102 results on '"Grasso, Ludovica F. S"'
Search Results
2. Clinical Case 1
- Author
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Grasso, Ludovica F. S., Auriemma, Renata S., De Martino, Maria Cristina, Pirchio, Rosa, Pivonello, Rosario, Colao, Annamaria, Tamagno, Gianluca, editor, and Gahete, Manuel D., editor
- Published
- 2022
- Full Text
- View/download PDF
3. Empty Sella Syndrome
- Author
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Colao, Annamaria, Pivonello, Claudia, Grasso, Ludovica F. S., Pirchio, Rosa, van Krieken, J. H. J. M., Series Editor, La Rosa, Stefano, editor, and Uccella, Silvia, editor
- Published
- 2022
- Full Text
- View/download PDF
4. Acromegaly
- Author
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Colao, Annamaria, Pivonello, Claudia, Grasso, Ludovica F. S., Pirchio, Rosa, van Krieken, J. H. J. M., Series Editor, La Rosa, Stefano, editor, and Uccella, Silvia, editor
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- 2022
- Full Text
- View/download PDF
5. Effect of combined treatment with a pan-PI3K inhibitor or an isoform-specific PI3K inhibitor and everolimus on cell proliferation in GH-secreting pituitary tumour in an experimental setting
- Author
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Pivonello, Claudia, Patalano, Roberta, Solari, Domenico, Auriemma, Renata S., Frio, Federico, Vitulli, Francesca, Grasso, Ludovica F. S., Di Cera, Marialuisa, De Martino, Maria Cristina, Cavallo, Luigi M., Cappabianca, Paolo, Colao, Annamaria, and Pivonello, Rosario
- Published
- 2018
- Full Text
- View/download PDF
6. Author Correction: Acromegaly
- Author
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Colao, Annamaria, Grasso, Ludovica F. S., Giustina, Andrea, Melmed, Shlomo, Chanson, Philippe, Pereira, Alberto M., and Pivonello, Rosario
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- 2019
- Full Text
- View/download PDF
7. Acromegaly
- Author
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Colao, Annamaria, Grasso, Ludovica F. S., Giustina, Andrea, Melmed, Shlomo, Chanson, Philippe, Pereira, Alberto M., and Pivonello, Rosario
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- 2019
- Full Text
- View/download PDF
8. Fertility in Acromegaly: A Single-Center Experience of Female Patients During Active Disease and After Disease Remission.
- Author
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Pirchio, Rosa, Auriemma, Renata S., Grasso, Ludovica F. S., Verde, Nunzia, Garifalos, Francesco, Castoro, Michele, Conforti, Alessandro, Menafra, Davide, Pivonello, Claudia, Angelis, Cristina de, Minnetti, Marianna, Alviggi, Carlo, Corona, Giovanni, Colao, Annamaria, and Pivonello, Rosario
- Subjects
ACROMEGALY ,DISEASE remission ,POLYCYSTIC ovary syndrome - Abstract
Context: Fertility represents a major concern in patients with acromegaly. Objective: The current retrospective study aimed to investigate gonadal function and fertility rates in acromegalic women. Methods: In this referral-center study, 50 acromegalic women with disease onset within reproductive age were evaluated for prevalence of gonadal dysfunction and infertility. Anthropometric, metabolic, hormonal parameters, and gynecological ultrasound were evaluated at diagnosis and after disease control. Data about menstrual disturbances, pregnancy, and polycystic ovarian morphology (PCOM) were investigated at disease onset, at diagnosis, and after disease control. Results: At presumed disease onset, menstrual disturbances were reported in 32% of patients. Uterine leiomyoma, ovarian cysts, and PCOM were diagnosed in 18%, 12%, and 8%, respectively; 36.8% of patients were infertile. At diagnosis, menstrual disturbances were found in 58.1% (P=.02), being significantly more prevalent in patients with higher insulin-like growth factor-I quartiles (Q) (P=.03, Q1 vs Q4). Gynecological ultrasound revealed uterine leiomyoma, ovarian cysts, and PCOM in 39.1% (P=.04), 28.2% (P=.09), and 13% (P=.55), respectively. The infertility rate was 100% (P=.02). At disease control, menstrual disturbances were slightly decreased as compared to diagnosis (P=.09). Noteworthy, menstrual disturbances (P=.05) and particularly amenorrhea (P=.03) were significantly more frequent in patients with active disease duration greater than 5 years (median) as compared to those achieving disease control in less than 5 years. Among patients with pregnancy desire, 73.3% conceived at least once, with resulting infertility significantly decreased compared to diagnosis (26.7%; P=.01). Atterm deliveries, preterm deliveries, and spontaneous abortions were recorded in 86.7%, 6.6%, and 6.6%, respectively, of the 15 pregnancies reported by the patients. No neonatal malformations and/or abnormalities were recorded. Conclusion: Gonadal dysfunction and infertility are common in acromegalic women within reproductive age, being directly influenced by disease status and/or duration. [ABSTRACT FROM AUTHOR]
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- 2023
- Full Text
- View/download PDF
9. Effects of long-term combined treatment with somatostatin analogues and pegvisomant on cardiac structure and performance in acromegaly
- Author
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Auriemma, Renata S., Grasso, Ludovica F. S., Galdiero, Mariano, Galderisi, Maurizio, Pivonello, Claudia, Simeoli, Chiara, De Martino, Maria Cristina, Ferrigno, Rosario, Negri, Mariarosaria, de Angelis, Cristina, Pivonello, Rosario, and Colao, Annamaria
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- 2017
- Full Text
- View/download PDF
10. Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities
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Pivonello, Rosario, Auriemma, Renata S., Grasso, Ludovica F. S., Pivonello, Claudia, Simeoli, Chiara, Patalano, Roberta, Galdiero, Mariano, and Colao, Annamaria
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- 2017
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11. Pituitary tumors and pregnancy: the interplay between a pathologic condition and a physiologic status
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Pivonello, Rosario, De Martino, Maria Cristina, Auriemma, Renata S., Alviggi, Carlo, Grasso, Ludovica F. S., Cozzolino, Alessia, De Leo, Monica, De Placido, Giuseppe, Colao, Annamaria, and Lombardi, Gaetano
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- 2014
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12. Medical therapy of pituitary adenomas: Effects on tumor shrinkage
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Colao, Annamaria, Pivonello, Rosario, Di Somma, Carolina, Savastano, Silvia, Grasso, Ludovica F. S., and Lombardi, Gaetano
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- 2009
