Evaluation of circulating levels and renal clearance of natural amino acids in patients with Cushing’s disease

Faggiano, Antongiulio; Pivonello, Rosario; Melis, Daniela; Alfieri, R.; Filippella, Mariagiovanna; Spagnuolo, G.; Salvatore, Francesco; Lombardi, Gaetano; Colao, Annamaria

doi:10.1007/bf03343978

Cited by 20 publications

(18 citation statements)

References 29 publications

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“…Phe was evaluated with a standardized quantitative enzymatic assay, in dried blood samples on filter paper (2992 Schleicher-Schull) with R&D Diagnostics Ltd reagens (Wendel et al, 1990). Tyr levels were evaluated in plasma as described by Faggiano et al (2002), CV 1.8%. Lipid variables were measured spectrophotometrically with a routine method, using commercially available kits.…”

Section: Methodsmentioning

confidence: 99%

Effect of diet on plasma total antioxidant status in phenylketonuric patients

et al. 2003

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Background: Phenylketonuria (PKU), an inborn error of phenylalanine (Phe) metabolism, is treated with a low Phe lifelong diet, which is a vegetarian and contains many antioxidants. Aim: The aim of this study was to evaluate the effect of diet on plasma total antioxidant status in our PKU patients. Methods, Results: Twenty-two PKU patients on strict diet (group A), 24 PKU patients who did not accurately follow their dietary control (group B) and 40 healthy children (controls) of comparable age took part in this study. Nutrients, as well as blood levels of lipids, vitamin C, b-carotene and a-tocopherol were evaluated in all groups. Vitamin C intake and its blood levels did not differ between the groups. However, the intake of b-carotene, a-tocopherol (2211 AE 116, 14 AE 1.0 mg=24 h) and their blood levels (0.7 AE 0.09, 34 AE 0.9 mmol=l) in group A were statistically significantly higher (P < 0.001) as compared with those of group B (1352 AE 118, 10 AE 1.0 mg=24 h and 0.49 AE 0.08, 22 AE 0.6 mmol=l) and controls (1290 AE 120, 9.0 AE 0.9 mg=24 h and 0.40 AE 0.09, 24 AE 1.6 mmol=l). Lipid intakes and their blood levels were lower in patients on the strict diet. Plasma total antioxidant status was higher in the same group of patients (group A). Additionally, positive correlations were found between the antioxidant vitamin blood levels and the plasma total antioxidant status in the groups, especially in the group A. PKU patients of group A showed significantly higher antioxidant status (1.6 AE 0.2 mmol=l) as compared with those of group B (1.0 AE 0.19 mmol=l; P < 0.001) and controls (1.01 AE 0.2 mmol=l). Conclusions: The high plasma antioxidant status in patients with PKU, especially in those with a good compliance with their diet, is possibly due to the amounts of antioxidants which are present in their special low Phe vegetarian diet.

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Section: Methodsmentioning

confidence: 99%

Effect of diet on plasma total antioxidant status in phenylketonuric patients

et al. 2003

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“…The involvement of renal structure and function in the clinical picture of CS is represented by the occurrence of nephrolithiasis and the impairment of renal clearance (15,16). Silent microlithiasis were the most common clinical expression of nephrolithiasis in patients with active disease, associated with hypercalciuria, hyperuricosuria, increased urinary levels of oxalate and decreased urinary levels of citrate.…”

Section: Renal Diseasesmentioning

confidence: 99%

“…Glucocorticoid excess exerts multiple and complex effects on the skeletal system, including osteopenia or osteoporosis, often associated with pathological fractures (11,12), osteoarthrosis (13), and osteonecrosis (14). Nephrolithiasis, together with an impairment of renal function, is also quite common, although it is usually not associated to a clinical syndrome (15,16). Mental disturbances complicate great part of patients with CS and include a range of psychological or psychiatric manifestations ranging from anxiety to psychosis, such as major depression, and intellective impairment involving cognition and memory, often associated with cerebral atrophy (17)(18)(19)(20).…”

