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  1. Article ; Online: Machine learning-based algorithms applied to drug prescriptions and other healthcare services in the Sicilian claims database to identify acromegaly as a model for the earlier diagnosis of rare diseases.

    Crisafulli, Salvatore / Fontana, Andrea / L'Abbate, Luca / Vitturi, Giacomo / Cozzolino, Alessia / Gianfrilli, Daniele / De Martino, Maria Cristina / Amico, Beatrice / Combi, Carlo / Trifirò, Gianluca

    Scientific reports

    2024  Volume 14, Issue 1, Page(s) 6186

    Abstract: Acromegaly is a rare disease characterized by a diagnostic delay ranging from 5 to 10 years from the symptoms' onset. The aim of this study was to develop and internally validate machine-learning algorithms to identify a combination of variables for the ... ...

    Abstract Acromegaly is a rare disease characterized by a diagnostic delay ranging from 5 to 10 years from the symptoms' onset. The aim of this study was to develop and internally validate machine-learning algorithms to identify a combination of variables for the early diagnosis of acromegaly. This retrospective population-based study was conducted between 2011 and 2018 using data from the claims databases of Sicily Region, in Southern Italy. To identify combinations of potential predictors of acromegaly diagnosis, conditional and unconditional penalized multivariable logistic regression models and three machine learning algorithms (i.e., the Recursive Partitioning and Regression Tree, the Random Forest and the Support Vector Machine) were used, and their performance was evaluated. The random forest (RF) algorithm achieved the highest Area under the ROC Curve value of 0.83 (95% CI 0.79-0.87). The sensitivity in the test set, computed at the optimal threshold of predicted probabilities, ranged from 28% for the unconditional logistic regression model to 69% for the RF. Overall, the only diagnosis predictor selected by all five models and algorithms was the number of immunosuppressants-related pharmacy claims. The other predictors selected by at least two models were eventually combined in an unconditional logistic regression to develop a meta-score that achieved an acceptable discrimination accuracy (AUC = 0.71, 95% CI 0.66-0.75). Findings of this study showed that data-driven machine learning algorithms may play a role in supporting the early diagnosis of rare diseases such as acromegaly.
    MeSH term(s) Humans ; Rare Diseases ; Retrospective Studies ; Acromegaly/diagnosis ; Delayed Diagnosis ; Algorithms ; Machine Learning ; Drug Prescriptions ; Early Diagnosis ; Sicily/epidemiology
    Language English
    Publishing date 2024-03-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-024-56240-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Rare forms of genetic paediatric adrenal insufficiency: Excluding congenital adrenal hyperplasia.

    Hasenmajer, Valeria / Ferrigno, Rosario / Minnetti, Marianna / Pellegrini, Bianca / Isidori, Andrea M / Lenzi, Andrea / Salerno, Mariacarolina / Cappa, Marco / Chan, Li / De Martino, Maria Cristina / Savage, Martin O

    Reviews in endocrine & metabolic disorders

    2023  Volume 24, Issue 2, Page(s) 345–363

    Abstract: Adrenal insufficiency (AI) is a severe endocrine disorder characterized by insufficient glucocorticoid (GC) and/or mineralocorticoid (MC) secretion by the adrenal glands, due to impaired adrenal function (primary adrenal insufficiency, PAI) or to ... ...