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13. Results of a Single-Center Observational 10-Year Survey Study on Recurrence of Hyperprolactinemia after Pregnancy and Lactation
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Auriemma, Renata S., Perone, Ylenia, Di Sarno, Antonella, Grasso, Ludovica F. S., Guerra, Ermelinda, Gasperi, Maurizio, Pivonello, Rosario, and Colao, Annamaria
- Published
- 2013
14. Growth hormone nadir during oral glucose load depends on waist circumference, gender and age: normative data in 231 healthy subjects
- Author
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Colao, Annamaria, Pivonello, Rosario, Auriemma, Renata S., Grasso, Ludovica F. S., Galdiero, Mariano, Pivonello, Claudia, Lombardi, Gaetano, and Savastano, Silvia
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- 2011
- Full Text
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15. Glucose Tolerance and Somatostatin Analog Treatment in Acromegaly: A 12-Month Study
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Colao, Annamaria, Auriemma, Renata S., Savastano, Silvia, Galdiero, Mariano, Grasso, Ludovica F. S., Lombardi, Gaetano, and Pivonello, Rosario
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- 2009
16. Impact of Somatostatin Analogs Versus Surgery on Glucose Metabolism in Acromegaly: Results of a 5-Year Observational, Open, Prospective Study
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Colao, Annamaria, Auriemma, Renata S., Galdiero, Mariano, Cappabianca, Paolo, Cavallo, Luigi M., Esposito, Felice, Grasso, Ludovica F. S., Lombardi, Gaetano, and Pivonello, Rosario
- Published
- 2009
17. Growth Hormone-Secreting Tumor Shrinkage after 3 Months of Octreotide-Long-Acting Release Therapy Predicts the Response at 12 Months
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Colao, Annamaria, Pivonello, Rosario, Auriemma, Renata S., Galdiero, Mariano, Savastano, Silvia, Grasso, Ludovica F. S., and Lombardi, Gaetano
- Published
- 2008
18. Erratum to: Pituitary tumors and pregnancy: the interplay between a pathologic condition and a physiologic status
- Author
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Pivonello, Rosario, De Martino, Maria Cristina, Auriemma, Renata S., Alviggi, Carlo, Grasso, Ludovica F. S., Cozzolino, Alessia, De Leo, Monica, De Placido, Giuseppe, Colao, Annamaria, and Lombardi, Gaetano
- Published
- 2014
- Full Text
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19. Left ventricular synchronicity in acromegaly
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Grasso, Ludovica F. S. and Colao, Annamaria
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- 2013
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20. Nell’acromegalia la delezione dell’esone 3 del recettore del GH si associa a una migliore risposta alla terapia con pegvisomant
- Author
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Bernabeu, I., Alvarez-Escolá, C., Quinteiro, C., Lucas, T., Puig-Domingo, M., Luque-Ramírez, M., Miguel-Novoa, P., Fernandez-Rodriguez, E., Halperin, I., Loidi, L., Casanueva, F. F., Marazuela, M., Grasso, Ludovica F. S., Auriemma, Renata S., Pivonello, Rosario, and Colao, Annamaria
- Published
- 2010
- Full Text
- View/download PDF
21. Somatostatin analogs, cabergoline and pegvisomant: comparing the efficacy of medical treatment for acromegaly.
- Author
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Grasso, Ludovica F. S., Auriemma, Renata S., Pivonello, Rosario, and Colao, Annamaria
- Subjects
ACROMEGALY treatment ,SOMATOSTATIN ,CABERGOLINE ,THERAPEUTICS - Abstract
Introduction: Therapies for acromegaly aim at normalizing hormonal excess and controlling tumor growth . Therapeutic approaches are surgery, pharmacotherapy and radiotherapy. Area covered: This review focuses on the role of medical therapy of acromegaly, comparing the efficacy of somatostatin analogues (SSA), dopamine-agonists (DA) and pegvisomant (PEG), the three available drug classes for treating acromegaly. To clarify the difference in response rates reported in the literature for these therapies, we performed a search for original articles published in PubMed. SSA represent the first-line approach to medical treatment. This therapy is effective in controlling acromegaly in about 40% of patients, however there are great differences in the reported hormonal efficacy of SSA in the different series. In patients partially resistant to SSA, cabergoline can be added when hormonal levels are close to normalization, resulting effective in control IGF-I levels in 43% of patients. In patients with higher hormonal levels PEG is indicated, normalizing IGF-I levels in 79.8% and 80.6% of cases when used in monotherapy or in combination with SSA. Pasireotide, the newly developed SSA multi-ligand receptor, represents a new option in SSA resistant patients. Expert commentary: Medical therapy represents an important therapeutic option resulting safe and effective in controlling acromegaly in a high percentage of patients. The best treatment should be individually tailored for each patient, taking into account sex, age, comorbidities, tumor characteristics and hormonal levels. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
22. The safety of treatments for prolactinomas
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Auriemma, Renata S., Grasso, Ludovica F. S., Pivonello, Rosario, and Colao, Annamaria
- Abstract
ABSTRACTIntroduction:Prolactinomas are the most common hormone-secreting pituitary tumors, accounting for approximately 40% of all pituitary tumors. Infertility, gonadal and sexual dysfunction are usually the most relevant clinical features in both sexes.Area covered:This review focuses on safety and tolerability of therapeutic approaches for prolactinomas. Complications from trans-sphenoidal surgery vary depending on tumor size, and mortality rate ranges 0.6%-31% for patients with microprolactinomas and macroprolactinoms, respectively. More than 50% of patients receiving pituitary radiotherapy will develop at least one hormone deficiency within the following decade, whereas cerebrovascular accidents, second brain tumors and optic neuropathy rarely occur. Nowadays, treatment of prolactinomas is based on dopamine-agonists (DA), mainly cabergoline (CAB). Whether CAB is associated with an increased risk of clinically relevant cardiac valvulopathy in patients with prolactinomas as in those with Parkinson’s disease (PD), is still debated. In most studies, CAB has been found not to be associated with an increased risk of significant valvulopathy in prolactinomas, and no correlation has been shown between valvular abnormalities and CAB duration or cumulative dose.Expert opinion:DA are safe and well tolerated, and the main safety concerns are related to the potential risk of clinically relevant valvulopathy following treatment with CAB, rarely occurring in patients with prolactinomas.
