Osteopathy in mild adrenal Cushing’s syndrome and Cushing disease

Frara, Stefano; Allora, Agnese; Filippo, Luigi di; Formenti, Anna Maria; Loli, Paola; Polizzi, Elisabetta; Tradati, Daniele; Ulivieri, Fabio Massimo; Giustina, Andrea

doi:10.1016/j.beem.2021.101515

Cited by 20 publications

(16 citation statements)

References 179 publications

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“…Interestingly, patients with a wide range of pituitary diseases were consistently reported in the last two decades to be burdened by a very high prevalence of morphometric VFs [36]. Specifically, prevalent VFs were found in one third to half of patients with acromegaly [37], Cushing disease [38], TSHsecreting adenomas [39] and hypopituitarism [40] equally in both sexes. Moreover, in acromegaly and hypopituitarism an increased incidence of VFs was also reported [41,42].…”

Section: Vertebral Fractures (Vfs)mentioning

confidence: 99%

COVID-19 and the pituitary

et al. 2021

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Background Despite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to the severity of the clinical presentation. Systemic involvement in COVID-19 is due to the ubiquitous expression of angiotensin-converting enzyme 2 (ACE2) receptor, responsible for the entry in the cells of SARS-CoV-2, Several reports in humans and animal models showed a significant ACE2 mRNA expression in hypothalamus and pituitary cells. Moreover, higher mortality and poorer outcomes have been widely described in COVID-19 patients with obesity, diabetes and vertebral fractures, which are all highly prevalent in subjects with pituitary dysfunctions. Aim To review the main endocrine manifestations of COVID-19 with their possible implications for pituitary diseases, the possible direct and indirect involvement of the pituitary gland in COVID-19, the impact of COVID-19 on the management of established pituitary diseases which can be already at increased risk for worse outcomes and on neurosurgical activities as well as vaccination. Conclusions Our review underlines that there could be a specific involvement of the pituitary gland which fits into a progressively shaping endocrine phenotype of COVID-19. Moreover, the care for pituitary diseases need to continue despite the restrictions due to the emergency. Several pituitary diseases, such as hypopituitarism and Cushing disease, or due to frequent comorbidities such as diabetes may be a risk factor for severe COVID-19 in affected patients. There is the urgent need to collect in international multicentric efforts data on all these aspects of the pituitary involvement in the pandemic in order to issue evidence driven recommendations for the management of pituitary patients in the persistent COVID-19 emergency.

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Section: Vertebral Fractures (Vfs)mentioning

confidence: 99%

COVID-19 and the pituitary

et al. 2021

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“…We can speculate that, besides the small percentage of cases with a genetically-determined coexistence of ACAs and meningiomas, an abnormal circulating steroidal milieu due to the adrenal mass may promote the development, the recurrence and the dimensional growing of a meningioma. In this setting, a relevant issue is represented by ACAs showing a subtle, apparently subclinical autonomous function with potentially negative clinical implications [ 44 , 45 ], for instance those associated with low DHEAS and/or ACTH levels or a partial cortisol inhibition after overnight dexamethasone [ 46 – 49 ].…”

Section: Discussionmentioning

confidence: 99%

High prevalence of adrenal cortical adenomas in patients with cerebral meningiomas

Filippo

Marca

Losa

et al. 2022

J Endocrinol Invest

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Purpose Adrenal cortical adenomas (ACAs) represent one of the most common endocrine neoplasms. Recently, a genetic syndrome, characterized by tumor-suppressor ARMC5-gene mutations and causing primary macronodular bilateral adrenal hyperplasia with concomitant meningiomas of the central nervous system, has been described. Apart from this rare disorder and despite the well-known influence of steroid hormones on meningiomas, no data are available about the association between ACAs and meningiomas. Methods We investigated the prevalence of ACAs in a group of patients with cerebral meningioma undergoing unenhanced chest CT scans before attending surgical treatment. Patients with meningioma were age- and sex-matched in a 1:3 ratio with hospitalized patients for COVID-19. Results Fifty-six patients with meningioma were included and matched with 168 control patients with COVID-19. One-hundred forty-four (66.1%) were female and the median age was 63 years. Twenty ACAs were detected in the overall population (8.9% of the subjects): 10 in patients with meningioma (18%) and the remaining 10 (6%) in the control group ( p = 0.007). Multivariate analysis showed that age and presence of meningioma were statistically associated with the presence of ACAs ( p = 0.01, p = 0.008). Conclusion We report, for the first time, a higher prevalence of ACAs in patients with meningioma as compared to age- and sex-matched controls. Larger studies are needed to confirm our data and to clarify the characteristics of the ACAs in patients with meningioma. Whether the detection of ACAs should prompt a neuroimaging evaluation to exclude the presence of meningiomas needs also to be considered.

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“…Skeletal fragility due to long-term suppressed bone formation may be a direct result of cortisol excess or an indirect effect of suppressed GH/IGF-1 and hypothalamic-pituitary-gonadal axes as well as disrupted PTH pulsatility ( 390 ). Fractures may occur with normal bone mineral density as the quality of bone is deleteriously affected by cortisol excess ( 391 ) The protein catabolism of hypercortisolism causes myopathy, reducing physical capacity and function and quality of life. Myopathy may not recover after successful surgery in patients with low IGF-1 ( 392 , 393 ).…”

Section: Long-term Comorbidities and Mortality Outcomesmentioning

confidence: 99%

Clinical Biology of the Pituitary Adenoma

et al. 2022

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All endocrine glands are susceptible to neoplastic growth, yet the health consequences of these neoplasms differ between endocrine tissues. Pituitary neoplasms are highly prevalent and overwhelmingly benign, exhibiting a spectrum of diverse behaviors and impact on health. To understand the clinical biology of these common yet often innocuous neoplasms, we review pituitary physiology, and adenoma epidemiology, pathophysiology, behavior, and clinical consequences. The anterior pituitary develops in response to a range of complex brain signals integrating with intrinsic ectodermal cell transcriptional events that together determine gland growth, cell type differentiation, and hormonal production, in turn maintaining optimal endocrine health. Pituitary adenomas occur in ten percent of the population; however, the overwhelming majority remain harmless during life. Triggered by somatic or germline mutations, disease-causing adenomas manifest pathogenic mechanisms that disrupt intra-pituitary signaling to promote benign cell proliferation associated with chromosomal instability. Cellular senescence acts as a mechanistic buffer protecting against malignant transformation, an extremely rare event. It is estimated that fewer than one thousandth of all pituitary adenomas cause clinically significant disease. Adenomas variably and adversely affect morbidity and mortality depending on cell type, hormone secretory activity, and growth behavior. For most clinically apparent adenomas, multimodal therapy controlling hormone secretion and adenoma growth lead to improved quality of life and normalized mortality. The clinical biology of pituitary adenomas and particularly their benign nature stands in marked contrast to other tumors of the endocrine system such as thyroid and neuroendocrine tumors.

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Osteopathy in mild adrenal Cushing’s syndrome and Cushing disease

Cited by 20 publications

References 179 publications

COVID-19 and the pituitary

COVID-19 and the pituitary

High prevalence of adrenal cortical adenomas in patients with cerebral meningiomas

Clinical Biology of the Pituitary Adenoma

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