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Scopo Il coinvolgimento delle ghiandole lacrimali (GL) in pazienti affetti da Oftalmopatia di Graves (OG) è stato considerato come una potenziale causa dei sintomi tipicamente associati a questa malattia. Diversi studi hanno rilevato che le dimensioni delle GL nei pazienti OG sono aumentate, ma non ci sono studi che prendono in considerazione pazienti con diversa attività della malattia. Abbiamo valutato l'erniazione delle GL rilevata sulle immagini di risonanza magnetica (RM), in pazienti con diversa attività OG. Materiale e metodi Trentadue pazienti (10M, 22F, età media 49,5 anni, range 30-68) con OG sono stati arruolati e raggruppati in base all'attività della malattia (A: n = 16 con OG inattivo, Clinical Activity Score (CAS)

In the original publication, the funding statement was incorrectly published and the Editorial Assistant information was missed in the published version. The correct funding statement and the Editorial Assistant statement should read as below. Funding. The study and article processing charges were funded by Novo Nordisk S.p.A. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and the accuracy of the data analysis. Editorial Assistance. Editorial assistance was provided by Paolo de Gennaro of Airon Communication. Support for this assistance was funded by Novo Nordisk S.p.A.

To evaluate the LG involvement, through the measurement of the LG herniation by of magnetic resonance imaging (MRI), in patients with different GO activity

OBJECTIVE: Growth hormone treatment (GHT) is commonly administered daily, although pulsatile GH secretion is unlikely to be achieved. The auxological effect of a three-injections-per-week (TIW) regimen is controversial, while the metabolic effects have been never evaluated in children. The objective was to evaluate whether two different regimens of weekly injections could lead to similar auxological and metabolic effects in children with GH deficiency (GHD). DESIGN: 32 GHD children (25 males, mean age 10.5 ± 2.2 yr) were randomly assigned to receive daily (group A, No 16) or TIW (group B, No 16) GHT for 12 months. METHODS: Auxological parameters, insulin-like growth factor-I (IGF-I), glucose and insulin during OGTT, glycosylated hemoglobin (HbA1c), lipid profile, the oral disposition index (DIo), the homeostasis model assessment estimate of insulin resistance (Homa-IR) and the insulin sensitivity index (ISI). RESULTS: After 12 months, both groups showed a significant and comparable improvement in height (p

Background: La terapia sostitutiva con glucocorticoidi (GC) non riflette la fisiologica secrezione endogena di cortisolo per cui è spesso associata a numerose complicanze croniche, fra cui quelle metaboliche con tendenza all’aumento della glicemia e riduzione dell’insulino-sensibilità con secondario iperinsulinismo. Obiettivi: Valutare gli effetti metabolici dello switch da terapia con GC a rapido rilascio (idrocortisone e cortisone acetato) somministrati 2-3 volte/die alla monosomministrazione giornaliera di idrocortisone “dual release” (IDR) mantenendo la stessa dose bioequivalente. Metodi: Abbiamo valutato, oltre ai classici parametri clinici e metabolici, l’indice di insulino-sensibilità ISI Matsuda e gli indici di insulino-secrezione AUC-insulinemia (durante OGTT) e Oral Disposition Index (Dio) in 34 pz. (23 F, 11 M, range età 23-73 aa) con iposurrenalismo (N 24 secondario, N 10 primitivo) durante terapia con GC tradizionali e dopo 12 mesi di terapia con IDR. Risultati: Dopo 12 mesi di IDR si è evidenziata una riduzione significativa di circonferenza vita (CV) (96 ± 2.4 vs. 98.5 ± 2.4 cm; p=0.001), con contestuale aumento di ISI Matsuda (12.2 ± 3.3 vs. 7.3 ± 1.3 cm; p=0.040) e di DIo (3.8 ± 0.7 vs. 1.4 ± 0.1; p=0.003), senza differenze significative nei livelli basali e nelle AUC di glicemia e insulinemia. ISI Matsuda a 12 mesi correla significativamente sia con il peso (Rho -0.758; p=0.011) che con la CV (Rho -0.645; p=0.017). Nessuna differenza si è evidenziata dividendo i pazienti in base al tipo di iposurrenalismo. Conclusioni: Lo switch terapeutico da GC tradizionali a IDR in pazienti con iposurrenalismo è associato ad un miglioramento del profilo clinico e metabolico, sia in termini di insulino-sensibilità che di insulino-secrezione.