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- 2016
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- View/download PDF
23. Safety of long-term treatment with cabergoline on cardiac valve disease in patients with prolactinomas.
- Author
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Auriemma, Renata S., Pivonello, Rosario, Perone, Ylenia, Grasso, Ludovica F. S., Ferreri, Lucia, Simeoli, Chiara, Iacuaniello, Davide, Gasperi, Maurizio, and Colao, Annamaria
- Subjects
MEDICATION safety ,HETEROCYCLIC compounds ,HEART valve diseases ,PITUITARY cancer ,AORTIC valve insufficiency ,PARKINSON'S disease ,DRUG dosage ,THERAPEUTICS - Abstract
Objective: Cabergoline (CAB) has been found to be associated with increased risk of cardiac valve regurgitation in Parkinson's disease, whereas several retrospective analyses failed to detect a similar relation in hyperprolactinemic patients. The current study aimed at investigating cardiac valve disease before and after 24 and 60 months of continuous treatment with CAB only in patients with hyperprolactinemia. Subjects and methods: Forty patients (11 men and 29 women, aged 38.7±12.5 years) newly diagnosed with hyperprolactinemia entered the study. Cumulative CAB dose ranged from 12 to 588 mg (median 48 mg) at 24 months and 48-1260 mg (median 149 mg) at 60 months. All patients underwent a complete trans-thoracic echocardiographic examination. Valve regurgitation was assessed according to the American Society of Echocardiography. Results: At baseline, the prevalence of trace mitral, aortic, pulmonic, and tricuspid regurgitations was 20, 2.5, 10, and 40% respectively, with no patient showing clinically relevant valvulopathy. After 24 months, no change in the prevalence of trace mitral (P=0.78) and pulmonic (P=0.89) regurgitations and of mild aortic (P=0.89) and tricuspid (P=0.89) regurgitations was found when compared with baseline. After 60 months, the prevalence of trace tricuspid regurgitation was only slightly increased when compared with that after 24 months (37.5%; P=0.82), but none of the patients developed significant valvulopathy. No correlation was found between cumulative dose and prevalence or grade of valve regurgitation at both evaluations. Prolactin levels normalized in all patients but one. Conclusion: CAB does not increase the risk of significant cardiac valve regurgitation in prolactinomas after the first 5 years of treatment. [ABSTRACT FROM AUTHOR]
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- 2013
- Full Text
- View/download PDF
24. Treatment with GH receptor antagonist in acromegaly: effect on cardiac arrhythmias.
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Auriemma, Renata S., Pivonello, Rosario, De Martino, Maria Cristina, Cudemo, Giuseppe, Grasso, Ludovica F. S., Galdiero, Mariano, Perone, Ylenia, and Colao, Annamaria
- Subjects
ARRHYTHMIA treatment ,SOMATOTROPIN ,ACROMEGALY ,ELECTROCARDIOGRAPHY ,HEART beat ,DISEASE prevalence - Abstract
Objective: To evaluate the effects of short- and long-term treatment with pegvisomant (PEG) on arrhythmias in acromegalic patients resistant to long-term, high-dose therapy with somatostatin analogs (SA). Materials and methods: Thirteen patients entered the study. All patients started PEGat initial dose of 10 mg daily and then titrated to 5 mg every 6 weeks on the basis of IGF1. A standard 24-h electrocardiography registration was performed in all patients at baseline and after 6 and 18 months of PEG to evaluate: mean (HR), maximum (MHR), and minimum (mHR) heart rate; pauses number (P) and duration (PD); supraventricular episodes (SEs) number and duration (SED); and ventricular ectopic beats (EB) number and duration (EBD). Left ventricular mass (LVM) was also evaluated by standard echocardiography. Results: A slight but not significant decrease in HR, MHR, and mHR was observed after 6-month PEG, whereas a significant decrease in HR (P=0.03), MHR (P=0.05), and mHR (P=0.05) was found after 18-month PEG compared with baseline. LVM significantly (P=0.05) correlated with MRH (r= -0.50) after short-term treatment, and with HR (r=-0.54) and mHR (r=-0.55) after long-term treatment. Long-term PEG induced the complete recovery of arrhythmias recorded at baseline in one patient and the improvement of rhythm disorders developed after 6-month therapy in another patient. The prevalence of conduction disturbances passed from 15 to 7.7% after long-term PEG. Conclusions: Long-term treatment with PEG reduces HR, MHR, and mHR and improves rhythm abnormalities in acromegaly. [ABSTRACT FROM AUTHOR]
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- 2013
- Full Text
- View/download PDF
25. Aortic root ectasia in patients with acromegaly: an emerging complication.
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Colao, Annamaria and Grasso, Ludovica F. S.
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AORTIC diseases , *ACROMEGALY , *SOMATOMEDIN , *CARDIOVASCULAR diseases , *PATIENTS , *ECHOCARDIOGRAPHY , *CARDIOMYOPATHIES , *DIAGNOSIS , *THERAPEUTICS - Abstract
In this article, the authors discuss the study of A. F. Casini and colleagues on the aortic root diameter and prevalence of aortic ectasia in 42 patients with acromegaly. They state that the long exposure to growth hormone (GH) and insulin-like growth factor-I (IGF-I) excess affect the cardiovascular system and aortic root. Moreover, they say that the findings suggest performing echocardiography to patients with acromegaly to investigate the possible acromegalic cardiomyopathy characteristics.
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- 2011
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26. Fertility in Acromegaly: A Single-Center Experience of Female Patients During Active Disease and After Disease Remission
- Author
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Rosa Pirchio, Renata S Auriemma, Ludovica F S Grasso, Nunzia Verde, Francesco Garifalos, Michele Castoro, Alessandro Conforti, Davide Menafra, Claudia Pivonello, Cristina de Angelis, Marianna Minnetti, Carlo Alviggi, Giovanni Corona, Annamaria Colao, Rosario Pivonello, Pirchio, Rosa, Auriemma, Renata S, Grasso, Ludovica F S, Verde, Nunzia, Garifalos, Francesco, Castoro, Michele, Conforti, Alessandro, Menafra, Davide, Pivonello, Claudia, de Angelis, Cristina, Minnetti, Marianna, Alviggi, Carlo, Corona, Giovanni, Colao, Annamaria, and Pivonello, Rosario
- Subjects
fertility ,menstrual disturbance ,Endocrinology ,uterine leiomyoma ,Endocrinology, Diabetes and Metabolism ,Acromegaly ,Biochemistry (medical) ,Clinical Biochemistry ,pregnancy ,Biochemistry - Abstract
Context Fertility represents a major concern in patients with acromegaly. Objective The current retrospective study aimed to investigate gonadal function and fertility rates in acromegalic women. Methods In this referral-center study, 50 acromegalic women with disease onset within reproductive age were evaluated for prevalence of gonadal dysfunction and infertility. Anthropometric, metabolic, hormonal parameters, and gynecological ultrasound were evaluated at diagnosis and after disease control. Data about menstrual disturbances, pregnancy, and polycystic ovarian morphology (PCOM) were investigated at disease onset, at diagnosis, and after disease control. Results At presumed disease onset, menstrual disturbances were reported in 32% of patients. Uterine leiomyoma, ovarian cysts, and PCOM were diagnosed in 18%, 12%, and 8%, respectively; 36.8% of patients were infertile. At diagnosis, menstrual disturbances were found in 58.1% (P = .02), being significantly more prevalent in patients with higher insulin-like growth factor-I quartiles (Q) (P = .03, Q1 vs Q4). Gynecological ultrasound revealed uterine leiomyoma, ovarian cysts, and PCOM in 39.1% (P = .04), 28.2% (P = .09), and 13% (P = .55), respectively. The infertility rate was 100% (P = .02). At disease control, menstrual disturbances were slightly decreased as compared to diagnosis (P = .09). Noteworthy, menstrual disturbances (P = .05) and particularly amenorrhea (P = .03) were significantly more frequent in patients with active disease duration greater than 5 years (median) as compared to those achieving disease control in less than 5 years. Among patients with pregnancy desire, 73.3% conceived at least once, with resulting infertility significantly decreased compared to diagnosis (26.7%; P = .01). At-term deliveries, preterm deliveries, and spontaneous abortions were recorded in 86.7%, 6.6%, and 6.6%, respectively, of the 15 pregnancies reported by the patients. No neonatal malformations and/or abnormalities were recorded. Conclusion Gonadal dysfunction and infertility are common in acromegalic women within reproductive age, being directly influenced by disease status and/or duration.
