News & Updates

Subscribe to News & Updates feed News & Updates
NCBI: db=pubmed; Term=adrenal tumor
Updated: 3 days 10 hours ago

Molecular markers and targeted therapies for adrenocortical carcinoma.

Tue, 09/30/2014 - 17:03
Related Articles

Molecular markers and targeted therapies for adrenocortical carcinoma.

Clin Endocrinol (Oxf). 2014 Feb;80(2):159-68

Authors: Xu Y, Qi Y, Zhu Y, Ning G, Huang Y

Abstract
Adrenocortical carcinoma (ACC) is a lethal disease with poor prognosis and lack of effective therapeutic options. Systemic treatment is often employed to treat patients with advanced ACC, but outcomes are disappointing. During the last decade, some of the causative genetic mutations in sporadic ACCs have been identified. Molecular analysis has had a significant impact on the understanding of the pathogenetic mechanism of ACC development and the evaluation of prognostic and predictive markers. Preclinical investigations and clinical trials of tyrosine kinase inhibitors and anti-angiogenic compounds have been initiated to seek target therapy of ACCs. This review summarizes the current view of molecular alterations involved in the pathophysiology of adrenocortical carcinogenesis. The rationale for testing targeted therapies of ACC is also presented.

PMID: 24304415 [PubMed - indexed for MEDLINE]

[Adrenalectomy for adrenal metastases: Is the laparoscopic approach beneficial for all patients?]

Tue, 09/23/2014 - 15:08
Related Articles

[Adrenalectomy for adrenal metastases: Is the laparoscopic approach beneficial for all patients?]

Prog Urol. 2014 Sep 18;

Authors: Peyronnet B, Tanguy L, Corre R, Léna H, Galland F, Guilhem I, Mathieu R, Verhoest G, Vincendeau S, Rioux-Leclercq N, Bensalah K, Manunta A

Abstract
INTRODUCTION: Laparoscopy has become the gold-standard approach for excision of benign adrenal tumors but the question of its safety for malignant lesions is still controversial. Our aim was to evaluate the oncologic outcome of laparoscopic adrenalectomy for adrenal metastasis and to look for predictors of a negative surgical outcome.
PATIENTS AND METHODS: We retrospectively reviewed the charts of all patients who underwent laparoscopic adrenalectomy for suspicion of adrenal metastasis between 2007 and 2013 at a single academic institution. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Univariate analysis was performed to determine risk factors of negative surgical outcome (positive surgical margins, complications, conversion, significant blood loss) and predictors of RFS and CSS.
RESULTS: Thirteen patients underwent 14 laparoscopic adrenalectomies. All patients were operated by a single highly experienced surgeon. Complications occurred in 2 patients (15%): 2 blood transfusions (Clavien-score=2). There were 3 positive surgical margins (21%). Mean length of hospital stay was 4.3 days. Unadjusted RFS and CSS were respectively 48.4% and 83.3% at 1 year, 39.5% and 66.7% at 5 years. In univariate analysis, tumor size was the only risk factor of complication (P=.009) and conversion (P=0.009). Capsule invasion and tumor size were risk factors of positive surgical margins (P=0.01 and P<0.0001). One hundred percent of complications, conversion and positive surgical margins occurred in tumor>7.5cm on preoperative CT-scan. No predictors of RFS and CSS was found in univariate analysis.
CONCLUSION: Laparoscopic adrenalectomy for adrenal metastasis achieves good surgical and oncologic outcomes. When performed by highly experienced surgeon, complications and positive surgical margins occur only in tumors>7.5cm. These patients may benefit from an open surgical approach.
LEVEL OF EVIDENCE: 5.

PMID: 25242339 [PubMed - as supplied by publisher]

Death in pediatric Cushing syndrome is uncommon but still occurs.

Tue, 09/23/2014 - 15:08
Related Articles

Death in pediatric Cushing syndrome is uncommon but still occurs.

