not considered. Methods: This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinologi (AME) has identified potentially relevant outcomes, which have then been rated for their impact on therapeutic choices. Only outcomes classified as “critical” and “important” have been considered in the systematic review of evidence and only those classified as “critical” have been considered in the formulation of recommendations. Results: The present GL provides recommendations regarding the role of pharmacological and neurosurgical treatment in the management of prolactinomas. We recommend cabergoline (Cab) vs. bromocriptine (Br) as the first-choice pharmacological treatment to be employed at the minimal effective dose capable of achieving the regression of the clinical picture. We suggest that medication and surgery are offered as suitable alternative first-line treatments to patients with non-invasive PRL-secreting adenoma, regardless of size. We suggest Br as an alternative drug in patients who are intolerant to Cab and are not candidates for surgery. We recommend pituitary tumor resection in patients 1) without any significant neuro-ophthalmologic improvement within two weeks from the start of Cab, 2) who are resistant or do not tolerate Cab or other dopamine-agonist drugs (DA), 3) who escape from previous efficacy of DA, and 4) who are unwilling to undergo a chronic DA treatment. We recommend that patients with progressive disease notwithstanding previous tumor resection and ongoing DA should be managed by a multidisciplinary team with specific expertise in pituitary diseases using a multimodal approach that includes repeated surgery, radiother-apy, DA, and possibly, the use of temoz

The deepwater fold-and-thrust belts (DWFTBs) are geological structures recently explored thanks to advances in offshore seismic imaging by oil industry. In this study we present a kinematic analysis based on three balanced cross-sections of depth-converted, 2-D seismic profiles along the offshore Lamu Basin (East African passive margin). This margin is characterized by a regional-scale DWFTB (>450 km long), which is the product of gravity-driven contraction on the shelf that exhibits complex structural styles and differing amount of shortening along strike. Net shortening is up to 48 km in the northern wider part of the fold-and-thrust belt (approximate to 180 km), diminishing to <15 km toward the south, where the belt is markedly narrower (approximate to 50 km). The three balanced profiles show a shortening percentage around 20% (comparable with the maximum values documented in other gravity-driven DWFTBs), with a significant variability along dip: higher values are achieved in the outer (i.e. down-dip) portion of the system, dominated by basinward-verging, imbricate thrust sheets. Fold wavelength increases landward, where doubly-verging structures and symmetric detachment folds accommodate a lower amount of shortening. Similar to other cases, a linear and systematic relationship between sedimentary thickness and fold wavelength is observed. Reconstruction of the rate of shortening through time within a fold-and-thrust belt shows that after an early phase of slow activation (Late Cretaceous), >95% of net shortening was produced in <10 Myr (during Paleocene). During this acme phase, which followed a period of high sedimentation rate, thrusts were largely synchronous and the shortening rate reached a maximum value of 5 mm/yr. The kinematic evolution reconstructed in this study suggests that the structural evolution of gravity-driven fold-and-thrust belts differs from the accretionary wedges and the collisional fold-and-thrust belts, where thrusts propagat