- Published
- 2023
27. Effect of combined treatment with a pan-PI3K inhibitor or an isoform-specific PI3K inhibitor and everolimus on cell proliferation in GH-secreting pituitary tumour in an experimental setting
- Author
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Annamaria Colao, Maria Cristina De Martino, Francesca Vitulli, Ludovica F S Grasso, Federico Frio, Marialuisa Di Cera, Paolo Cappabianca, Claudia Pivonello, Renata S. Auriemma, Roberta Patalano, Rosario Pivonello, Domenico Solari, Luigi Maria Cavallo, Pivonello, Claudia, Patalano, Roberta, Solari, Domenico, Auriemma, Renata S., Frio, Federico, Vitulli, Francesca, Grasso, Ludovica F. S., DI CERA, Marialuisa, De Martino, Maria Cristina, Cavallo, Luigi, Cappabianca, Paolo, Colao, Annamaria, and Pivonello, Rosario
- Subjects
0301 basic medicine ,MAPK/ERK pathway ,GH-secreting pituitary adenoma ,Cell Survival ,Morpholines ,Endocrinology, Diabetes and Metabolism ,Aminopyridines ,Antineoplastic Agents ,PI3K ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Cell Line, Tumor ,medicine ,Animals ,Pituitary Neoplasms ,Everolimus ,Viability assay ,Enzyme Inhibitors ,Clonogenic assay ,Protein kinase B ,PI3K/AKT/mTOR pathway ,Cell Proliferation ,Phosphoinositide-3 Kinase Inhibitors ,Chemistry ,Cell growth ,NVP-BKM120 ,Rats ,Everolimu ,Thiazoles ,030104 developmental biology ,Cell culture ,030220 oncology & carcinogenesis ,mTOR ,Cancer research ,Signal Transduction ,medicine.drug - Abstract
PI3K/Akt/mTOR pathway activation is common in GH-secreting pituitary tumours, and a target for treatment with mTOR inhibitors, including everolimus (EVE). The current study aimed to evaluate the efficacy of two PI3K inhibitors (PI3Ki), NVP-BKM120 and NVP-BYL719, alone and in combination with EVE in rat GH-secreting pituitary tumour cell line (GH3) and human GH-secreting pituitary tumour cell cultures. In GH3 cell line and in six GH-secreting tumour cell cultures, the effects of PI3Ki and EVE, as single agents and in combination, were tested on cell viability and colony survival, by MTT and clonogenic assay, respectively, whereas western blot was performed to evaluate the underlying intracellular signalling pathways. PI3Ki and EVE showed a dose-dependent inhibition of cell viability in GH3 cell line, with PI3Ki displaying a synergistic effect when combined with EVE. PI3Ki and EVE inhibited colony survival in GH3 cell line with no further improvement in combination. In GH-secreting pituitary tumour cell cultures PI3Ki are effective in inhibiting cell viability increasing the slight and non significant inhibition induced by EVE as single agent, generally showing a synergistic effect. Despite in both GH3 cell line and GH-secreting pituitary tumour cell cultures combination of PI3Ki enhanced EVE effect, the study of intracellular signalling pathways revealed a different regulation of PI3K/Akt/mTOR and MAPK between the two models. The results of the current study demonstrated that PI3Ki, especially in combination with EVE, are effective in inhibiting cell proliferation, therefore representing a promising therapeutic tool for the treatment of aggressive GH-secreting pituitary tumours, not responsive to standard medical therapies.
- Published
- 2018
28. Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities
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Rosario Pivonello, Mariano Galdiero, Annamaria Colao, Ludovica F S Grasso, Roberta Patalano, Chiara Simeoli, Claudia Pivonello, Renata S. Auriemma, Pivonello, Rosario, Auriemma, RENATA SIMONA, Grasso, Ludovica F. S, Pivonello, Claudia, Simeoli, Chiara, Patalano, Roberta, Galdiero, Mariano, and Colao, Annamaria
- Subjects
medicine.medical_specialty ,Medical therapy ,Cardiomyopathy ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Comorbidity ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Sleep Apnea Syndromes ,0302 clinical medicine ,Endocrinology ,Internal medicine ,Diabetes mellitus ,Acromegaly ,medicine ,Humans ,Glucose homeostasis ,Respiratory function ,Metabolic Syndrome ,Human Growth Hormone ,business.industry ,Sleep apnea ,Pituitary surgery ,medicine.disease ,Surgery ,Cardiovascular Diseases ,Cardiology ,Metabolic syndrome ,business - Abstract
Acromegaly is associated with an enhanced mortality, with cardiovascular and respiratory complications representing not only the most frequent comorbidities but also two of the main causes of deaths, whereas a minor role is played by metabolic complications, and particularly diabetes mellitus. The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases, as well as vascular endothelial dysfunction. Biochemical control of acromegaly significantly improves cardiovascular disease, albeit completely recovering to normal mainly in young patients with short disease duration. Respiratory complications, represented mainly by sleep-breathing disorders, particularly sleep apnea, and respiratory insufficiency, frequently occur at the early stage of the disease and, although their severity decreases with disease control, this improvement does not often change the indication for a specific therapy directed to improve respiratory function. Metabolic complications, including glucose and lipid disorders, are variably reported in acromegaly. Treatments of acromegaly may influence glucose metabolism, and the presence of diabetes mellitus in acromegaly may affect the choice of treatments, so that glucose homeostasis is worth being monitored during the entire course of the disease. Early diagnosis and prompt treatment of acromegaly, aimed at obtaining a strict control of hormone excess, are the best strategy to limit the development or reverse the complications and prevent the premature mortality.