Eur J Pediatr. 2014 Sep 23;

Authors: Gkourogianni A, Lodish MB, Zilbermint M, Lyssikatos C, Belyavskaya E, Keil MF, Stratakis CA

Abstract
Cushing syndrome (CS) in children is rare. Delayed diagnosis and treatment of CS may be associated with increased morbidity and, unfortunately, mortality. We performed a retrospective review of all patients with CS under the age of 18 years referred to the National Institutes of Health (NIH) from 1998 to 2013 in order to describe deceased patients among cases of pediatric CS referred to the National Institutes of Health (NIH). The deaths of four children (three females and one male), aged 7.5-15.5 years (mean age 11.2 years) with length of disease 2-4 years, were recorded among 160 (2.5 %) children seen at or referred to the NIH over the last 15 years. All died at different institutions, prior to coming to the NIH (two) or after leaving NIH (two). Presenting symptoms included increasing weight and decreasing height gain, facial plethora, dorsocervical fat pad (webbed neck), striae, headache, vision disturbances, and depression and other mood or behavior changes; there were no differences between how these patients presented and the others in our cohort. The causes of CS in the deceased patients were also not different, in fact, they spanned the entire spectrum of CS: pituitary disease (one), ectopic corticotropin production (one), and primary adrenal hyperplasia (one). In one patient, the cause of CS could not be verified. Three died of sepsis and one due to residual disease and complications of the primary tumor. Conclusions: Despite the advances in early diagnosis and treatment of pediatric CS, a 2.5 % mortality rate was identified in a large cohort of patients with this condition referred to an experienced, tertiary care referral center (although these deaths occurred elsewhere). Pediatricians need to recognize the possibility of death, primarily due to sepsis, in a patient with pediatric CS and treat accordingly.

PMID: 25241829 [PubMed - as supplied by publisher]

Number of liver metastatic nodules affects treatment options for pulmonary adenocarcinoma patients with liver metastases.

Tue, 09/23/2014 - 15:08
Related Articles

Number of liver metastatic nodules affects treatment options for pulmonary adenocarcinoma patients with liver metastases.

Lung Cancer. 2014 Sep 16;

Authors: Tseng SE, Chiou YY, Lee YC, Perng RP, Jacqueline WP, Chen YM

Abstract
BACKGROUND: In patients with non-small cell lung cancer (NSCLC), the development of liver metastasis (LM) is a poor prognostic factor. Whether systemic treatment combined with local treatment for LM has benefit for NSCLC patients with LM is unknown.
METHODS: We retrospectively reviewed and analyzed the clinical data and tumor epidermal growth factor receptor (EGFR) mutation status of 673 pulmonary adenocarcinoma patients, including 85 patients who developed LM at any time point in the course of the disease. Radiofrequency ablation (RFA) with real-time ultrasonographic guidance was used for local treatment of LM in these patients, if appropriate.
RESULTS: Patients with an EGFR mutation were more prone to having synchronous LM than patients with EGFR wild-type (50.0% vs. 23.5%, P=0.019). Fifty-six patients (65.9%) had ≦5 LM nodules. The median overall survival (OS) of patients with ≦5 LM nodules was 7.6 months compared with 2.9 months for those with multiple nodules (P<0.001). The independent prognostic factors after LM were performance status, EGFR mutation, synchronous LM and LM numbers. The independent prognostic factors for patients with ≦5 LM nodules were performance status, EGFR mutation, LM concomitant with adrenal metastasis and having received RFA. Patients who received RFA treatment (n=6) had longer OS after LM than those without RFA treatment (n=42) (23.1 vs. 7.9 months, P=0.035).
CONCLUSIONS: We recommend that patients with a better performance status and ≦5 LM nodules be considered for systemic treatment combined with RFA when LM develops.

PMID: 25240517 [PubMed - as supplied by publisher]

A new risk stratification algorithm for the management of patients with adrenal incidentalomas.

Tue, 09/23/2014 - 15:08
Related Articles

A new risk stratification algorithm for the management of patients with adrenal incidentalomas.

Surgery. 2014 Oct;156(4):959-66

Authors: Birsen O, Akyuz M, Dural C, Aksoy E, Aliyev S, Mitchell J, Siperstein A, Berber E