Background: La terapia con GH determina iperinsulinemia sia per effetto diretto del GH sulla β-cellula, sia per effetto controregolatorio indiretto. I dati in letteratura sulla valutazione dell’insulino-secrezione durante terapia con GH, basati prevalentemente su indici surrogati derivati da livelli basali o stimolati di insulinemia, sono piuttosto discordanti tra loro e pochissimi studi hanno considerato i livelli di C-peptide, che sia nei soggetti sani che diabetici rappresentano una stima più accurata della funzione β-cellulare rispetto all’insulinemia. Obiettivi: Valutare l’utilità del C-peptide nello studio dell’insulino-secrezione in bambini GHD durante terapia con GH. Metodi: Abbiamo valutato il C-peptide a digiuno e dopo stimolo con glucagone (AUCCpep), oltre ad altri indici surrogati di insulino-secrezione, in 48 bambini (32 M, 16 F; età media 9.8 aa) affetti da GHD idiopatico in baseline e dopo 12 e 24 mesi di terapia con GH e in 56 bambini sani appaiati per età, sesso e BMI. Risultati: Il gruppo GHD alla diagnosi presenta livelli inferiori di AUCCpep (p=0.006) rispetto ai controlli sani, senza differenza negli altri indici di insulino-secrezione. C-peptide a digiuno (beta 0.307, p=0.016) e AUCCpep (beta 0.379, p=0.002) correlano indipendentemente con i livelli di IGF-I, mentre non si evidenzia alcuna correlazione per gli altri indici. Dopo 12 mesi di terapia, il gruppo GHD presenta un aumento significativo di Homa-β (p

Background: I criteri AIFA di rimborsabilità dei farmaci ad azione incretino-mimetica limitano notevolmente l’utilizzo degli stessi ad un range molto ristretto di HbA1c alla prima prescrizione(7,5-8,5%), escludendone quindi dal loro utilizzo i pazienti con più severo scompenso glicometabolico. Obiettivi: Valutare la diversa efficacia di liraglutide durante i primi 12 mesi di terapia in relazione ai valori di HbA1c di partenza. Metodi: Sono stati retroattivamente valutati i dati clinici e metabolici di 62 pazienti diabetici di tipo 2 (38 M, 24 F, range età 29-74 aa, range durata di malattia 0-30 aa) trattati in un periodo antecedente l’entrata in vigore dei limiti di rimborsabilità AIFA, in terapia stabile per 12 mesi con liraglutide 1,2 mg/die, suddivisi in base all’HbA1c di partenza in gruppo A (n° 34 pz. con Hba1c ≤8,5%; media 7.3 ± 0.7%) e gruppo B (n° 28 pz. con Hba1c >8,5%; media 9.8 ± 1.2%). I due gruppi sono risultati appaiati per età, sesso, BMI, durata di malattia e terapia associata (n° 29 pz. in duplice con metformina, n° 33 pz. in triplice con metformina e sulfanilurea). Risultati: In tutti i pazienti, indipendentemente dalla terapia associata, dopo 12 mesi si osserva una riduzione significativa di HbA1c (p