    Abstract Adrenal insufficiency (AI) is a severe endocrine disorder characterized by insufficient glucocorticoid (GC) and/or mineralocorticoid (MC) secretion by the adrenal glands, due to impaired adrenal function (primary adrenal insufficiency, PAI) or to insufficient adrenal stimulation by pituitary ACTH (secondary adrenal insufficiency, SAI) or tertiary adrenal insufficiency due to hypothalamic dysfunction. In this review, we describe rare genetic causes of PAI with isolated GC or combined GC and MC deficiencies and we also describe rare syndromes of isolated MC deficiency. In children, the most frequent cause of PAI is congenital adrenal hyperplasia (CAH), a group of adrenal disorders related to steroidogenic enzyme deficiencies, which will not be included in this review. Less frequently, several rare diseases can cause PAI, either affecting exclusively the adrenal glands or with systemic involvement. The diagnosis of these diseases is often challenging, due to the heterogeneity of their clinical presentation and to their rarity. Therefore, the current review aims to provide an overview on these rare genetic forms of paediatric PAI, offering a review of genetic and clinical features and a summary of diagnostic and therapeutic approaches, promoting awareness among practitioners, and favoring early diagnosis and optimal clinical management in suspect cases.
    MeSH term(s) Child ; Humans ; Adrenal Hyperplasia, Congenital/diagnosis ; Adrenal Hyperplasia, Congenital/genetics ; Adrenal Hyperplasia, Congenital/complications ; Adrenal Insufficiency/diagnosis ; Adrenal Insufficiency/genetics ; Adrenal Glands
    Language English
    Publishing date 2023-02-10
    Publishing country Germany
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2185718-0
    ISSN 1573-2606 ; 1389-9155
    ISSN (online) 1573-2606
    ISSN 1389-9155
    DOI 10.1007/s11154-023-09784-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Development and testing of diagnostic algorithms to identify patients with acromegaly in Southern Italian claims databases.

    Crisafulli, Salvatore / Fontana, Andrea / L'Abbate, Luca / Ientile, Valentina / Gianfrilli, Daniele / Cozzolino, Alessia / De Martino, Maria Cristina / Ragonese, Marta / Sultana, Janet / Barone-Adesi, Francesco / Trifirò, Gianluca

    Scientific reports

    2022  Volume 12, Issue 1, Page(s) 15843

    Abstract: Acromegaly is a rare disease characterized by an excessive production of growth-hormone and insulin-like growth factor 1, typically resulting from a GH-secreting pituitary adenoma. This study was aimed at comparing and measuring accuracy of newly and ... ...

    Abstract Acromegaly is a rare disease characterized by an excessive production of growth-hormone and insulin-like growth factor 1, typically resulting from a GH-secreting pituitary adenoma. This study was aimed at comparing and measuring accuracy of newly and previously developed coding algorithms for the identification of acromegaly using Italian claims databases. This study was conducted between January 2015 and December 2018, using data from the claims databases of Caserta Local Health Unit (LHU) and Sicily Region in Southern Italy. To detect acromegaly cases from the general target population, four algorithms were developed using combinations of diagnostic, surgical procedure and co-payment exemption codes, pharmacy claims and specialist's visits. Algorithm accuracy was assessed by measuring the Youden Index, sensitivity, specificity, positive and negative predictive values. The percentage of positive cases for each algorithm ranged from 7.9 (95% CI 6.4-9.8) to 13.8 (95% CI 11.7-16.2) per 100,000 inhabitants in Caserta LHU and from 7.8 (95% CI 7.1-8.6) to 16.4 (95% CI 15.3-17.5) in Sicily Region. Sensitivity of the different algorithms ranged from 71.1% (95% CI 54.1-84.6%) to 84.2% (95% CI 68.8-94.0%), while specificity was always higher than 99.9%. The algorithm based on the presence of claims suggestive of acromegaly in ≥ 2 different databases (i.e., hospital discharge records, copayment exemptions registry, pharmacy claims and specialist visits registry) achieved the highest Youden Index (84.2) and the highest positive predictive value (34.8; 95% CI 28.6-41.6). We tested four algorithms to identify acromegaly cases using claims databases with high sensitivity and Youden Index. Despite identifying rare diseases using real-world data is challenging, this study showed that robust validity testing may yield the identification of accurate coding algorithms.
    MeSH term(s) Acromegaly/diagnosis ; Acromegaly/epidemiology ; Adenoma/diagnosis ; Adenoma/epidemiology ; Algorithms ; Databases, Factual ; Human Growth Hormone ; Humans ; Insulin-Like Growth Factor I ; Sicily
    Chemical Substances Human Growth Hormone (12629-01-5) ; Insulin-Like Growth Factor I (67763-96-6)
    Language English
    Publishing date 2022-09-23
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-022-20295-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: MicroRNAs and Long Non-Coding RNAs in Adrenocortical Carcinoma.