Abstract
BACKGROUND: Although adrenal incidentalomas (AI) are detected in ≤5% of patients undergoing chest and abdominal computed tomography (CT), their management is challenging. The current guidelines include recommendations from the National Institutes of Health, the American Association of Endocrine Surgeons (AAES), and the American Association for Cancer Education (AACE). The aim of this study was to develop a new risk stratification model and compare its performance against the existing guidelines for managing AI.
METHODS: A risk stratification model was designed by assigning points for adrenal size (1, 2, or 3 points for tumors <4, 4-6, or >6 cm, respectively) and Hounsfield unit (HU) density on noncontrast CT (1, 2, or 3 points for HU <10, 10-20, or >20, respectively). This model was applied retrospectively to 157 patients with AI managed in an endocrine surgery clinic to assign a score to each tumor. The utility of this model versus the AAES/AACE guidelines was assessed.
RESULTS: Of the 157 patients, 54 (34%), had tumors <4 cm with HU <10 (a score of 2). One third of these were hormonally active on biochemical workup and underwent adrenalectomy. The remaining two thirds were nonsecretory lesions and have been followed conservatively with annual testing. In 103 patients (66%), the adrenal mass was >4 cm and/or had indeterminate features on noncontrast CT (HU >10, irregular borders, heterogeneity), and adrenalectomy was performed after hormonal evaluation was completed (10 were hormonally active on biochemical testing). Seven of these patients (7%) had adrenocortical cancer on final pathology with tumor size <4 cm in 0, 4-6 cm in 1, and >6 cm in 5 patients. Of the hormonally inactive patients, 32% had a score of 3, 38% 4, and 30% 5 or 6. The incidence of adrenocortical cancer in these subgroups was 0, 0, and 25%, respectively.
CONCLUSION: This study shows that an algorithm that utilizes the hormonal activity at the first decision step followed by a consolidated risk stratification, based on tumor size and HU density, has a potential to spare a substantial number of patients from unnecessary "diagnostic" surgery for AI.

PMID: 25239353 [PubMed - in process]

Phaeochromocytoma and paraganglioma: next-generation sequencing and evolving Mendelian syndromes.

Tue, 09/23/2014 - 15:08
Related Articles

Phaeochromocytoma and paraganglioma: next-generation sequencing and evolving Mendelian syndromes.

Clin Med. 2014 Aug;14(4):440-4

Authors: Maher ER

PMID: 25099851 [PubMed - indexed for MEDLINE]

Therapy of endocrine disease: treatment of malignant pheochromocytoma and paraganglioma.

Tue, 09/23/2014 - 15:08
Related Articles

Therapy of endocrine disease: treatment of malignant pheochromocytoma and paraganglioma.

Eur J Endocrinol. 2014 Sep;171(3):R111-22

Authors: Baudin E, Habra MA, Deschamps F, Cote G, Dumont F, Cabanillas M, Arfi-Roufe J, Berdelou A, Moon B, Al Ghuzlan A, Patel S, Leboulleux S, Jimenez C

Abstract
Metastatic pheochromocytomas and paragangliomas (MPPs) present clinicians with three major challenges: scarcity, complexity of characterization, and heterogeneous behavior and prognosis. As with the treatment for all neuroendocrine tumors, the control of hormonal symptoms and tumor growth is the main therapeutic objective in MPP patients. A significant number of MPP patients still die from uncontrolled hormone secretion. In addition, the management of MPPs remains palliative. Steps forward include proper characterization of MPP patients at large cancer referral centers with multidisciplinary teams; improved strategies to stratify patients prognostically; and implementation of trials within national and international networks. Progress in the molecular characterization and staging of MPPs constitutes the basis for significant treatment breakthroughs.

PMID: 24891137 [PubMed - indexed for MEDLINE]

MicroRNA expression patterns in adrenocortical carcinoma variants and clinical pathologic correlations.

Tue, 09/23/2014 - 15:08
Related Articles

MicroRNA expression patterns in adrenocortical carcinoma variants and clinical pathologic correlations.

Hum Pathol. 2014 Aug;45(8):1555-62

Authors: Duregon E, Rapa I, Votta A, Giorcelli J, Daffara F, Terzolo M, Scagliotti GV, Volante M, Papotti M

Abstract
Several microRNAs (miRNAs) were shown to be deregulated in adrenocortical carcinoma (ACC) as compared with adenoma, but a detailed assessment of their expression in its histologic variants and correlation with clinicopathologic characteristics has not been performed, so far. Our aim was to assess the expression of 5 selected miRNAs (IGF2 gene-related miR-483-3p and 5p and hypoxia-induced miR-210, miR-195, and miR-1974) in a series of 51 ACCs (35 classical, 6 myxoid, and 10 oncocytic) as compared with clinical and pathologic features and immunohistochemical expression of prognostic markers, including steroidogenic factor 1, p53, β-catenin, and glucose transporter 1. Oncocytic carcinomas had a reduced expression of miR-483-3p (P = .0325), miR-483-5p (P = .0175), and miR-210 (P = .0366), as compared with other histotypes. Overexpression of miR-210 was associated with the presence of necrosis (P = .0035), high Ki-67 index (P = .0013), and high glucose transporter 1 expression (P = .0043), whereas an inverse correlation with mitotic rate was observed in cases with high miR-493-3p (P = .0191) and miR-1974 (P = .0017) expression. High miR-1974 was also associated with low Ki-67 (P = .0312) and European Network for the Study of Adrenal Tumors stage (P = .0082) and negative p53 (P = .0013). At univariate analysis myxoid/classic histotype (P = .026), high miR-210 (P = .0465), high steroidogenic factor 1 protein (P = .0017), high Ki-67 (P = .0066), and high mitotic index (P = .0006) were significantly associated the shorter overall survival, the latter being the sole independent prognostic factor at multivariate analysis (P = .017). In conclusion, (a) miR-483-3p, miR-483-5p, and miR-210 are differentially expressed in ACC variants, and (b) high miR-210 is associated with clinicopathologic parameters of aggressiveness and a poor prognosis.

