Objective To analyze the clinical presentations of patients with endogenous Cushing’s syndrome (CS) affected by Coronavirus disease-19 (COVID-19). Materials and methods Patients who were referred to our clinic with active CS from 31st March to 15th May 2020 were screened for COVID-19 using real-time reverse transcriptase–polymerase chain reaction (RT-PCR). Late-night serum cortisol (64–327 nmol/L), late-night salivary cortisol (LNSC) (0.5–9.4 nmol/L), or 24-h urinary free cortisol (24 hUFC) (100–379 nmol/24 h) were measured by electrochemiluminescence immunoassay. Results Among 22 patients with active CS we found three cases affected by COVID-19. Nonspecific inflammation markers were within the reference range or slightly elevated in these patients. A 71-year-old woman with newly diagnosed CS (late-night serum cortisol >1750 nmol/L, LNSC 908.6 nmol/L) developed dyspnea as an only symptom and died from bilateral polysegmantal hemorrhagic pneumonia 7 days later. A 38-year-old woman with a 5-year medical history of active Cushing’s disease (CD) (late-night serum cortisol 581.3 nmol/L, 24 hUFC 959.7 nmol/24-h) suffered from dyspnea, cough, fever (39.3 °C) and chest pain. Oxygen therapy, antibiotics and symptomatic treatments lead to full recovery 24 days later. A 66-year-old woman with a 4-year medical history of mild CD (late-night serum cortisol 603.4 nmol/L, LNSC 10.03 nmol/L) tested positive for COVID-19 in routine screening and remained asymptomatic. Conclusions The outcome of COVID-19 in patients with CS depends on the severity of hypercortisolism. Thus, severe hypercortisolism is a warning sign that CS affected by COVID-19 could require emergency care despite a lack of clinical presentations and low inflammation biomarkers.
Due to continuous aging of population and increase in the number of elderly people, osteoporosis became socially significant disease leading to disability, increasing mortality and thereby putting an additional burden on the public healthcare system.Screening to identify groups with a high probability of fracture is recommended using the FRAX® Tool for all postmenopausal women and men over 50 years old (А1). In the presense of major pathological fractures (hip, spine, multiple fractures) it is recommended to diagnose osteoporosis and prescribe treatment regardless of the results of spine and hip double X-ray absorptiometry (DXA) or FRAX® (B2).It is recommended to evaluate C-terminal telopeptide when prescribing antiresorptive therapy and procollagen type 1 N-terminal propeptide (P1NP) when prescribing anabolic therapy to patients receiving osteoporosis treatment at baseline and 3 months after the start of therapy in order to assess the effectiveness of treatment early and adherence to the therapy (А2). It is recommended to diagnose osteoporosis and prescribe treatment to patients with high individual 10-year probability of major pathological fractures (FRAX®) regardless of the results of spine and hip DXA (В3).It is recommended to diagnose osteoporosis and prescribe treatment with a decrease in BMD, measured by DXA, by 2.5 or more T-score standard deviations in femoral neck, and/or in total hip, and/or in lumbar vertebrae, in postmenopausal women and men over 50 years old (А2).It is recommended to prescribe bisphosphonates, denosumab or teriparatide to prevent pathological fractures and increase BMD in patients with postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis (А2). When the clinical effect of therapy in osteoporotic patients without pathological fractures is achieved (BMD T-score > -2.0 SD in femoral neck and absence of new fractures), it is recommended to interrupt bisphosphonates therapy for 1-2 years with subsequent follow-up (B2). In patients with vertebral fractures, hip fractures or multiple fractures, it is recommended to continue ceaseless long-term treatment of osteoporosis (В3).All drugs for the treatment of osteoporosis are recommended to be prescribed in combination with calcium and cholecalciferol (А2). In order to reduce the risk of recurrent fractures by prescribing osteoporosis therapy timely and maintaining long-term follow-up of patients over 50 years old with pathological fractures, it is recommended to create Fracture Liaison Services (В2).