- Published
- 2017
29. Somatostatin analogs, cabergoline and pegvisomant: comparing the efficacy of medical treatment for acromegaly
- Author
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Annamaria Colao, Renata S. Auriemma, Ludovica F S Grasso, Rosario Pivonello, Grasso, Ludovica F. S., Auriemma, Renata S., Pivonello, Rosario, and Colao, Annamaria
- Subjects
Drug ,Oncology ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,media_common.quotation_subject ,efficacy ,somatostatin analogue ,030209 endocrinology & metabolism ,Pharmacology ,03 medical and health sciences ,chemistry.chemical_compound ,combined therapy ,0302 clinical medicine ,Pharmacotherapy ,Internal medicine ,Cabergoline ,Acromegaly ,medicine ,pegvisomant ,media_common ,pasireotide ,Medical treatment ,business.industry ,medicine.disease ,Pasireotide ,medical therapy ,Somatostatin ,chemistry ,030220 oncology & carcinogenesis ,Pegvisomant ,cabergoline ,business ,medicine.drug - Abstract
Therapies for acromegaly aim at normalizing hormonal excess and controlling tumor growth . Therapeutic approaches are surgery, pharmacotherapy and radiotherapy. Area covered: This review focuses on the role of medical therapy of acromegaly, comparing the efficacy of somatostatin analogues (SSA), dopamine-agonists (DA) and pegvisomant (PEG), the three available drug classes for treating acromegaly. To clarify the difference in response rates reported in the literature for these therapies, we performed a search for original articles published in PubMed. SSA represent the first-line approach to medical treatment. This therapy is effective in controlling acromegaly in about 40% of patients, however there are great differences in the reported hormonal efficacy of SSA in the different series. In patients partially resistant to SSA, cabergoline can be added when hormonal levels are close to normalization, resulting effective in control IGF-I levels in 43% of patients. In patients with higher hormonal levels PEG is indicated, normalizing IGF-I levels in 79.8% and 80.6% of cases when used in monotherapy or in combination with SSA. Pasireotide, the newly developed SSA multi-ligand receptor, represents a new option in SSA resistant patients. Expert commentary: Medical therapy represents an important therapeutic option resulting safe and effective in controlling acromegaly in a high percentage of patients. The best treatment should be individually tailored for each patient, taking into account sex, age, comorbidities, tumor characteristics and hormonal levels.
- Published
- 2016
30. Pituitary Disorders: Diagnosis and Management
- Author
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Ludovica F. S. Grasso, Alessia Cozzolino, Annamaria Colao, Krystallenia I. Alexandraki, Gregory A. Kaltsas, George P. Chrousos, Marco Faustini-Fustini, Giorgio Frank, Paul B. Rizzoli, Andrea L. Utz and Sashank Prasad, Ludovica F. S. Grasso, Alessia Cozzolino, Annamaria Colao, Krystallenia I. Alexandraki, Gregory A. Kaltsas, George P. Chrousos, Marco Faustini-Fustini, Giorgio Frank, Paul B. Rizzoli, Andrea L. Utz and Sashank Prasad, Grasso, Ludovica F. S., Cozzolino, Alessia, Colao, Annamaria, Alexandraki, Krystallenia I., Kaltsas, Gregory A., Chrousos, George P., Faustini-Fustini, Marco, Frank, Giorgio, Rizzoli, Paul B., and Utz and Sashank Prasad, Andrea L.
- Published
- 2013
31. Acromegaly and Changes in Growth Parameters: A Focus on Cardiovascular, Metabolic, Respiratory Abnormalities, Malignancies, and Bone Alterations
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Rosario Pivonello, Gaetano Lombardi, Ludovica F S Grasso, Annamaria Colao, Renata S. Auriemma, Colao, Annamaria, Grasso, Ludovica F. S., Auriemma, Renata S., Lombardi, Gaetano, and Pivonello, Rosario
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,Physiology ,Disease ,medicine.disease ,Endocrinology ,Pituitary adenoma ,Internal medicine ,Diabetes mellitus ,Pegvisomant ,Acromegaly ,Medicine ,business ,education ,Nursing (all)2901 Nursing (miscellaneous) ,Dyslipidemia ,Progressive disease ,medicine.drug - Abstract
Acromegaly is a slow progressive disease characterized by exaggerated somatic growth and distorted proportion arising from hypersecretion of growth hormone (GH) and insulin-like growth factor 1 IGF-1. The estimated prevalence of the disease is 40 cases per million population with three to four new cases per million population per year. Diagnosis is made biochemically by the findings of increased serum GH concentrations, not suppressed following a 75 g oral glucose load (OGTT), and an increase in IGF-I levels, the main GH-dependent growth factor. A random GH level lower than 0.4 μg/L and GH nadir below 1.0 μg/L after OGTT with an IGF-I value in the age- and sex-matched normal range exclude the diagnosis of acromegaly. In 95% of cases acromegaly is induced by a pituitary adenoma, demonstrated by MRI. Acromegaly is associated with increased morbidity and mortality for cardiovascular and respiratory complications, whereas neoplasms seem to be a minor cause of increased risk of death. Other associated diseases are osteoarthritis, carpal tunnel syndrome, fatigue, visual abnormalities, and reproductive disorders. Acromegaly results in premature death because of prolonged elevation of GH and IGF-I levels, and a strong biochemical control improves well-being and restores life expectancy to normal. The main goals of medical treatment of acromegaly include normalization of biochemical markers of disease activity, improvement in signs and symptoms of the disease, removal or reduction of tumor mass, and preservation of pituitary function. This chapter discusses the effects of biochemical control of acromegaly on cardiovascular diseases, metabolic complications, respiratory abnormalities, malignancies, and bone alterations.
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- 2011
32. Pituitary magnetic resonance imaging predictive role in the therapeutic response of growth hormone-secreting pituitary adenomas.