PMID: 24890943 [PubMed - indexed for MEDLINE]

Adiponectin regulates ACTH secretion and the HPAA in an AMPK-dependent manner in pituitary corticotroph cells.

Tue, 09/23/2014 - 15:08
Related Articles

Adiponectin regulates ACTH secretion and the HPAA in an AMPK-dependent manner in pituitary corticotroph cells.

Mol Cell Endocrinol. 2014 Mar 5;383(1-2):118-25

Authors: Chen M, Wang Z, Zhan M, Liu R, Nie A, Wang J, Ning G, Ma Q

Abstract
It is known that adipokines can regulate the hypothalamic-pituitary-adrenal axis (HPAA). In this study, we confirmed that adiponectin regulates the HPAA by affecting pituitary corticotroph cells. Using RT-PCR and immunofluorescence, we determined that adiponectin receptors were expressed in pituitary corticotroph tumour cells (AtT-20 cells and human corticotroph tumours). Adiponectin stimulated calcium influx and increased basal ACTH secretion without affecting corticotrophin-releasing hormone (CRH)-stimulated ACTH secretion, which was most likely due to the expression of adiponectin repressing CRH receptor 1 (CRHR1). Adiponectin also acutely stimulated ACTH release in primary culture pituitary cells. Lastly, adiponectin directly phosphorylated 5' AMP-activated protein kinase (AMPK) in AtT-20 cells. The effects of adiponectin were mimicked by AICAR, which was blocked by compound C. Taken together, our results suggested that adiponectin stimulated ACTH secretion and down-regulated CRHR1, possibly via an AMPK-dependent mechanism in pituitary corticotroph cells.

PMID: 24361598 [PubMed - indexed for MEDLINE]

Predictors of malignancy in primary aldosteronism.

Tue, 09/23/2014 - 15:08
Related Articles

Predictors of malignancy in primary aldosteronism.

Langenbecks Arch Surg. 2014 Jan;399(1):93-8

Authors: Agha A, Hornung M, Iesalnieks I, Schreyer A, Jung EM, Haneya A, Schlitt HJ

Abstract
INTRODUCTION: Primary aldosteronism (PA, also Conn syndrome) is a benign disease in majority of cases. However, malignant transformation has been described. Present study reports on three cases of aldosterone producing adrenocortical carcinoma (APAC) in comparison to patients with benign PA.
PATIENTS AND METHODS: Data of patients undergoing adrenalectomy for benign PA were compared to patients with APAC. Retrospective chart analysis was performed. All patients received spironolactone for 6-8 weeks preoperatively.
RESULTS: Seventy-four patients underwent adrenalectomy for PA between 1994 and 2011. Three of them revealed an APAC. Patients with APAC presented with a significantly lower serum potassium level (1.7 mmol/l vs. 3.4 mmol/l, p = 0.001) and significant larger tumors (5.2 vs. 1.8 cm, p = 0.002). In addition, aldosterone/renin (A/R) ratio 675 in patients with APAC as compared to 74 in patients with benign PA (p = 0.0001). Sixty-eight of 71 patients with benign PA underwent minimal invasive surgery, whereas all three patients with APAC were operated conventionally. All patients with APAC developed disease recurrence 6-18 months postoperatively.
CONCLUSION: Tumor size >4 cm and a very high A/R ratio seems to predictors of malignancy in patients with PA. If these criteria are present, open adrenalectomy should be performed instead of endoscopic procedure.

PMID: 24048685 [PubMed - indexed for MEDLINE]

Quercetin-3-O-glucuronide inhibits noradrenaline-promoted invasion of MDA-MB-231 human breast cancer cells by blocking β₂-adrenergic signaling.

Tue, 09/16/2014 - 15:02
Related Articles

Quercetin-3-O-glucuronide inhibits noradrenaline-promoted invasion of MDA-MB-231 human breast cancer cells by blocking β₂-adrenergic signaling.