Background Increased insulin levels during GH replacement therapy are often reported both in adults and in children with GH deficiency (GHD), although discordant data fully describe the behavior of metabolic parameters during GH therapy in children and overall the majority of published data are limited to the first 12 months of follow-up and in small populations. Aim To evaluate the long-term metabolic influences of GH replacement in a large selected cohort of prepubertal children with idiopathic GHD during GH therapy. Subjects and Methods Data of 194 prepubertal GHD children (150 M, 44 F; age 10.85 ± 2.77 yrs) were analyzed. Before GH therapy and yearly up to 36 months we measured body mass index (BMI), waist circumference (WC), IGF-1, total-, HDL- and LDL-cholesterol, triglycerides, glucose and insulin levels, Homa-IR and HbA1c. In a subgroup of 34 patients (28 M, 8 F) we performed yearly OGTT and calculated ISI-Matsuda (ISI), Insulinogenic Index (InsIn) and Oral Disposition Index (DIo). Results No subject showed overt dysglycemia or dyslipidemia at baseline and during GH therapy. Compared to baseline (17.62 ± 3.14 Kg/m2), BMI significantly increased after 12 (17.81 ± 3.36 Kg/m2; p

Our aime was to investigate the correlation between GO ocular parameters obtained by MRI with contrast administration and the well-know clinical indicators of GO and to examine the relationship between the clinical course of hyperthyroidism and GO severity

Introduction: This study investigates the effects of dapagliflozin on the visceral adiposity index (VAI), lipid accumulation product (LAP), product of triglycerides and glucose (TyG) and triglycerides to HDL-cholesterol ratio (TG/HDL-C) in patients with type 2 diabetes mellitus (T2D). Methods: In this real-life study, dapaglifozin was added to metformin alone (group 1, no. 42) or insulin plus metformin (group 2, no. 58) in 100 T2D patients. Results: In group 1, after 6 months of dapaglifozin addition, a significant decrease in BMI (p < 0.001), waist circumference (WC) (p < 0.001), systolic blood pressure (SBP) (p = 0.009), diastolic blood pressure (DBP) (p = 0.012), mean fasting blood glucose (FBG), post-breakfast glucose (PBG), post-lunch glucose (PLG) and post-dinner glucose (PDG) (all p < 0.001), HbA1c (p < 0.001), VAI (p = 0.020), LAP (p = 0.028), Tyg (p < 0.001), TG/HDL-C (p = 0.020) and glutamate pyruvate transaminase (GPT) (p < 0.001) was observed compared to baseline. After 12 months a significant decrease in BMI (p < 0.001), WC (p = 0.006), SBP (p = 0.023), DBP (p = 0.005), mean FPG, PBG, PLG and PDG (all p < 0.001), HbA1c (p < 0.001), total cholesterol (p = 0.038), triglycerides (p = 0.026), VAI (p = 0.013), GPT (p < 0.001), LAP index (p = 0.024), Tyg index (p < 0.001) and TG/HDL-c ratio (p = 0.016) was observed compared to baseline. In group 2, after 6 months of dapaglifozin addition, a significant decrease in BMI (p < 0.001), WC (p < 0.001), SBP (p = 0.015), DBP (p = 0.007), mean FPG, PBG, PLG and PDG (all p < 0.001), HbA1c (p < 0.001), VAI (p = 0.040), LAP (p = 0.047), Tyg (p < 0.001), TG/HDL-C (p = 0.048) and GPT (p < 0.001) was observed compared to baseline. By contrast, after 12 months a significant decrease in BMI (p < 0.001), WC (p < 0.001), SBP (p = 0.001), DBP (p = 0.002), mean FPG, PBG, PLG and PDG (all p < 0.001), HbA1c (p < 0.001), GPT (p < 0.001) and Tyg index (p = 0.003) was observed compared to baseline. Conclusions: Dapagliflozin treatment significantly reduced surrogate indexes of insulin resistance and adiposity in patients with T2D.