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Tortora F, Negro A, Grasso LFS, Colao A, Pivonello R, Splendiani A, Brunese L, and Caranci F
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Background: Growth hormone (GH)-secreting pituitary adenomas, responsible for the development of acromegaly, are the second most frequent type of secreting pituitary adenomas and are characterized by very variable T2-weighted signal intensity on pituitary magnetic resonance imaging (MRI). Previous data have demonstrated a correlation between T2-weighted tumor signal intensity and response to therapy with conventional somatostatin analogs (SSA) in patients with acromegaly. The aim of the current retrospective study was to investigate the correlation between the T2-weighted tumor signal on pituitary MRI and both biochemical and radiological response to first-line SSA therapy., Methods: Twenty-two naive patients with acromegaly were eligible for the study (14 females and 8 males, mean age ± SD: 58.8±15.74). A biochemical evaluation (GH and IGF-I levels) and an MRI assessment (volume and signal intensity analysis of adenoma) were conducted in each patient at diagnosis and after 12 months of SSA therapy., Results: On diagnostic pituitary MRI, 16 (72.7%) adenomas were T2- hypointense and 6 (27.2%) T2-hyperintense. After 12 months of SSA therapy, IGF-I levels decreased by more than 50% from baseline in 62.5% of patients with T2-hypointense and 33.3% of patients with T2- hyperintense tumor signal, respectively (P=0.03). Moreover, GH levels decreased by more than 80% from baseline in 81.3% and 33.3% of patients with T2-hypointense and T2-hyperintense tumor signal (P=0.02). A significant tumor volume reduction (≥20%) was observed in 75% of the T2-hypointense and 33.3% of the T2-hyperintense adenomas (P=0.001)., Conclusions: In naive patients with acromegaly, first-line SSA therapy is associated with a better biochemical response and greater tumor shrinkage in T2-hypointense compared to T2-hyperintense adenomas. Therefore, T2-weighted sequences of pituitary MRI can help to classify GH-secreting pituitary adenomas into a T2-hypointense and T2-hyperintense type and, therefore, to identify patients who can better respond to first-line SSA therapy., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
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- 2019
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33. Acromegaly and Heart Failure.
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Colao A, Grasso LFS, Di Somma C, and Pivonello R
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- Acromegaly blood, Biomarkers blood, Comorbidity, Global Health, Heart Failure blood, Humans, Morbidity trends, Survival Rate trends, Acromegaly epidemiology, Heart Failure epidemiology, Insulin-Like Growth Factor I metabolism
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In patients with acromegaly, chronic GH and IGF-I excess commonly causes a specific cardiomyopathy characterized by a concentric cardiac hypertrophy associated with diastolic dysfunction and, in later stages, with systolic dysfunction ending in heart failure in untreated and uncontrolled patients. Additional relevant cardiovascular complications are represented by arterial hypertension, valvulopathies, arrhythmias, and vascular endothelial dysfunction, which, together with the respiratory and metabolic complications, contribute to the development of cardiac disease and the increase cardiovascular risk in acromegaly. Disease duration plays a pivotal role in the determination of acromegalic cardiomyopathy. The main functional disturbance in acromegalic cardiomyopathy is the diastolic dysfunction, observed in 11% to 58% of patients, it is usually mild, without clinical consequence, and the progression to systolic dysfunction is generally uncommon, not seen or observed in less than 3% of the patients. Consequently, the presence of overt CHF is rare in acromegaly, ranging between 1 and 4%, in patients with untreated and uncontrolled disease. Control of acromegaly, induced by either pituitary surgery or medical therapy improves cardiac structure and performance, limiting the progression of acromegaly cardiomyopathy to CHF. However, when CHF is associated with dilative cardiomyopathy, it is generally not reversible, despite the treatment of the acromegaly., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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34. Adverse events associated with somatostatin analogs in acromegaly.
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Grasso LF, Auriemma RS, Pivonello R, and Colao A
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- Animals, Drug Monitoring methods, Glucose metabolism, Human Growth Hormone metabolism, Humans, Insulin-Like Growth Factor I metabolism, Somatostatin adverse effects, Somatostatin therapeutic use, Acromegaly drug therapy, Quality of Life, Somatostatin analogs & derivatives
- Abstract
Introduction: In patients with acromegaly, somatostatin analogs (SSA) represent the first choice medical treatment. The long-acting SSA have been found to be effective in controlling growth hormone and IGF-I levels in a high percentage of patients, resulting in an improvement in the quality of life; moreover, these peptide analogs have a proven safety record and are generally well tolerated., Areas Covered: The most commonly reported adverse events include injection-site discomfort and erythema, gastrointestinal (GI) disturbances such as diarrhea, abdominal pain, nausea and vomiting, biliary sludge or gallstones, and abnormal glucose metabolism. Most SSA-related adverse events are transient and of mild-to-moderate intensity, and the prevalence of such effects markedly and progressively decreases during treatment, so that treatment discontinuations due to adverse events are rare and commonly related to GI disturbances. Cholelithiasis represents the most serious complication of SSA, but is generally asymptomatic, and has been reported in 3 - 56% of patients. Whereas the effect of SSA on glucose metabolism is still controversial, several pieces of evidence have confirmed a modest and transient negative impact on glucose homeostasis. Also the novel SSA pasireotide has shown a safety profile as expected for a SSA, except for the degree of hyperglycemia., Expert Opinion: On the basis of these findings, a close and careful monitoring of gallbladder ultrasound and glucose levels is recommended in patients receiving SSA for medical treatment of acromegaly.
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- 2015
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35. Investigational therapies for acromegaly.
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Grasso LF, Pivonello R, and Colao A
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- Dacarbazine analogs & derivatives, Dacarbazine therapeutic use, Human Growth Hormone analogs & derivatives, Human Growth Hormone therapeutic use, Humans, Octreotide therapeutic use, Pioglitazone, Rosiglitazone, Temozolomide, Thiazolidinediones therapeutic use, Acromegaly drug therapy, Drugs, Investigational therapeutic use, Somatostatin analogs & derivatives, Somatostatin therapeutic use
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Introduction: The treatment of acromegaly aims at normalizing growth hormone (GH) and insulin-like growth factor (IGF-I) levels and controlling tumor growth. The approaches to therapy are essentially three: surgery and pharmacotherapy, alone or in combination, and radiotherapy, generally used in more aggressive tumors., Areas Covered: This review focuses on the novel drug formulations being developed for medical therapy of acromegaly. Even though many efficient treatments have been made available to manage acromegaly in the last two decades, a significant number of patients remain still uncontrolled. Medical therapy represents an important therapeutic option and can be used as the first-line treatment in many patients. However, roughly 25% of patients might be considered as poor responsive or resistant to conventional long-acting somatostatin analogs (SSA) treatment. Therefore, new longer-acting SSA, oral SSA formulations, new combined therapies with weekly doses of pegvisomant, combination therapy with pegvisomant (PEG) and cabergoline (CAB) or SSA and new approaches have been proposed. New molecules are currently under investigation in clinical trials, such as the SSA multi-receptor ligand, pasireotide, which represents a promising option therapy, especially in patients not adequately controlled with currently available SSA. Further, temozolomide has been suggested as an efficient drug for treating GH-aggressive pituitary tumors resistant to conventional therapy., Expert Opinion: All these novel SSA formulations and new molecules implement the available options in therapies of acromegaly to improve disease control. However, further studies are needed to define the exact role of these newer agents. The predicting factors for response to these new therapies should also be determined.
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- 2013
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36. Treatment with GH receptor antagonist in acromegaly: effect on cardiac arrhythmias.