Arch Biochem Biophys. 2014 Sep 1;557:18-27

Authors: Yamazaki S, Miyoshi N, Kawabata K, Yasuda M, Shimoi K

Abstract
Endogenous catecholamines such as adrenaline (A) and noradrenaline (NA) are released from the adrenal gland and sympathetic nervous system during exposure to stress. The adrenergic system plays a central role in stress signaling, and excessive stress was found to be associated with increased production of reactive oxygen species (ROS). Overproduction of ROS induces oxidative damage in tissues and causes the development of diseases such as cancer. In this study, we investigated the effects of quercetin-3-O-glucuronide (Q3G), a circulating metabolite of quercetin, which is a type of natural flavonoid, on the catecholamine-induced β2-adrenergic receptor (β2-AR)-mediated response in MDA-MB-231 human breast cancer cells expressing β2-AR. Treatment with A or NA at concentrations above 1μM generated significant levels of ROS, and NA treatment induced the gene expression of heme oxygenase-1 (HMOX1), and matrix metalloproteinase-2 (MMP-2) and -9 (MMP9). Inhibitors of p38 MAP kinase (SB203580), cAMP-dependent protein kinase (PKA) (H-89), activator protein-1 (AP-1) transcription factor (SR11302), and NF-κB and AP-1 (Tanshinone IIA) decreased MMP2 and MMP9 gene expression. NA also enhanced cAMP induction, RAS activation and phosphorylation of ERK1/2. These results suggested that the cAMP-PKA, MAPK, and ROS-NF-κB pathways are involved in β2-AR signaling. Treatment with 0.1μM Q3G suppressed ROS generation, cAMP and RAS activation, phosphorylation of ERK1/2 and the expression of HMOX1, MMP2, and MMP9 genes. Furthermore, Q3G (0.1μM) suppressed invasion of MDA-MB-231 breast cancer cells and MMP-9 induction, and inhibited the binding of [(3)H]-NA to β2-AR. These results suggest that Q3G may function to suppress invasion of breast cancer cells by controlling β2-adrenergic signaling, and may be a dietary chemopreventive factor for stress-related breast cancer.

PMID: 24929186 [PubMed - indexed for MEDLINE]

[Analysis of characteristics of renin, aldosterone and aldosterone/renin ratio in patients with aldosterone-producing adenoma].

Tue, 09/16/2014 - 15:02
Related Articles

[Analysis of characteristics of renin, aldosterone and aldosterone/renin ratio in patients with aldosterone-producing adenoma].

Zhonghua Yi Xue Za Zhi. 2013 Nov 12;93(42):3379-83

Authors: He YB, Yu X, Zhou XR, Shu BH, Liu JH

Abstract
OBJECTIVE: To characterize the plasma renin activity (PRA) and plasma aldosterone concentration (PAC) and aldosterone/renin ratio (ARR) in patients with aldosterone-producing adenoma (APA).
METHODS: We retrospectively analysed the data of PRA, PAC and ARR from 80 patients with APA, 70 patients with essential hypertension (EH) and 26 individuals with normal blood pressure (NBP). Patients with hypertension were further divided into taking anti-hypertensive drug group (D) and non drug treatment group (ND). All participants received at least one following tests:ARR screening test, supine-upright position test and saline load test.Receiver-operating characteristic (ROC) analysis was used for exploring the best cut-off value of ARR and low PRA.
RESULTS: The median and percentages of PRA (ng×ml(-1)×h(-1), 1 ng×ml(-1)×h(-1) = 1 µg×L(-1)×h(-1)), PAC (ng/dl, 1 ng/dl = 27.7 pmol/L) and ARR (ng×dl(-1)/ng×ml(-1)×h(-1)) between NBP and EH (ND) groups showed no differences.Over 90% supine PRA ≥ 0.52 and 100% upright PRA ≥ 0.52 in the above two groups. On the contrary, 90% APA (ND) patients upright PRA <0.52. The lowest supine and upright ARR in APA (ND) patients was ≥ 24.2 and ≥ 37.5 respectively. ROC analysis suggested that the best screening cut-off values for APA were supine ARR ≥ 26.0, upright ARR ≥ 37.0; and low PRA cut-off value for APA were supine PRA <0.50 and upright PRA < 0.63 respectively. The sensitivity and specificity for APA diagnosis were about 88.2% and 61.5% when PAC ≥ 10.0 after saline load test.
CONCLUSIONS: The distinguishing features of PRA, PAC and ARR can be used as a diagnostic indexs for the exclusive diagnosis of APA in various clinical tests. And low PRA cut-off values exist in APA patients.

