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Article: Radiomic Analysis in Pituitary Tumors: Current Knowledge and Future Perspectives.

Bioletto, Fabio / Prencipe, Nunzia / Berton, Alessandro Maria / Aversa, Luigi Simone / Cuboni, Daniela / Varaldo, Emanuele / Gasco, Valentina / Ghigo, Ezio / Grottoli, Silvia

Journal of clinical medicine

2024 Volume 13, Issue 2

Abstract: Radiomic analysis has emerged as a valuable tool for extracting quantitative features from medical imaging data, providing in-depth insights into various contexts and diseases. By employing methods derived from advanced computational techniques, ... ...

Abstract	Radiomic analysis has emerged as a valuable tool for extracting quantitative features from medical imaging data, providing in-depth insights into various contexts and diseases. By employing methods derived from advanced computational techniques, radiomics quantifies textural information through the evaluation of the spatial distribution of signal intensities and inter-voxel relationships. In recent years, these techniques have gained considerable attention also in the field of pituitary tumors, with promising results. Indeed, the extraction of radiomic features from pituitary magnetic resonance imaging (MRI) images has been shown to provide useful information on various relevant aspects of these diseases. Some of the key topics that have been explored in the existing literature include the association of radiomic parameters with histopathological and clinical data and their correlation with tumor invasiveness and aggressive behavior. Their prognostic value has also been evaluated, assessing their role in the prediction of post-surgical recurrence, response to medical treatments, and long-term outcomes. This review provides a comprehensive overview of the current knowledge and application of radiomics in pituitary tumors. It also examines the current limitations and future directions of radiomic analysis, highlighting the major challenges that need to be addressed before a consistent integration of these techniques into routine clinical practice.
Language	English
Publishing date	2024-01-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13020336
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Article ; Online: Severe hypothyroidism as a trigger for Brugada-type ECG abnormalities: a case report and literature review.

Bioletto, Fabio / Cuboni, Daniela / Varaldo, Emanuele / Bona, Chiara / Berton, Alessandro Maria / Maccario, Mauro / Prencipe, Nunzia

Archives of endocrinology and metabolism

2024 Volume 68, Page(s) e230027

Abstract: Brugada syndrome (BrS) is an inherited disorder that can cause ventricular fibrillation and sudden cardiac death in individuals with otherwise structurally normal hearts. Several provoking factors are known to potentially unmask or exacerbate a typical ... ...

Abstract	Brugada syndrome (BrS) is an inherited disorder that can cause ventricular fibrillation and sudden cardiac death in individuals with otherwise structurally normal hearts. Several provoking factors are known to potentially unmask or exacerbate a typical Brugada ECG pattern in predisposed subjects. Hypothyroidism has been suggested as one of these triggers, but the exact mechanisms underlying this relationship remain poorly understood. Moreover, the severity of thyroid dysfunction beyond which a Brugada-type ECG alteration might be triggered is still unclear. We report the case of a 33-year-old male who displayed a Brugada type 1 ECG pattern and was diagnosed with severe hypothyroidism (TSH > 100 mU/L with undetectable levels of fT4 and fT3). Hormonal replacement therapy with levothyroxine was initiated at increasing doses; serial biochemical and ECG controls were performed, initially every 3 weeks up to 15 weeks and afterward every 3 months. The regression of typical Brugada ECG waveforms could be seen at an early stage, when the patient was still taking a low dose of levothyroxine (37.5 µg/day, i.e., one-fourth of his final requirements of 150 µg/day), and laboratory tests still showed a marked alteration of thyroid hormonal parameters. Hypothyroidism may act as a trigger for Brugada-type ECG abnormalities, but a very severe alteration of the hormonal parameters is necessary to prompt these alterations. In our case, the initiation of replacement therapy with levothyroxine rapidly reversed the ECG modifications, even at a low subtherapeutic dose.
MeSH term(s)	Adult ; Humans ; Male ; Brugada Syndrome/diagnosis ; Brugada Syndrome/etiology ; Electrocardiography ; Hypothyroidism/complications ; Hypothyroidism/drug therapy ; Thyroid Diseases/complications ; Thyroxine/therapeutic use
Chemical Substances	Thyroxine (Q51BO43MG4)
Language	English
Publishing date	2024-01-25
Publishing country	Brazil
Document type	Review ; Case Reports
ISSN	2359-4292
ISSN (online)	2359-4292
DOI	10.20945/2359-4292-2023-0027
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Article ; Online: Long-term efficacy of empagliflozin as an add-on treatment for chronic SIAD: a case report and literature review.

Bioletto, Fabio / Varaldo, Emanuele / Prencipe, Nunzia / Benso, Andrea / Berton, Alessandro Maria

Hormones (Athens, Greece)

2023 Volume 22, Issue 2, Page(s) 343–347

Abstract: Background: SLGT-2 inhibitors have recently been investigated as a promising therapy for syndrome of inappropriate antidiuresis (SIAD). However, to our knowledge, no report has been published about their use for this indication in the long term.: Case ...