Purpose To evaluate factors influencing the insulin and levothyroxine requirement in patients with autoimmune polyglandular syndrome type 3 (APS-3) vs. patients with type 1 diabetes mellitus (T1DM) and autoimmune hypothyroidism (AH) alone, respectively. Methods Fifty patients with APS-3, 60 patients with T1DM and 40 patients with AH were included. Anthropometric, clinical and biochemical parameters were evaluated in all patients. Insulin requirement was calculated in patients with APS-3 and T1DM, while levothyroxine requirement was calculated in APS-3 and AH. Results Patients with APS-3 showed higher age (p = 0.001), age of onset of diabetes (p = 0.006) and TSH (p = 0.004) and lower total insulin as U/day (p p = 0.001), long-acting insulin as U/day (p = 0.030) and U/kg (p = 0.038) and irisin (p = 0.002) compared to T1DM. Patients with APS-3 had higher waist circumference (p = 0.008), duration of thyroid disease (p = 0.020), levothyroxine total daily dose (p = 0.025) and mcg/kg (p = 0.006), triglycerides (p = 0.007) and VAI (p = 0.010) and lower age of onset of thyroid disease (p = 0.007) than AH. At multivariate analysis, levothyroxine treatment and VAI were associated with insulin and levothyroxine requirement in APS-3, respectively. VAI was independently associated with insulin requirement in T1DM. Circulating irisin levels were independently associated with levothyroxine requirement in AH. Conclusion Patients with APS-3 show lower insulin requirement and higher levothyroxine requirement than T1DM and AH alone, respectively. Levothyroxine treatment and VAI affect insulin and levothyroxine requirement, respectively, in APS-3. In T1DM, adipose tissue dysfunction, indirectly expressed by high VAI, is associated with an increased insulin requirement, while circulating irisin levels influence the levothyroxine requirement in AH.

Lacrimal gland (LG) involvement in patients with Graves ophthalmopathy (GO) has been considered as a potential cause of the associated GO symptoms and different studies demonstrated the LG involvement in patients with GO than healthy controls. The aim of this study was to evaluate LG involvement, through measurement of its herniation, using a magnetic resonance imaging (MRI) index, in patients with different GO activities. Thirty-two consecutive Caucasian patients affected by GO were enrolled and grouped in group A (16 with inactive GO, CAS < 3) and B (16 with active GO, CAS ≥ 3) according to their GO activity. All patients underwent clinical-endocrinological assessment, a complete ocular evaluation, and orbital MRI examination. No difference was found between the hormonal parameters, thyroid ultrasound-derived parameters, and thyroid-stimulating hormone (TSH) receptor (TSH-R) antibodies (TRAb) levels in group B and those in group A. The LG herniation (LGH) measurement evaluated by MRI was significantly higher in group B for both right (10.1 (7.3–17) vs. 7 (0–3.4) mm; p = 0.004) and left (8.5 (6.6–13) vs. 5.8 (0–12) mm; p = 0.026) eye than group A. A positive correlation was found between TRAb and LGH herniation (Rho 0.462, p = 0.009). Measurement of LGH seems to be a good marker of the disease and GO activity. • Lacrimal gland herniation is a simple index related to disease activity • Lacrimal gland herniation is correlated to TRAb levels • Lacrimal gland evaluation could be useful to differentiate active from inactive Graves ophthalmopathy in an early stage of disease

IntroductionActive surveillance is considered a viable option for papillary thyroid microcarcinoma. Since the last decade of the 20th century, this method has spread from Japan to other countries, but has not yet been fully accepted and validated by the major Western Scientific Societies. In 2016, a systematic review on the results of active surveillance was published, based on two articles that showed encouraging results. Other reviews published subsequently, were mainly based on articles from the Far East. The aim of this review is to assess the most recent results published from 2017 to 2020 on this subject.Materials and MethodsA systematic literature search was performed on MEDLINE via PUBMED, Web of Science, and Scopus according to PRISMA criteria. The MESH terms “papillary thyroid microcarcinoma” and “active surveillance” were adopted. Tumor progression, secondary localizations, and quality of life were the main benchmarks.ResultsNine studies met the inclusion criteria. The increase in volume ranged from 2.7% and 23.2%; the occurrence of lymph node metastases from 1.3% to 29%; QoL was improved in both articles that addressed this topic. The level of evidence is considered low due to the retrospective and uncontrolled nature of most of the studies included in the review.ConclusionThe evidence from the literature currently available on AS falls into two strands: a robust data set from the Japanese experience, and an initial experience from Western countries, whose data are still limited but which show a lack of substantial alerts against this practice. Further data is useful to validate the spread of Active Surveillance.