PMID: 24418036 [PubMed - indexed for MEDLINE]

Calculating optimal surveillance for detection of von Hippel-Lindau-related manifestations.

Sat, 09/13/2014 - 18:03
Related Articles

Calculating optimal surveillance for detection of von Hippel-Lindau-related manifestations.

Endocr Relat Cancer. 2014 Feb;21(1):63-71

Authors: Kruizinga RC, Sluiter WJ, de Vries EG, Zonnenberg BA, Lips CJ, van der Horst-Schrivers AN, Walenkamp AM, Links TP

Abstract
von Hippel-Lindau (VHL) mutation carriers develop benign and malignant tumors, requiring regular surveillance. The aim of this study was to calculate the optimal organ-specific age to initiate surveillance and optimal intervals to detect initial and subsequent VHL-related manifestations. In this study, we compare these results with the current VHL surveillance guidelines. We collected data from 82 VHL mutation carriers in the Dutch VHL surveillance program. The cumulative proportion of carriers diagnosed with a first VHL-related manifestation was estimated by the Kaplan-Meier method. The Poisson distribution model was used to calculate average time to detection of the first VHL-related manifestation and subsequent manifestations. We used this to calculate the optimal organ-specific age to initiate surveillance and the surveillance interval that results in a detection probability of 5%. The calculated organ-specific ages to initiate surveillance were 0 years (birth) for adrenal glands, 7 years for the retina, 14 years for the cerebellum, 15 years for the spinal cord, 16 years for pancreas, and 18 years for the kidneys. The calculated surveillance intervals were 4 years for the adrenal glands, biennially for the retina and pancreas, and annually for the cerebellum, spinal cord, and kidneys. Compared with current VHL guidelines, the calculated starting age of surveillance was 6 years later for the retina and 5 years earlier for adrenal glands. The surveillance intervals were two times longer for the retina and four times longer for the adrenal glands. To attain a 5% detection probability rate per organ, our mathematical model indicates that several modifications of current VHL surveillance guidelines should be considered.

PMID: 24132471 [PubMed - indexed for MEDLINE]

Infection risk in rheumatoid arthritis and spondyloarthropathy patients under treatment with DMARDs, corticosteroids and TNF-α antagonists.

Sat, 09/06/2014 - 17:41
Related Articles

Infection risk in rheumatoid arthritis and spondyloarthropathy patients under treatment with DMARDs, corticosteroids and TNF-α antagonists.

J Transl Med. 2014;12:77

Authors: Germano V, Cattaruzza MS, Osborn J, Tarantino A, Di Rosa R, Salemi S, D'Amelio R

Abstract
BACKGROUND: Infections which complicate rheumatic diseases such as Rheumatoid Arthritis (RA) and Spondyloarthropathy (SpA) (Psoriatic Arthritis [PA] and Ankylosing Spondylitis [AS]), may cause significant morbidity and mortality. However, among the studies on the incidence rate (IR) of infections in such patients, very few have involved controls and the results have been controversial, probably due to methodological difficulties.To estimate infection rates in RA and SpA patients under disease-modifying anti-rheumatic drugs (DMARDs), corticosteroids (CS) and tumor necrosis factor (TNF)α antagonists, alone or combined, a single-centre retrospective observational cohort study has been performed.
PATIENTS AND METHODS: Incidence rates/100 patient-years of any infections were evaluated in RA and SpA outpatients observed in the period November 1, 2003 through December 31, 2009 and stratified according to therapy. Infection incidence rate ratios (IRR) were calculated using Poisson regression models which adjusted for demographic/clinical characteristics of the patients.
RESULTS: Three hundred and thirtyone infections [318 (96.1%) non-serious and 13 (3.9%) serious] have been registered among 176 of the 341 patients (52%). The IR/100 patient-years of all infections was 36.3 ranging from 12.4 (DMARDs + CS) to 62.7 (anti-TNFα + CS). The most frequent infection site was respiratory tract, and bacteria were responsible for three quarters of all infections. In the multivariate analysis, adding anti-TNFα to DMARDs doubled the IRR compared to DMARDs alone, anti-TNFα + CS significantly tripled it, whereas anti-TNFα + CS + DMARDs only increased the risk 2.5 times. The degree of disease activity was strongly and significantly associated with the infection risk (severe or moderate versus mild, IRR = 4). Female sex was significantly associated with increased infection risk, while duration of disease and anti-influenza vaccination were protective, the latter even for cutaneous/soft-tissue (mainly herpetic) infections.
CONCLUSION: The combination anti-TNFα with CS was found to be the most pro-infective treatment, whereas DMARDs alone were relatively safe. Physicians, therefore, should be aware that there may be an increased risk of infection when using anti-TNFα and CS therapy together. Anti-influenza vaccination appears to provide broad protection, adding evidence to support its use in these patients, and deserves further study.