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confidence: 99%

Cushing's syndrome: aftermath of the cure

Pivonello¹,

Martino²,

Leo³

et al. 2007

Arq Bras Endocrinol Metab

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Cushing's syndrome (CS) is a chronic and systemic disease caused by endogenous or exogenous hypercortisolism, associated with an increase of mortality rate due to the clinical consequences of glucocorticoid excess, especially cardiovascular diseases. After cure, usually obtained by the surgical removal of the tumor responsible for the disease, the normalization of cortisol secretion is not constantly followed by the recovery of the clinical complications developed during the active disease, and it is often followed by the development of novel clinical manifestations induced by the fall of cortisol levels. These evidences were mostly documented in patients with pituitary-dependent CS, after surgical resection of the pituitary tumor. Indeed, despite an improvement of the mortality rate, metabolic syndrome and the consequent cardiovascular risk have been found to partially persist after disease remission, strictly correlated to the insulin resistance. Skeletal diseases, mainly osteoporosis, improve after normalization of cortisol levels but require a long period of time or the use of specific treatment, mainly bisphosphonates, to reach the normalization of bone mass. A relevant improvement or resolution of mental disturbances has been described in patients cured from CS, although in several cases, cognitive decline persisted and psychological or psychiatric improvement was erratic, delayed, or incomplete. On the other hand, development or exacerbation of autoimmune disorders, mainly thyroid autoimmune diseases, was documented in predisposed patients with CS after disease remission. The totality of these complications persisting or occurring after successful treatment contribute to the impairment of quality of life registered in patients with CS after disease cure. A síndrome de Cushing (SC) é uma desordem sistêmica crônica causada por hipercortisolismo endógeno ou exógeno, associada a um aumento da taxa de mortalidade devido às conseqüências clínicas do excesso de glicocorticóides, especialmente a doença cardiovascular. Após a cura, usualmente obtida pela remoção cirúrgica do tumor responsável pela desordem, a normalização da secreção de cortisol não é sistematicamente seguida da recuperação das complicações clínicas desenvolvidas durante a fase ativa da doença, e é freqüentemente seguida pelo surgimento de novas manifestações clínicas induzidas pela queda dos níveis de cortisol. Estas evidências foram, na sua maioria, documentadas em pacientes com SC de origem hipofisária, após a ressecção cirúrgica do tumor na hipófise. Na verdade, a despeito de uma melhoria na taxa de mortalidade, a sín-drome metabólica e seu conseqüente risco cardiovascular têm se mostrado parcialmente persistentes após a remissão da doença, em estrita relação com a resistência à insulina. Anormalidades esqueléticas, especialmente a osteoporose, melhoram após a normalização dos níveis de cortisol, mas requerem um longo tempo ou o uso de tratamento especí-fico, principalmente bisfosfonatos, para se obter a normalização da massa óssea. Um...

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“…In both studies they reported that patients with Cushing's disease (active and cured) showed a lower clearance than controls, but the difference was not statistically significant. When we compare our study results with those of Faggiano et al (9,10) we notice that their control group did not include overweight individuals. When GFR was estimated by the Cockroft -Gault equation we found no statistical differences between our cases and controls.…”

Section: Discussionmentioning

confidence: 70%

“…In two previous studies Faggiano et al (9,10) determined the creatinine clearance using a 24-h urine collection. In both studies they reported that patients with Cushing's disease (active and cured) showed a lower clearance than controls, but the difference was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Glomerular filtration rate in patients with Cushing’s disease: a matched case–control study

Haentjens

Meirleir²,

Abs³

et al. 2005

eur j endocrinol

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Background: Patients with Cushing's disease have a high prevalence of atherosclerosis and maintain an increased cardiovascular risk even after cure of the disease. However, the impact of Cushing's disease on renal function remains to be quantified. Objectives: To evaluate glomerular filtration rate (GFR) and to identify predictors of GFR in patients with Cushing's disease. Design and methods: We conducted a matched case -control study: 18 patients with active or cured Cushing's disease were compared with healthy population controls matched for age and sex. The main outcome measures were GFR and micro-albuminuria. Results: Patients with Cushing's disease had a lower GFR, as measured by 24-h creatinine clearance (79 versus 95 ml/min per 1.73 m 2 , P ¼ 0.005) and estimated by the MDRD 2 formula (75 versus 88 ml/min per 1.73 m 2 , P ¼ 0.008). Multiple regression analyses indicated that disease duration was the strongest predictor for a worse GFR. The prevalence of micro-albuminuria was low (5.5% in both groups). Conclusions: Patients with Cushing's disease have a decreased GFR. Even if they are cured, close follow-up with strict control of cardiovascular risk factors and monitoring of GFR seems mandatory. Furthermore, the dosage of certain drugs should be adapted to the individual GFR.

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Evaluation of circulating levels and renal clearance of natural amino acids in patients with Cushing’s disease

Cited by 20 publications

References 29 publications

Effect of diet on plasma total antioxidant status in phenylketonuric patients

Effect of diet on plasma total antioxidant status in phenylketonuric patients

Cushing's syndrome: aftermath of the cure

Glomerular filtration rate in patients with Cushing’s disease: a matched case–control study

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