Aim The aim of this study was to analyze changes in the incidence, management and mortality of DFU in Sicilian Type 2 diabetic patients hospitalized between two eras, i.e. 2008–2013 and 2014–2019. Methods We compared the two eras, era1: 2008–13, era2: 2014–19. In era 1, n = 149, and in era 2, n = 181 patients were retrospectively enrolled. Results In the population hospitalized for DFU in 2008–2013, 59.1% of males and 40.9% of females died, whilst in 2014–2019 65.9% of males and 34.1% of females died. Moderate chronic kidney disease (CKD) was significantly higher in patients that had died than in ones that were alive (33% vs. 43%, p < 0.001), just as CKD was severe (14.5% vs. 4%, p < 0.001). Considering all together the risk factors associated with mortality, at Cox regression multivariate analysis only moderate-severe CKD (OR 1.61, 95% CI 1.07–2.42, p 0.021), age of onset greater than 69 years (OR 2.01, 95% CI 1.37–2.95, p Conclusions Patients with DFU have high mortality and reduced life expectancy. Age at onset of diabetic foot ulcer, eGFR values and CKD are the principal risk factors for mortality.

Purpose To evaluate circulating soluble α-klotho (sαKL) levels in GHD children before and after 12 months of GH treatment (GHT). Methods Auxological and basal metabolic parameters, oral glucose tolerance test for glucose and insulin levels, insulin sensitivity indices and klotho levels were evaluated before and after 12 months of follow-up in 58 GHD children and 56 healthy controls. Results At baseline, GHD children showed significantly lower growth velocity standard deviation score (SDS) (p p p p p p p = 0.003) and sαKL (p p p p p p p p p = 0.002) and WC (SDS) (p = 0.038) than baseline. At ROC curve analysis, we identified a sαKL cut-off to discriminate controls and GHD children of 1764.4 pg/mL in females and 1339.4 pg/mL in males. At multivariate analysis, the independent variables significantly associated with sαKL levels after 12 months of GHT were the oral disposition index (p = 0.004, β = 0.327) and IGF-1 (p = 0.019, β = 0.313). Conclusions Gender-related sαKL may be used as a marker of GHD combined to GH and IGF-1. Insulin and IGF-1 are independently associated with sαKL values after 12 months of GHT.

Objective: Few large-scale studies regarding the impact of GH deficiency (GHD) on hematopoiesis in children have been reported. Our aim was to investigate hematopoiesis indices in a large cohort of GHD children at diagnosis and during GH treatment (GHT) and any correlation with hormonal parameters. Design: Clinical and biochemical data of children with idiopathic GHD at diagnosis and annually up to 36 months of GHT were retrospectively evaluated. Overall, 255 children reached 12 months, 140 children 24 months and 86 children 36 months of follow-up during GHT. Results: At baseline, 18.4% of GHD children and 10.1% of controls showed normocytic anemia. GHD children showed lower hemoglobin (Hb) (p = 0.007), red blood cells (RBC) (p < 0.001) and hematocrit (Ht) (p = 0.001) than controls. During GHT, the percentage of anemic patients decreased from 18.4 to 5.4–3.5 and 4.6% after 12 (p = 0.001), 24 (p < 0.001) and 36 months (p < 0.001) of GHT, respectively. In both anemic and non-anemic patients, a significant increase in Hb (p < 0.001