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Auriemma RS, Pivonello R, De Martino MC, Cudemo G, Grasso LF, Galdiero M, Perone Y, and Colao A
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- Acromegaly physiopathology, Adult, Female, Heart Rate drug effects, Human Growth Hormone therapeutic use, Humans, Male, Middle Aged, Prospective Studies, Acromegaly drug therapy, Arrhythmias, Cardiac drug therapy, Human Growth Hormone analogs & derivatives, Receptors, Somatotropin antagonists & inhibitors
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Objective: To evaluate the effects of short- and long-term treatment with pegvisomant (PEG) on arrhythmias in acromegalic patients resistant to long-term, high-dose therapy with somatostatin analogs (SA)., Materials and Methods: Thirteen patients entered the study. all patients started peg at initial dose of 10MG daily and then titrated to 5MG every 6 weeks on the basis of IGF1. A standard 24-H electrocardiography registration was performed in all patients at baseline and after 6 AND 18 months of PEG to evaluate: mean (HR), maximum (MHR), and minimum (mHR) heart rate; pauses number (P) and duration (PD); supraventricular episodes (SEs) number and duration (SED); and ventricular ectopic beats (EB) number and duration (EBD). Left ventricular mass (LVM) was also evaluated by standard echocardiography., Results: A slight but not significant decrease in HR, MHR, and mHR was observed after 6-month PEG, whereas a significant decrease in HR (P=0.03), MHR (P=0.05), and mHR (P=0.05) was found after 18-month PEG compared with baseline. LVM significantly (P=0.05) correlated with MRH (r=-0.50) after short-term treatment, and with HR (r=-0.54) and mHR (r=-0.55) after long-term treatment. Long-term PEG induced the complete recovery of arrhythmias recorded at baseline in one patient and the improvement of rhythm disorders developed after 6-month therapy in another patient. The prevalence of conduction disturbances passed from 15 to 7.7% after long-term PEG., Conclusions: Long-term treatment with PEG reduces HR, MHR, and mHR and improves rhythm abnormalities in acromegaly.
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- 2012
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37. Somatostatin analogs as a first-line treatment in acromegaly: when is it appropriate?
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Grasso LF, Pivonello R, and Colao A
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- Acromegaly blood, Acromegaly surgery, Age Factors, Female, Human Growth Hormone metabolism, Humans, Insulin-Like Growth Factor I metabolism, Male, Patient Selection, Sex Factors, Treatment Outcome, Acromegaly drug therapy, Human Growth Hormone drug effects, Insulin-Like Growth Factor I drug effects, Somatostatin analogs & derivatives, Somatostatin therapeutic use
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Purpose of Review: To discuss the role of medical therapy of acromegaly as a first-line treatment, focusing on recent data on the use of somatostatin analogs (SSAs), the first-choice pharmacotherapy for treating acromegaly., Recent Findings: Despite pituitary surgery and radiotherapy, a significant number of patients with acromegaly needed adjuvant medical therapy, and primary medical therapy nowadays is increasingly considered. According to a recent consensus statement on the management of acromegaly, primary pharmacological therapy with SSAs may be indicated in patients who are otherwise poor surgical candidates or refuse surgery, and in those in whom there is a low probability of a surgical cure. The long-acting SSAs have been found to be effective in improving symptoms and signs of acromegaly in a high percentage of patients and induce normalization of growth hormone and insulin-like growth factor-I levels approximately in 60-80% of patients, respectively. Evidence has suggested that SSAs induce a clinically significant tumor shrinkage when given as first-line, when this reduction of tumor volume could be helpful in improving the outcome of subsequent surgery or improving the clinical syndrome in patients with unacceptable surgical risk, whereas the tumor shrinkage was seen less frequently when the drug was used after surgical resection and/or radiotherapy., Summary: Pharmacological management plays a pivotal role in the treatment of acromegaly, and first-line medical therapy with SSAs is being widely used in clinical practice, either prior to surgery or in patients who are otherwise poor surgical candidates and in those in whom there is a low probability of a surgical cure.
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- 2012
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38. Therapy of aggressive pituitary tumors.
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Colao A, Grasso LF, Pivonello R, and Lombardi G
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- Adenoma physiopathology, Adenoma therapy, Antineoplastic Agents pharmacology, Combined Modality Therapy, Humans, Neoplasm Recurrence, Local, Pituitary Neoplasms physiopathology, Prognosis, Prolactinoma physiopathology, Treatment Failure, Antineoplastic Agents therapeutic use, Pituitary Neoplasms therapy, Prolactinoma therapy
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Introduction: Aggressive tumors of the pituitary gland are classically defined as pituitary tumors with a massive invasion of the surrounding anatomical structures and rapid growth. They are notoriously difficult to manage and are associated with poor prognosis because the therapeutic options are limited and the tumors are generally unresponsive to therapy., Areas Covered: This review focuses on treatment options for aggressive pituitary tumors, including surgery, radiotherapy and medical treatment, as well as focusing on the promising therapeutic options for aggressive pituitary tumors, evaluating the literature of the last 15 years. With the exception of prolactinomas, surgery is the first-line option, but most aggressive pituitary tumors often require repeated surgery. Pharmacotherapies are useful when surgery is unlikely to improve symptoms, or as an adjunct therapy to surgery. In prolactinomas, dopamine agonists are the first-line treatment and normalize prolactin levels in most patients, even those with macroprolactinomas. Somatostatin analogs are effective agents for primary therapy, pre-operatively or post-operatively to control tumor re-expansion of pituitary adenomas. However, dopamine agonists and somatostatin analogs are not as effective as they are for the treatment of non-aggressive adenomas. When surgery and pharmacotherapy fail, radiotherapy is a useful third-line strategy. Conventional chemotherapy is poorly effective but recent case reports with the temozolomide, an alkylating agent, have provided better results in the short term., Expert Opinion: Aggressive pituitary tumors are associated with poor prognosis as therapeutic options are limited. Moreover, they tend to recur quickly after initial treatment, are generally unresponsive to therapy, and are difficult to manage. To improve the overall response rate, the early application of current therapeutic approaches with the incorporation of new therapeutic developments is mandatory., (© 2011 Informa UK, Ltd.)
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- 2011
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39. The kidney in acromegaly: renal structure and function in patients with acromegaly during active disease and 1 year after disease remission.