    Detomas, Mario / Pivonello, Claudia / Pellegrini, Bianca / Landwehr, Laura-Sophie / Sbiera, Silviu / Pivonello, Rosario / Ronchi, Cristina L / Colao, Annamaria / Altieri, Barbara / De Martino, Maria Cristina

    Cells

    2022  Volume 11, Issue 14

    Abstract: Non-coding RNAs (ncRNAs) are a type of genetic material that do not encode proteins but regulate the gene expression at an epigenetic level, such as microRNAs (miRNAs) and long non-coding RNAs (lncRNAs). The role played by ncRNAs in many physiological ... ...

    Abstract Non-coding RNAs (ncRNAs) are a type of genetic material that do not encode proteins but regulate the gene expression at an epigenetic level, such as microRNAs (miRNAs) and long non-coding RNAs (lncRNAs). The role played by ncRNAs in many physiological and pathological processes has gained attention during the last few decades, as they might be useful in the diagnosis, treatment and management of several human disorders, including endocrine and oncological diseases. Adrenocortical carcinoma (ACC) is a rare and aggressive endocrine cancer, still characterized by high mortality and morbidity due to both endocrine and oncological complications. Despite the rarity of this disease, recently, the role of ncRNA has been quite extensively evaluated in ACC. In order to better explore the role of the ncRNA in human ACC, this review summarizes the current knowledge on ncRNA dysregulation in ACC and its potential role in the diagnosis, treatment, and management of this tumor.
    MeSH term(s) Adrenal Cortex Neoplasms/genetics ; Adrenocortical Carcinoma/genetics ; Humans ; MicroRNAs/genetics ; MicroRNAs/metabolism ; RNA, Long Noncoding/genetics ; RNA, Long Noncoding/metabolism ; RNA, Untranslated/genetics ; RNA, Untranslated/metabolism
    Chemical Substances MicroRNAs ; RNA, Long Noncoding ; RNA, Untranslated
    Language English
    Publishing date 2022-07-18
    Publishing country Switzerland
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2661518-6
    ISSN 2073-4409 ; 2073-4409
    ISSN (online) 2073-4409
    ISSN 2073-4409
    DOI 10.3390/cells11142234
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Is mortality in Cushing's disease reversible with remission?

    Pivonello, Rosario / Simeoli, Chiara / De Martino, Maria Cristina / Colao, Annamaria

    The lancet. Diabetes & endocrinology

    2016  Volume 4, Issue 7, Page(s) 551–552

    Language English
    Publishing date 2016-07
    Publishing country England
    Document type Journal Article
    ISSN 2213-8595
    ISSN (online) 2213-8595
    DOI 10.1016/S2213-8587(16)30044-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Comment on Azmahani et al. "Steroidogenic enzymes, their related transcription factors and nuclear receptors in human sebaceous glands under normal and pathological conditions".

    Pivonello, Claudia / De Martino, Maria Cristina / Colao, Annamaria / Pivonello, Rosario

    The Journal of steroid biochemistry and molecular biology

    2016  Volume 155, Issue Pt A, Page(s) 177

    MeSH term(s) Female ; Humans ; Male ; Nuclear Receptor Subfamily 4, Group A, Member 1/metabolism ; Oxidoreductases/metabolism ; Phosphoproteins/metabolism ; Receptors, Androgen/metabolism ; Sebaceous Glands/metabolism
    Chemical Substances Nuclear Receptor Subfamily 4, Group A, Member 1 ; Phosphoproteins ; Receptors, Androgen ; Oxidoreductases (EC 1.-)
    Language English
    Publishing date 2016-01
    Publishing country England
    Document type Comment ; Letter
    ZDB-ID 1049188-0
    ISSN 1879-1220 ; 0960-0760
    ISSN (online) 1879-1220
    ISSN 0960-0760
    DOI 10.1016/j.jsbmb.2015.09.031
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: How should patients with adrenal incidentalomas be followed up?