This study investigates the effects of dapagliflozin on the visceral adiposity index (VAI), lipid accumulation product (LAP), product of triglycerides and glucose (TyG) and triglycerides to HDL-cholesterol ratio (TG/HDL-C) in patients with type 2 diabetes mellitus (T2D). In this real-life study, dapaglifozin was added to metformin alone (group 1, no. 42) or insulin plus metformin (group 2, no. 58) in 100 T2D patients. In group 1, after 6 months of dapaglifozin addition, a significant decrease in BMI (p

Purpose Patients with growth hormone deficiency (GHD) demonstrate an increased cortisol/cortisone ratio which could potentially explain the metabolic features of GHD, while GH treatment (GHT) could increase the cortisol metabolism. Methods In 35 children (27 M, mean age 10.1 years) with idiopathic GHD at baseline and after 12 months of GHT and in 25 controls, in addition to metabolic parameters, we assessed adrenal function by morning serum cortisol, its peak, and its area under the curve (AUCCOR) during insulin tolerance test (ITT). Results A cortisol peak

Background:Conventional glucocorticoid treatment has a significant impact on liver in patients with adrenal insufficiency. Dual-release hydrocortisone (DR-HC) provides physiological cortisol exposure, leading to an improvement in anthropometric and metabolic parameters. We aimed to evaluate the effects of 12-month DR-HC treatment on the hepatic steatosis index (HSI), a validated surrogate index of hepatic steatosis, in patients with secondary adrenal insufficiency (SAI).Methods:A total of 45 patients with hypopituitarism, 22 with hypogonadism, hypothyroidism, ACTH, and GH deficiencies, and 23 with hypogonadism, hypothyroidism, and ACTH deficiency, on replacement therapy for all the pituitary deficiencies, were switched from conventional hydrocortisone to DR-HC. At baseline and after 12 months, glucose and insulin levels, surrogate estimates of insulin sensitivity, and hepatic steatosis were evaluated through ultrasonography and HSI.Results:At diagnosis, ultrasonography documented steatosis in 31 patients (68.8%) while 33 (73.3%) showed high HSI. Hydrocortisone (HC) dose (β = 1.231, p = 0.010), insulin resistance index (HOMA-IR) (β = 1.431, p = 0.002), and insulin sensitivity index (ISI)-Matsuda (β = −1.389, p = 0.034) were predictors of HSI at baseline. After 12 months of DR-HC, a significant decrease in body mass index (BMI) ( p = 0.008), waist circumference (WC) ( p = 0.010), fasting insulin ( p = 0.041), HOMA-IR ( p = 0.047), HSI ( p Conclusions:In adults with SAI, DR-HC is associated with an improvement in HSI, regardless of the dose used, mainly related to an improvement in insulin sensitivity.

Background The approach to acromegalic patients with persistent acromegaly after surgery and inadequate response to first-generation somatostatin receptor ligands (SRLs) should be strictly tailored. Current options include new pituitary surgery and/or radiosurgery, or alternative medical treatment with SRLs high dose regimens, pegvisomant (PEG) as monotherapy, or combined therapy with the addition of PEG or cabergoline to SRLs. A new pharmacological approach includes pasireotide, a second-generation SRL approved for patients who do not adequately respond to surgery and/or for whom surgery is not an option. No reports on efficacy and safety of combined therapy with pasireotide and pegvisomant (PEG) in acromegaly are available. Case presentation Here we report the case of a 41-year-old acromegalic man with a mixed GH/PRL pituitary adenoma post-surgical resistant to first-generation SRLs both alone and in combination with cabergoline and PEG who achieved biochemical and tumor control with the combined triple treatment with pasireotide, PEG and cabergoline without adverse events and with a good compliance to treatment. Conclusions Twelve months of therapy with pasireotide, PEG and cabergoline proved to be safe and effective in this particular patient and the clinical improvement of disease resulted in an improved compliance to treatment.