PMID: 24655394 [PubMed - indexed for MEDLINE]

Palliative intensity modulated radiation therapy for symptomatic adrenal metastasis.

Sat, 09/06/2014 - 17:41
Related Articles

Palliative intensity modulated radiation therapy for symptomatic adrenal metastasis.

J Nepal Health Res Counc. 2013 May;11(24):212-4

Authors: Mod H, Patel V

Abstract
Metastasis to the adrenal glands is quite common; especially from melanomas, breast, lung, renal and gastro-intestinal tumours. The most common tumour found in the adrenals in post mortem series is a metastatic tumour; incidence ranging from 13 to 27%. The diagnosis of adrenal metastasis is now more common and easier due to staging and subsequent follow up with Computed tomography /Magnetic resonance imaging and or positron emission tomography-computed tomography imaging studies. Most of the times these metastatic lesions are clinically occult and those that do have clinical symptoms complain of pain, nausea, vomiting and early satiety. We irradiated a patient of non small cell lung cancer with adrenal metastasis with palliative Intensity Modulated Radiation Therapy and achieved a good response in terms of pain relief, stable disease and no side effects of the treatment.

PMID: 24362614 [PubMed - indexed for MEDLINE]

Osteoporosis in psoriatic arthritis: an assessment of densitometry and fragility fractures.

Sat, 08/30/2014 - 14:42
Related Articles

Osteoporosis in psoriatic arthritis: an assessment of densitometry and fragility fractures.

Clin Rheumatol. 2013 Dec;32(12):1799-804

Authors: Riesco M, Manzano F, Font P, García A, Nolla JM

PMID: 23846386 [PubMed - indexed for MEDLINE]

Colorectal cancer with multiple metachronous metastasis achieving complete remission 14 years after surgical resection: report of a case.

Sat, 08/30/2014 - 14:42
Related Articles

Colorectal cancer with multiple metachronous metastasis achieving complete remission 14 years after surgical resection: report of a case.

Int Surg. 2013 Jan-Mar;98(1):49-54

Authors: Murono K, Kawai K, Kazama S, Tsuno NH, Sunami E, Kitayama J, Watanabe T

Abstract
A 63-year-old man underwent a colectomy for sigmoid colon cancer in 1997. The upper lobe of his left lung and his left adrenal gland were resected because of metachronous metastases, 7 and 10 years after the initial surgery, respectively. Recurrence of metastases to the middle lobe of the right lung and left adrenal gland were sequentially detected in 2007, and a multimodal therapy, consisting of the combination of radiotherapy and chemotherapy, was conducted since 2007. The chemotherapy included drugs such as FOLFOX, FOLFIRI, bevacizumab, capecitabine, and cetuximab. In 2011, the complete response of all metastatic lesions could be achieved, and no recurrence was detected for more than 1 year. In spite of repeated recurrences, by the combination of surgical resection, chemotherapy, and radiotherapy, the complete response could be achieved 14 years after the initial surgical resection, which can be attributed to the development of new treatment modalities and new agents for colorectal cancer.

PMID: 23438276 [PubMed - indexed for MEDLINE]

CYP2W1 Is Highly Expressed in Adrenal Glands and Is Positively Associated with the Response to Mitotane in Adrenocortical Carcinoma.

Sat, 08/23/2014 - 12:51
Related Articles

CYP2W1 Is Highly Expressed in Adrenal Glands and Is Positively Associated with the Response to Mitotane in Adrenocortical Carcinoma.

PLoS One. 2014;9(8):e105855

Authors: Ronchi CL, Sbiera S, Volante M, Steinhauer S, Scott-Wild V, Altieri B, Kroiss M, Bala M, Papotti M, Deutschbein T, Terzolo M, Fassnacht M, Allolio B