Cardiovascular complications including arrhythmias and cardiac conduction disorders are one of the main reasons of high mortality rate in acromegaly, while they have not been well explored. Aim.To estimate arrhythmias frequency in acromegaly, identify risk factors leading to the development of arrhythmia and cardiac conduction disorder, to determine the role of cardiac MRI in detecting structural and functional changes. Materials and methods.A single-center prospective cohort study, which included 461 patients (151 men and 310 women) with acromegaly, was conducted. All the patients underwent a standard medical examination, including hormonal blood test, electrocardiogram, echocardiography, electrocardiogram daily monitoring. 18 patients with arrhythmias (11 men and 7 women) had cardiac MRI with gadolinium-based contrast. Results.The results of our research show high frequency of arrhythmias and cardiac conduction disorders in patients with acromegaly 42%. Most frequent kinds of arrhythmias and cardiac conduction disorders were sinus bradycardia 19.1% of the cases and conduction disorders of bundle branch blocks 14.5%. Men were more likely to suffer from arrhythmias and cardiac conduction disorders than women (54.2% and 37.4%, respectively,p=0.0005). Not acromegaly activity but duration of the disease was a main risk factor of arrhythmias and cardiac conduction disorders. Patients with arrhythmias had a long anamnesis of acromegaly (10 and 7 years, respectively, p=0.04). Meanwhile, cardiac conduction disorders were commonly observed in the patients who were treated with somatostatin analogs comparing to the patients who didnt undergo this therapy (50% and 38.6% respectively,p=0.004). We showed that 61% of patients with acromegaly and cardiac conduction disorders who underwent magnetic resonance imaging (MRI) had the signs of myocardial fibrosis. The value of the ejection fraction of the left ventricle according to MRI was higher than with echocardiography (p=0.04). Conclusion.Arrhythmias and cardiac conduction disorders are often observed in patients with acromegaly even with remission of the disease. High risk group need careful diagnostic and monitoring approaches. Cardiac MRI is the gold standard for visualization of structural and morphological changes in the heart. Use of cardiac MRI in acromegalic patients expands our understanding of arrhythmias and cardiac conduction disorders in this disease. There are no specific laboratory markers of diffuse myocardial fibrosis, and the role of myocardial fibrosis in the occurrence of cardiac arrhythmias and conduction disorders needs further studying.
Aim. To estimate the trabecular bone score (TBS) for evaluation of fracture probability in order to make decisions about starting osteoporosis treatment in patients with type 2 diabetes mellitus (T2DM). Materials and methods. We obtained the bone mineral density (BMD) and trabecular bone score (TBS) using dual energy X-ray absorptiometry (iDXA) in patients with T2DM (with and without a history of osteoporotic fractures) versus the control group. Before and after TBS measurements we assessed the ten-year probability of fracture using the Fracture Risk Assessment Tool (FRAX). Results. We enrolled 48 patients with T2DM, including 17 with a history of low-traumatic fracture, 31 patients without fractures and 29 subjects of a control group. BMD was higher in patients with T2DM compared to the control group at L1L4 (mean T-score 0.44, 95% CI -3.2 4.9 vs mean T-score 0.33, 95% CI -2.9 3.0 in a control group p=0.052) and Total Hip (mean T-score 0.51, 95% CI -2.1 3.0 vs mean T-score -0.03, 95% CI -1.4 1.2 in a control group p=0,025). The TBS and 10-year probability of fracture (FRAX) was not different in patients with T2DM versus the control group. However, when the TBS was entered as an additional risk factor, the 10-year probability of fracture became higher in patients with T2DM (10-year probability of fracture in T2DM- 8.68, 95% CI 0.3-25.0 versus 6.68, 95% CI 0.415.0 in control group, p=0.04). Among patients with diabetes with and without fractures the FRAX score was higher in subjects with fractures, but no difference was found in regards to BMD or TBS. Entering BMD and TBS values into the FRAX tool in subjects with diabetes and fractures decreased the FRAX score. However, patients with low-traumatic fractures should be treated for osteoporosis without a BMD, TBS or FRAX assessment. Conclusion. TBS improves the results of FRAX assessment in patients with T2DM and should be entered while evaluating FRAX in patients with T2DM. However, additional research is needed to develop a more sensitive tool to evaluate fracture risk in patients with T2DM.