INTRODUCTION: Although liraglutide is widely recognized to have glycemic and extra-glycemic effects, few studies have compared these effects in relation to hypoglycemic treatment starting from the diagnosis of diabetes. We evaluated the effectiveness of liraglutide in reducing the Framingham risk score (FRS) and visceral adiposity index (VAI) in relation to first-line hypoglycemic treatment from diagnosis of type 2 diabetes, continued without any changes. METHODS: We selected 105 diabetic outpatients who were treated with liraglutide for at least 48 months as an add-on therapy to metformin alone (group A, n = 52) or insulin secretagogues (group B, n = 53) from diagnosis time. RESULTS: Although both groups showed a reduction in BMI, waist circumference, blood pressure, HbA1c and triglycerides, only group A showed a significant reduction in FRS (p < 0.001) and VAI (p = 0.012) after 48 months. No significant intergroup difference was found for any parameters at either baseline or 48 months, with the exception of FRS at 48 months, lower in group A (p = 0.002), regardless of duration of disease, improvement in glycemic control and VAI. CONCLUSION: Our data show that during a 48-month follow-up liraglutide was more efficacious in reducing cardiovascular risk than when it was used as add-on therapy to the first-line therapy from diagnosis with metformin and not with insulin secretagogues.

The visceral adiposity index, based on anthropometric and metabolic parameters, has been shown to be related to adipose tissue function and insulin sensitivity. We aimed to evaluate the performance of the visceral adiposity index in adult patients with growth hormone deficiency. We enrolled 52 patients(mean age 51 ± 13 years) with newly diagnosed growth hormone deficiency and 50 matched healthy subjects as controls at baseline. At baseline and after 12 and 24 months of treatment we evaluated anthropometric measures, lipid profile, glucose and insulin during an oral glucose tolerance test, hemoglobin A1c, homeostasis model assessment estimate of insulin resistance, quantitative insulin sensitivity check index, insulin sensitivity index Matsuda, insulin-like growth factor-I and visceral adiposity index. At baseline growth hormone deficiency patients showed higher waist circumference (p < 0.001), low-density lipoprotein cholesterol (p < 0.001) and visceral adiposity index (p = 0.003) with lower insulin sensitivity index (p = 0.007) and high-density lipoprotein cholesterol (p = 0.001) than controls. During growth hormone treatment we observed a significant increase in insulin-like growth factor-I (p < 0.001), high-density lipoprotein (p < 0.001) with a trend toward increase in insulin sensitivity index (p = 0.055) and a significant decrease in total cholesterol (p < 0.001) and visceral adiposity index (p < 0.001), while no significant changes were observed in other clinical and metabolic parameters. The visceral adiposity index was the only parameter that significantly correlated with growth hormone peak at diagnosis (p < 0.001) and with insulin-like growth factor-I and insulin sensitivity index both at diagnosis (p = 0.009 and p < 0.001) and after 12 (p = 0.026 and p = 0.001) and 24 months (p < 0.001 and p = 0.001) of treatment. The visceral adiposity index, which has shown to be associated with both insulin-like growth factor-I and insulin sensitivity, proved to be the most reliable index of metabolic perturbation, among the most common indexes of adiposity assessment and a marker of benefit during treatment in adult growth hormone deficiency patients.

Objective. To evaluate whether two different regimens of weekly injections could lead to similar auxological and metabolic effects in children with growth hormone deficiency (GHD).Design. 32 GHD children (25 males, mean age 10.5 ± 2.2 yr) were randomly assigned to receive daily (group A, 16 patients) or TIW (group B, 16 patients) GHT for 12 months.Methods. Auxological parameters, insulin-like growth factor-I (IGF-I), glucose and insulin during OGTT, glycosylated hemoglobin (HbA1c), lipid profile, the oral disposition index (DIo), the homeostasis model assessment estimate of insulin resistance (Homa-IR), and the insulin sensitivity index (ISI).Results. After 12 months, both groups showed a significant and comparable improvement in height (p<0.001) and IGF-I (p<0.001). As regards the metabolic parameters, in both groups, we found a significant increase in fasting insulin (p<0.001andp=0.026) and Homa-IR (p<0.001andp=0.019). A significant increase in fasting glucose (p=0.001) and a decrease in ISI (p<0.001) and DIo (p=0.002) were only found in group A.Conclusions. The TIW regimen is effective and comparable with the daily regimen in improving auxological parameters and has a more favorable metabolic impact in GHD children. This trial is registered with ClinicalTrials.govNCT03033121.