Abstract
BACKGROUND: Adrenocortical tumors comprise frequent adenomas (ACA) and rare carcinomas (ACC). Human cytochrome P450 2W1 (CYP2W1) is highly expressed in some cancers holding the potential to activate certain drugs into tumor cytotoxins.
OBJECTIVE: To investigate the CYP2W1 expression in adrenal samples and its relationship with clinical outcome in ACC.
MATERIAL AND METHODS: CYP2W1 expression was investigated by qRT-PCR in 13 normal adrenal glands, 32 ACA, 25 ACC, and 9 different non-adrenal normal tissue samples and by immunohistochemistry in 352 specimens (23 normal adrenal glands, 33 ACA, 239 ACC, 67 non-adrenal normal or neoplastic samples).
RESULTS: CYP2W1 mRNA expression was absent/low in normal non-adrenal tissues, but high in normal and neoplastic adrenal glands (all P<0.01 vs non-adrenal normal tissues). Accordingly, CYP2W1 immunoreactivity was absent/low (H-score 0-1) in 72% of non-adrenal normal tissues, but high (H-score 2-3) in 44% of non-adrenal cancers, in 65% of normal adrenal glands, in 62% of ACAs and in 50% of ACCs (all P<0.001 vs non-adrenal normal tissues), being significantly increased in steroid-secreting compared to non-secreting tumors. In ACC patients treated with mitotane only, high CYP2W1 immunoreactivity adjusted for ENSAT stage was associated with longer overall survival and time to progression (P<0.05 and P<0.01, respectively), and with a better response to therapy both as palliative (response/stable disease in 42% vs 6%, P<0.01) or adjuvant option (absence of disease recurrence in 69% vs 45%, P<0.01).
CONCLUSION: CYP2W1 is highly expressed in both normal and neoplastic adrenal glands making it a promising tool for targeted therapy in ACC. Furthermore, CYP2W1 may represent a new predictive marker for the response to mitotane treatment.

PMID: 25144458 [PubMed - as supplied by publisher]

Coexisting Differentiated Neuroblastoma and Ossifying Renal Tumor of Infancy in a Patient.

Sat, 08/23/2014 - 12:51
Related Articles

Coexisting Differentiated Neuroblastoma and Ossifying Renal Tumor of Infancy in a Patient.

Fetal Pediatr Pathol. 2014 Aug 21;

Authors: Zhu K, Yang M, Zheng Y, Zhao M, Shu Y, Zhao Y, Tang H

Abstract
We presented a 5-month-old boy with differentiated neuroblastoma and ossifying renal tumor of infancy (ORTI) arising at the left adrenal gland and upper pole of the ipsilateral kidney, respectively. They were located in the adjacent organs with different morphology and immunohistochemistry characteristics. To our best knowledge, coexistence of differentiated neuroblastoma and ORTI in a patient has never been reported. In our report, two contiguous lesions might be represented collision tumor, originated from the same clusters of immature cells and triggered by different mechanism.

PMID: 25144397 [PubMed - as supplied by publisher]

A retrospective study of surgically excised phaeochromocytomas in Newfoundland, Canada.

Sat, 08/23/2014 - 12:51
Related Articles

A retrospective study of surgically excised phaeochromocytomas in Newfoundland, Canada.

Indian J Endocrinol Metab. 2014 Jul;18(4):542-5

Authors: Holland J, Chandurkar V

Abstract
OBJECTIVE: A retrospective study detailing the circumstances surrounding diagnosis and treatment of pheochromocytomas with the associated genetic disorders.
MATERIALS AND METHODS: All patients with surgically excised pheochromocytomas in the Health Sciences Center, St. John's, Newfoundland, Canada between January 2001 and December 2010 were retrospectively analyzed to determine associated familial syndromes, age, tumor size, symptomatology, and percentage of paragangliomas and bilateral pheochromocytomas. Pathology specimen reports, adrenalectomy lists and Meditech (electronic medical record) diagnostic codes provided a comprehensive database for this study.
RESULTS: Twenty-four patients were studied; familial disorder patients comprised 42% (10/24). Average age at diagnosis was 57 among the sporadic and 34 in familial disorder groups (P = 0.006). Average tumor size was 4.5 cm in the sporadic group and 3 cm in the familial disorder group (P = 0.19). All atypical cases including bilateral or extra-adrenal tumors and malignancy occurred in familial disorder patients.
CONCLUSIONS: The proportion of familial disorder patients (42%) was higher in this study than would be expected, likely a result of the relatively high incidence of hereditary autosomal dominant disorders within Newfoundland. Among familial disorder patients, the average younger age at diagnosis and the smaller tumor size suggest syndromic pheochromocytomas may develop earlier, however they are more likely to be diagnosed sooner due to biochemical surveillance testing in known genetic disorder patients. We also demonstrate a relatively high incidence of surgically resected pheochromocytomas of 4.679/million/year in Newfoundland.

PMID: 25143914 [PubMed]

Pages