АКТУАЛЬНОСТЬ: сердечно-сосудистые осложнения, включая нарушение ритма и проводимости сердца (НПРС) составляют более 60% от всех летальных исходов пациентов с акромегалией. НРПС выявляются у 40% больных акромегалий и могут приводить к внезапной сердечной смерти. Следствием гиперсекреции соматотропного гормона и инсулиноподобного фактора роста-1 является формирование гипертрофической кардиомиопатии и миокардиального интерстициального фиброза. В результате чего, измененная структура миокарда приводит к электрофизиологическим нарушениям. Дополнительным фактором риска развития НРПС может являться терапия аналогами соматостатина, используемая для лечения акромегалии.Несмотря на достижение целевых значений СТГ и ИФР-1 на фоне лечения, возникшие осложнения акромегалии часто являются необратимыми. Поэтому необходимо выявление группы пациентов с акромегалией, имеющих высокий риск развития жизнеугрожающих НРПС для своевременного лечения и профилактики ВСС, а также повышения качества жизни данных пациентов.ЦЕЛЬ: оценить частоту и тяжесть НРПС, выявить факторы риска, способствующие развитию НРПС у больных акромегалией, встречаемость фиброза миокарда по данным магнитно-резонансной томографии (МРТ) сердца у пациентов с НРПС.МАТЕРИАЛЫ И МЕТОДЫ: проведено одноцентровое одномоментное исследование, в которое включен 461 пациент (151 мужчина и 310 женщин) с акромегалией, госпитализированные в ФГБУ «НМИЦ эндокринологии» Минздрава России в период с января 2018г. по март 2020г. Всем пациентам выполнено стандартное медицинское обследование, включающее гормональное исследование крови, регистрацию электрокардиограммы, эхокардиографию, холтеровское мониторирование ЭКГ. МРТ сердца с контрастированием гадолинием выполнено 18 пациентам с НРПС (11 мужчин и 7 женщин).РЕЗУЛЬТАТЫ: результаты нашего исследования демонстрируют высокую встречаемость НРПС у пациентов с акромегалией -42%. Наиболее частыми видами НРПС были синусовая брадикардия (СБ) -19,1% случаев и нарушение проводимости по ножкам пучка Гиса -14,5%. Между тем, СБ обычно наблюдались у пациентов, которые лечились аналогами соматостатина, по сравнению с пациентами, которые не получали данную терапию (50% и 38,6% соответственно, p=0,004). Однако урежение пульса менее 50 в минуту наблюдалось только у 27,3%. Несмотря на то, что терапия аналогами соматостатина увеличивала риск развития СБ, только 41,6% пациентов в группе с ЧСС менее 50 в минуту получали данный вид лечения. Мужчины чаще страдали НРПС, чем женщины (54,2% и 37,4% соответственно, p=0,0005). Выявлено, что развитие НРПС зависит, в первую очередь от длительности акромегалии (p=0,04), в то время как активность заболевания не оказывает значимого влияния. По нашим данным пациенты с НРПС имели более низкие показатели ИФР−1 и СТГ в отличие от пациентов без НРПС. 61% пациентов с акромегалией и НРПС, которым была проведена МРТ сердца, имели признаки фиброза миокарда. В тоже время, признаки фиброза миокарда регистрировались у пациентов при отсутствии значительных отклонений от нормы по данным ЭХО−КГ.ВЫВОДЫ: в исследовании выявлена высокая ...
The purpose of the study is to improve the accuracy of CT diagnostics of pulmonary ACTH-Secreting Tumor.Material and methods. During the period from 2010 to 2022 at the Endocrinology Research Centre and the National Medical Research Center of Surgery named after A. Vishnevsky of the Ministry of Health of Russia 23 patients with pulmonary ACTH-Secreting Tumor were examined and treated. CT-features were analyzed: localization, shape, contours, connection of the formation with the bronchus, connection of the formation with the vessel, adherence to the vessel and bronchus along the long axis, structure of the neoplasm. We also analyzed the largest size of the formation, the size of the largest regional lymph node, the density of the tumor on axial sections in the native, arterial, venous and delayed phases of the study.Results. In the study, we identified a new phenotypic CT sign – the relationship with the bronchovascular bundle. The connection with the bronchus and vessel was assessed in detail. In the majority of patients, the connection with the pulmonary vessels (in most cases with small bronchial arteries) was especially clearly noted: an intimate attachment of the tumor along its long axis to the vessel. Less often it was possible to trace the connection with the bronchus.Conclusion. ACTH-producing NET of the lung is most often a peripherally located oval-shaped formation with even/ lobulated contours, adjacent to the bronchovascular bundle along the long axis of the tumor, intensively enchancing (increase of density parameters by more than 40 HU compared with the unenhanced phase) in the venous, less often the arterial phase of bolus contrast enhancement.
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