    Pivonello, Rosario / De Martino, Maria Cristina / Colao, Annamaria

    The lancet. Diabetes & endocrinology

    2014  Volume 2, Issue 5, Page(s) 352–354

    MeSH term(s) Adrenal Gland Neoplasms/complications ; Adrenal Gland Neoplasms/mortality ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Cushing Syndrome/etiology ; Female ; Humans ; Male
    Language English
    Publishing date 2014-05
    Publishing country England
    Document type Comment ; Journal Article
    ISSN 2213-8595
    ISSN (online) 2213-8595
    DOI 10.1016/S2213-8587(13)70190-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Cushing's disease: the burden of illness.

    Pivonello, Rosario / De Martino, Maria Cristina / De Leo, Monica / Simeoli, Chiara / Colao, Annamaria

    Endocrine

    2017  Volume 56, Issue 1, Page(s) 10–18

    Abstract: Cushing's syndrome is caused by prolonged exposure to elevated cortisol levels. The most common form of endogenous Cushing's syndrome is Cushing's disease, which results from an adrenocorticotropic hormone-secreting pituitary tumour. Cushing's disease is ...

    Abstract Cushing's syndrome is caused by prolonged exposure to elevated cortisol levels. The most common form of endogenous Cushing's syndrome is Cushing's disease, which results from an adrenocorticotropic hormone-secreting pituitary tumour. Cushing's disease is associated with increased mortality, mostly attributable to cardiovascular complications, and a host of comorbidities such as metabolic and skeletal disorders, infections and neuropsychiatric disturbances. As a consequence, Cushing's disease substantially impairs health-related quality of life. It is crucial that the condition is diagnosed as early as possible, and that rapid and effective treatment is initiated in order to limit long-term morbidity and mortality. The initial treatment of choice for Cushing's disease is selective transsphenoidal pituitary surgery; however, the risk of recurrence after initial surgery is high and remains so for many decades after surgery. A particular concern is the growing body of evidence indicating that the negative physical and psychosocial sequelae of chronic hypercortisolism may persist in patients with Cushing's disease even after long-term surgical 'cure'. Current treatment options for post-surgical patients with persistent or recurrent Cushing's disease include second surgery, radiotherapy, bilateral adrenalectomy and medical therapy; however, each approach has its limitations and there is an unmet need for more efficacious treatments. The current review provides an overview of the burden of illness of Cushing's disease, underscoring the need for prompt diagnosis and effective treatment, as well as highlighting the need for better therapies.
    MeSH term(s) Adrenalectomy ; Cost of Illness ; Humans ; Hydrocortisone/blood ; Pituitary ACTH Hypersecretion/blood ; Pituitary ACTH Hypersecretion/diagnosis ; Pituitary ACTH Hypersecretion/psychology ; Pituitary ACTH Hypersecretion/therapy ; Pituitary Gland/surgery ; Quality of Life ; Treatment Outcome
    Chemical Substances Hydrocortisone (WI4X0X7BPJ)
    Language English
    Publishing date 2017-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1194484-5
    ISSN 1559-0100 ; 1355-008X ; 0969-711X
    ISSN (online) 1559-0100
    ISSN 1355-008X ; 0969-711X
    DOI 10.1007/s12020-016-0984-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: The role of mTOR pathway as target for treatment in adrenocortical cancer.

    De Martino, Maria Cristina / Feelders, Richard A / Pivonello, Claudia / Simeoli, Chiara / Papa, Fortuna / Colao, Annamaria / Pivonello, Rosario / Hofland, Leo J

    Endocrine connections

    2019  Volume 8, Issue 9, Page(s) R144–R156

    Abstract: Adrenocortical carcinomas (ACCs) are rare tumors with scant treatment options for which new treatments are required. The mTOR pathway mediates the intracellular signals of several growth factors, including the insulin-like growth factors (IGFs), and ... ...