OBJECTIVE: GH treatment (GHT) can lead to glucose metabolism impairment through decreased insulin sensitivity and impaired pancreatic β-cell function, which are the two key components of the pathogenesis of diabetes. Therefore, in addition to insulin sensitivity, during GHT it is very important to perform a reliable evaluation of insulin secretion. However, conflicting data exist regarding the insulin secretion in children during GHT. C-peptide provides a more reliable estimate of β-cell function than insulin, but few studies evaluated it during GHT. Our aim was to assess the usefulness of C-peptide in the evaluation of insulin secretion in GH deficiency (GHD) children. DESIGN: In 48 GHD children, at baseline and after 12 and 24months of GHT, and in 56 healthy subjects we evaluated fasting and glucagon-stimulated (AUCCpep) C-peptide levels in addition to other commonly used secretion indexes, such as fasting and oral glucose tolerance test-stimulated insulin levels (AUCINS), Homa-β, and insulinogenic index. The main outcomes were the change in C-peptide during GHT and its correlation with the auxological and hormonal parameters. RESULTS: At baseline GHD children showed a significant lower AUCCpep (p=0.006), while no difference was found for the other indexes. Both fasting C-peptide (beta 0.307, p=0.016) and AUCCpep (beta 0.379, p=0.002) were independently correlated with IGF-I SDS, while no correlation was found for all other indexes. After 12months an increase in Homa-β (p

OBJECTIVE: The eye represents a target site for GH action, although few data are available in patients with GH deficiency (GHD). Our aim was to evaluate central corneal thickness (CCT) and intraocular pressure (IOP) values in GHD children to assess the role played by GHD or GH treatment on these parameters. DESIGN: In 74 prepubertal GHD children (51M, 23F, aged 10.4±2.4years) we measured CCT and IOP before and after 12months of treatment. A baseline evaluation was also made in 50 healthy children matched for age, gender and body mass index. The study outcome considered CCT and IOP during treatment and their correlations with biochemical and auxological data. RESULTS: No difference in CCT and IOP between GHD children at baseline and controls was found (all p>0.005). GHD children after 12months of therapy showed greater CCT (564.7±13.1μm) than both baseline values (535.7±17μm; p

Introduction: Active surveillance is considered a viable option for papillary thyroid microcarcinoma. Since the last decade of the 20th century, this method has spread from Japan to other countries, but has not yet been fully accepted and validated by the major Western Scientific Societies. In 2016, a systematic review on the results of active surveillance was published, based on two articles that showed encouraging results. Other reviews published subsequently, were mainly based on articles from the Far East. The aim of this review is to assess the most recent results published from 2017 to 2020 on this subject., Materials and Methods: A systematic literature search was performed on MEDLINE via PUBMED, Web of Science, and Scopus according to PRISMA criteria. The MESH terms "papillary thyroid microcarcinoma" and "active surveillance" were adopted. Tumor progression, secondary localizations, and quality of life were the main benchmarks., Results: Nine studies met the inclusion criteria. The increase in volume ranged from 2.7% and 23.2%; the occurrence of lymph node metastases from 1.3% to 29%; QoL was improved in both articles that addressed this topic. The level of evidence is considered low due to the retrospective and uncontrolled nature of most of the studies included in the review., Conclusion: The evidence from the literature currently available on AS falls into two strands: a robust data set from the Japanese experience, and an initial experience from Western countries, whose data are still limited but which show a lack of substantial alerts against this practice. Further data is useful to validate the spread of Active Surveillance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Orlando, Scerrino, Corigliano, Vitale, Tutino, Radellini, Cupido, Graceffa, Cocorullo, Salamone and Melfa.)