Clinical endocrinology
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Clinical endocrinology · Aug 2007
Clinical TrialLong-term (up to 18 years) effects on GH/IGF-1 hypersecretion and tumour size of primary somatostatin analogue (SSTa) therapy in patients with GH-secreting pituitary adenoma responsive to SSTa.
The role of somatostatin analogues (SSTa) in the treatment of acromegaly. ⋯ Long-term (up to 18 years) treatment with SSTa used as first-line therapy is effective from both an antihormonal and antitumour perspective, and is well tolerated in acromegalic patients.
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Clinical endocrinology · Aug 2007
Comparative StudyDoes partial surgical tumour removal influence the response to octreotide-LAR in acromegalic patients previously resistant to the somatostatin analogue?
To compare the intrapatient response to the same dose of slow-release octreotide (OCT-LAR) before and after noncurative surgery in acromegalic patients who did not attain disease control after primary treatment with OCT-LAR. ⋯ Using strict criteria (same patient, same drug, same dose) our results strongly suggest that the surgical reduction of tumour mass can improve the outcome of OCT-LAR treatment in acromegalic patients resistant to primary therapy with SA.
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Clinical endocrinology · Aug 2007
Prevalence and predictive factors of post-traumatic hypopituitarism.
To estimate the prevalence and predictive factors of hypopituitarism following traumatic brain injury (TBI). ⋯ The prevalence of hypopituitarism was estimated at 16%. Although high, this value was lower than previously reported, and may still be overestimated because of well-known confounding factors, such as obesity. Indicators of increased TBI severity were predictive of hypopituitarism, with a high negative predictive value. Neuroendocrine evaluation should therefore be considered in patients with severe TBI, and in particular in those with increased intracerebral pressure (ICP).
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Clinical endocrinology · Jun 2007
Multicenter Study Clinical TrialA prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of patients with acromegaly.
To evaluate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of acromegaly. ⋯ Octreotide LAR represents a viable alternative to surgery for primary treatment of acromegaly leading to a progressive regression of tumour volume, a sustained control of biochemical abnormalities and an adequate relief of symptoms of the disease.
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Clinical endocrinology · Jun 2007
Clinical TrialIntraoperative parathyroid hormone assay improves outcomes of minimally invasive parathyroidectomy mainly in patients with a presumed solitary parathyroid adenoma and missing concordance of preoperative imaging.
Intraoperative parathyroid hormone assay (IOPTH) is often used during minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (pHPT). However, several investigators have reported conflicting outcomes, throwing doubt on the real influence of this adjunct on surgical decision-making. The aim of this study was to determine the impact of routine use of IOPTH on the success rate of MIP as the primary outcome, and whether it value-added to surgical decision-making during the operations at our institution. ⋯ Routine use of IOPTH significantly improves cure rates of MIP in comparison to open image-guided UNE without IOPTH. It is a valuable adjunct in surgical decision-making, allowing for intraoperative recognition and resection of additional hyperfunctioning parathyroid tissue missed by preoperative imaging studies. IOPTH offers substantial value-adding to surgical decision-making, particularly in patients with only one positive imaging study result, and significantly improves the success rate of MIP in these patients. However, in patients with concordant results of two imaging studies, the assay offers significantly lower value-adding to surgical decisions, as a vast majority of patients are cured after removal of a two-image-indexed parathyroid lesion. Despite this, we strongly advocate routine use of IOPTH in all patients undergoing MIP, as this adjunct offers maximum safety for the patient and confidence for the surgeon.