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Auriemma RS, Galdiero M, De Martino MC, De Leo M, Grasso LF, Vitale P, Cozzolino A, Lombardi G, Colao A, and Pivonello R
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- Acromegaly drug therapy, Acromegaly metabolism, Adult, Aged, Citric Acid metabolism, Creatinine metabolism, Cross-Sectional Studies, Female, Humans, Kidney metabolism, Male, Middle Aged, Remission Induction, Somatostatin analogs & derivatives, Somatostatin therapeutic use, Acromegaly pathology, Acromegaly physiopathology, Kidney pathology, Kidney physiopathology
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Background: The GH/insulin-like growth factor 1 axis is physiologically involved in the regulation of electrolytes and water homeostasis by kidneys, and influences glomerular filtration and tubular re-absorption processes. The aim of the study was to investigate renal structure and function in acromegalic patients during active disease and disease remission., Patients: Thirty acromegalic patients (15 males and 15 females), aged 32-70 years, were enrolled for the study. Ten de novo patients had active disease, whereas 20 patients showed disease remission 1 year after medical treatment with somatostatin analogs (SA) (ten patients) or surgery (ten patients). Thirty healthy subjects matched for age, gender, and body surface area were enrolled as controls., Results: In both active (A) and controlled (C) patients, creatinine clearance (P<0.001) and citrate (P<0.05) and oxalate levels (P<0.001) were higher, whereas filtered Na (P<0.001) and K (P<0.001) fractional excretions were lower than those in the controls. Urinary Ca (P<0.001) and Ph (P<0.05) levels were significantly increased compared with the controls, and in patients with disease control, urinary Ca (P<0.001) levels were significantly reduced compared with active patients. Microalbuminuria was significantly increased in active patients (P<0.05) compared with controlled patients and healthy control subjects. The longitudinal (P<0.05) and transverse (P<0.05) diameters of kidneys were significantly higher than those in the controls. In all patients, the prevalence of micronephrolithiasis was higher than that in the controls (P<0.001), and was significantly correlated to disease duration (r=0.871, P<0.001) and hydroxyproline values (r=0.639, P<0.001)., Conclusions: The results of the current study demonstrated that acromegaly affects both renal structure and function. The observed changes are not completely reversible after disease remission.
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- 2010
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40. Complete disappearance of a GH-secreting pituitary macroadenoma in a patient with acromegaly: effect of treatment with lanreotide Autogel and consequence of treatment withdrawal.
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Auriemma RS, Galdiero M, Grasso LF, Vitale P, Cozzolino A, Lombardi G, Colao A, and Pivonello R
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- Female, Humans, Middle Aged, Remission Induction, Somatostatin therapeutic use, Acromegaly drug therapy, Adenoma drug therapy, Peptides, Cyclic therapeutic use, Pituitary Neoplasms drug therapy, Somatostatin analogs & derivatives
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Background: Somatostatin analogs (SA) are the cornerstone in the medical treatment of acromegaly, used as either primary or adjunctive therapy. In particular, SA are effective in inducing the biochemical remission of the disease and tumor shrinkage, although only few cases of complete disappearance of the pituitary tumor in patients treated with SA as long-acting formulations have been reported. SA withdrawal has been demonstrated to keep safe levels of GH and IGF1 at least in a small subset of patients well responsive to SA, although it is generally followed by disease recurrence after several months., Case Report: A 61-year-old female patient bearing a very large GH-secreting pituitary macroadenoma was treated with 12-month lanreotide Autogel (ATG), at the initial dose of 120 mg/28 days. After 3 months, GH and IGF1 levels were fully normalized, to prolong the administration interval from 28 to 56 days. After 6 months of treatment, a significant tumor shrinkage (90% of baseline size) was observed, whereas GH and IGF1 excess was still well controlled. After 12-month therapy, a complete disappearance of the pituitary tumor was observed, and the hormonal evaluation confirmed the complete biochemical remission of acromegaly. Lanreotide ATG treatment was withdrawn. The clinical, biochemical, and radiological remission of acromegaly was maintained 24 months after lanreotide ATG treatment discontinuation, without evidence of disease recurrence., Conclusions: This report represents an exemplary case of the potentiality of treatment with lanreotide ATG in inducing a complete remission of acromegalic disease, persistent after a long period of time from treatment withdrawal.
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- 2010
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41. Relationships between serum IGF1 levels, blood pressure, and glucose tolerance: an observational, exploratory study in 404 subjects.
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Colao A, Di Somma C, Cascella T, Pivonello R, Vitale G, Grasso LF, Lombardi G, and Savastano S
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- Adolescent, Adult, Aged, Aged, 80 and over, Blood Glucose metabolism, Blood Pressure, Cross-Sectional Studies, Diabetes Mellitus epidemiology, Diabetes Mellitus metabolism, Female, Homeostasis, Humans, Hypercholesterolemia epidemiology, Hypercholesterolemia metabolism, Hypertriglyceridemia epidemiology, Hypertriglyceridemia metabolism, Male, Middle Aged, Prevalence, Risk Factors, Glucose Intolerance epidemiology, Glucose Intolerance metabolism, Hypertension epidemiology, Hypertension metabolism, Insulin-Like Growth Factor I metabolism
- Abstract
Background: In the general population, low IGF1 has been associated with higher prevalence of cardiovascular disease and mortality., Objective: To investigate the relationships between IGF1 levels, blood pressure (BP), and glucose tolerance (GT)., Subjects: Four-hundred and four subjects (200 men aged 18-80 years)., Exclusion Criteria: personal history of pituitary or cardiovascular diseases; previous or current treatments with drugs interfering with BP, GT, or lipids, corticosteroids (>2 weeks), estrogens, or testosterone (>12 weeks); smoking of >15 cigarettes/day and alcohol abuse (>3 glasses of wine/day)., Results: Two hundred and ninety-six had normal BP (73.3%), 86 had mild (21.3%), and 22 had severe (5.4%) hypertension; 322 had normal GT (NGT (79.7%)), 53 had impaired glucose tolerance (IGT (13.1%)), 29 had diabetes mellitus (7.2%). Normotensive subjects had significantly higher IGF1 levels (0.11+/-0.94 SDS) than those with mild (-0.62+/-1.16 SDS, P<0.0001) or severe (-1.01+/-1.07 SDS, P<0.0001) hypertension. IGF1 SDS (t=-3.41, P=0.001) independently predicted systolic and diastolic BP (t=-2.77, P=0.006) values. NGT subjects had significantly higher IGF1 levels (0.13+/-0.90 SDS) than those with IGT (-0.86+/-1.14 SDS, P<0.0001) or diabetes mellitus (-1.31+/-1.13 SDS, P<0.0001). IGF1 SDS independently predicted fasting glucose (t=-3.49, P=0.0005) and homeostatic model assessment (HOMA)-R (t=-2.15, P=0.033) but not insulin (t=-1.92, P=0.055) and HOMA-beta (t=-0.19, P=0.85)., Conclusion: IGF1 levels in the low normal range are associated with hypertension and diabetes in subjects without pituitary and cardiovascular diseases.
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- 2008
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