    Abstract Adrenocortical carcinomas (ACCs) are rare tumors with scant treatment options for which new treatments are required. The mTOR pathway mediates the intracellular signals of several growth factors, including the insulin-like growth factors (IGFs), and therefore represents a potential attractive pathway for the treatment of several malignancies including ACCs. Several mTOR inhibitors, including sirolimus, temsirolimus and everolimus, have been clinically developed. This review summarizes the results of the studies evaluating the expression of the mTOR pathway components in ACCs, the effects of the mTOR inhibitors alone or in combination with other drugs in preclinical models of ACCs and the early experience with the use of these compounds in the clinical setting. The mTOR pathway seems a potential target for treatment of patients with ACC, but further investigation is still required to define the potential role of mTOR inhibitors alone or in combination with other drugs in the treatment of ACC patients.
    Language English
    Publishing date 2019-07-31
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2668428-7
    ISSN 2049-3614
    ISSN 2049-3614
    DOI 10.1530/EC-19-0224
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Paediatric Cushing's disease: Epidemiology, pathogenesis, clinical management and outcome.

    Ferrigno, Rosario / Hasenmajer, Valeria / Caiulo, Silvana / Minnetti, Marianna / Mazzotta, Paola / Storr, Helen L / Isidori, Andrea M / Grossman, Ashley B / De Martino, Maria Cristina / Savage, Martin O

    Reviews in endocrine & metabolic disorders

    2021  Volume 22, Issue 4, Page(s) 817–835

    Abstract: Cushing's disease (CD) is rare in paediatric practice but requires prompt investigation, diagnosis and therapy to prevent long-term complications. Key presenting features are a change in facial appearance, weight gain, growth failure, virilization, ... ...

    Abstract Cushing's disease (CD) is rare in paediatric practice but requires prompt investigation, diagnosis and therapy to prevent long-term complications. Key presenting features are a change in facial appearance, weight gain, growth failure, virilization, disturbed puberty and psychological disturbance. Close consultation with an adult endocrinology department is recommended regarding diagnosis and therapy. The incidence of CD, a form of ACTH-dependent Cushing's syndrome (CS), is equal to approximately 5% of that seen in adults. The majority of ACTH-secreting adenomas are monoclonal and sporadic, although recent studies of pituitary tumours have shown links to several deubiquitination gene defects. Diagnosis requires confirmation of hypercortisolism followed by demonstration of ACTH-dependence. Identification of the corticotroph adenoma by pituitary MRI and/or bilateral inferior petrosal sampling for ACTH may contribute to localisation before pituitary surgery. Transsphenoidal surgery (TSS) with selective microadenomectomy is first-line therapy, followed by external pituitary irradiation if surgery is not curative. Medical therapy to suppress adrenal steroid synthesis is effective in the short-term and bilateral adrenalectomy should be considered in cases unfit for TSS or radiotherapy or when urgent remission is needed after unsuccessful surgery. TSS induces remission of hypercortisolism and improvement of symptoms in 70-100% of cases, particularly when performed by a surgeon with experience in children. Post-TSS complications include pituitary hormone deficiencies, sub-optimal catch-up growth, and persisting excess of BMI. Recurrence of hypercortisolism following remission is recognised but infrequent, being less common than in adult CD patients. With experienced specialist medical and surgical care, the overall prognosis is good. Early referral to an experienced endocrine centre is advised.
    MeSH term(s) Adult ; Child ; Cushing Syndrome/etiology ; Humans ; Pituitary ACTH Hypersecretion/diagnosis ; Pituitary ACTH Hypersecretion/epidemiology ; Pituitary ACTH Hypersecretion/etiology ; Pituitary Gland/surgery ; Pituitary Neoplasms/surgery ; Treatment Outcome
    Language English
    Publishing date 2021-01-30
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 2185718-0
    ISSN 1573-2606 ; 1389-9155
    ISSN (online) 1573-2606
    ISSN 1389-9155
    DOI 10.1007/s11154-021-09626-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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