Abstract	Background: SLGT-2 inhibitors have recently been investigated as a promising therapy for syndrome of inappropriate antidiuresis (SIAD). However, to our knowledge, no report has been published about their use for this indication in the long term. Case presentation: We report the case of a 68-year-old male with type 2 diabetes and chronic SIAD, in whom serum sodium levels were not adequately controlled by urea monotherapy. Other treatment options were not viable due to inefficacy or adverse effects. The initiation of empagliflozin, in addition to urea, led to the full normalization of serum sodium. Reduction and subsequent discontinuation of urea were attempted upon patient request, but this resulted in a relapse of hyponatremia. Nevertheless, stable normonatremia was again achieved and maintained for more than 6 months after re-establishing a combination therapy with empagliflozin and urea. Conclusions: SGLT2 inhibitors might represent an effective treatment for SIAD, even in the long term. Specific clinical trials are needed to confirm this result.
MeSH term(s)	Male ; Humans ; Aged ; Inappropriate ADH Syndrome/complications ; Inappropriate ADH Syndrome/drug therapy ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Hyponatremia/drug therapy ; Hyponatremia/etiology ; Urea/therapeutic use ; Sodium
Chemical Substances	empagliflozin (HDC1R2M35U) ; Urea (8W8T17847W) ; Sodium (9NEZ333N27)
Language	English
Publishing date	2023-01-19
Publishing country	Switzerland
Document type	Review ; Case Reports ; Journal Article
ZDB-ID	2075912-5
ISSN	2520-8721 ; 1109-3099
ISSN (online)	2520-8721
ISSN	1109-3099
DOI	10.1007/s42000-023-00430-0
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Article: Markers of Aggressiveness in Pituitary Tumors: Update and Perspectives.

Bioletto, Fabio / Berton, Alessandro Maria / Prencipe, Nunzia / Varaldo, Emanuele / Bona, Chiara / Grottoli, Silvia

Journal of clinical medicine

2022 Volume 11, Issue 21

Abstract: Pituitary neuroendocrine tumors (PitNETs) are relatively common intracranial neoplasms, potentially originating from various pituitary cell types [ ... ]. ...

Abstract	Pituitary neuroendocrine tumors (PitNETs) are relatively common intracranial neoplasms, potentially originating from various pituitary cell types [...].
Language	English
Publishing date	2022-11-02
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11216508
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Article: Isolated anterior pituitary dysfunction in adulthood.

Prencipe, Nunzia / Marinelli, Lorenzo / Varaldo, Emanuele / Cuboni, Daniela / Berton, Alessandro Maria / Bioletto, Fabio / Bona, Chiara / Gasco, Valentina / Grottoli, Silvia

Frontiers in endocrinology

2023 Volume 14, Page(s) 1100007

Abstract: Hypopituitarism is defined as a complete or partial deficiency in one or more pituitary hormones. Anterior hypopituitarism includes secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, growth hormone deficiency and ... ...

Abstract	Hypopituitarism is defined as a complete or partial deficiency in one or more pituitary hormones. Anterior hypopituitarism includes secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, growth hormone deficiency and prolactin deficiency. Patients with hypopituitarism suffer from an increased disability and sick days, resulting in lower health status, higher cost of care and an increased mortality. In particular during adulthood, isolated pituitary deficits are not an uncommon finding; their clinical picture is represented by vague symptoms and unclear signs, which can be difficult to properly diagnose. This often becomes a challenge for the physician. Aim of this narrative review is to analyse, for each anterior pituitary deficit, the main related etiologies, the characteristic signs and symptoms, how to properly diagnose them (suggesting an easy and reproducible step-based approach), and eventually the treatment. In adulthood, the vast majority of isolated pituitary deficits are due to pituitary tumours, head trauma, pituitary surgery and brain radiotherapy. Immune-related dysfunctions represent a growing cause of isolated pituitary deficiencies, above all secondary to use of oncological drugs such as immune checkpoint inhibitors. The diagnosis of isolated pituitary deficiencies should be based on baseline hormonal assessments and/or dynamic tests. Establishing a proper diagnosis can be quite challenging: in fact, even if the diagnostic methods are becoming increasingly refined, a considerable proportion of isolated pituitary deficits still remains without a certain cause. While isolated ACTH and TSH deficiencies always require a prompt replacement treatment, gonadal replacement therapy requires a benefit-risk evaluation based on the presence of comorbidities, age and gender of the patient; finally, the need of growth hormone replacement therapies is still a matter of debate. On the other side, prolactin replacement therapy is still not available. In conclusion, our purpose is to offer a broad evaluation from causes to therapies of isolated anterior pituitary deficits in adulthood. This review will also include the evaluation of uncommon symptoms and main etiologies, the elements of suspicion of a genetic cause and protocols for diagnosis, follow-up and treatment.
MeSH term(s)	Humans ; Prolactin ; Pituitary Hormones, Anterior ; Hypopituitarism/diagnosis ; Hypopituitarism/etiology ; Hypopituitarism/therapy ; Pituitary Hormones ; Pituitary Gland/pathology ; Hypothalamic Diseases/complications ; Hypothyroidism/etiology
Chemical Substances	Prolactin (9002-62-4) ; Pituitary Hormones, Anterior ; Pituitary Hormones
Language	English
Publishing date	2023-03-08
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2023.1100007
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Article ; Online: The Effects of Omega 3 and Omega 6 Fatty Acids on Glucose Metabolism: An Updated Review.

Egalini, Filippo / Guardamagna, Ornella / Gaggero, Giulia / Varaldo, Emanuele / Giannone, Beatrice / Beccuti, Guglielmo / Benso, Andrea / Broglio, Fabio

Nutrients

2023 Volume 15, Issue 12

Abstract: Massive changes have occurred in our diet. A growing consumption of vegetal oils rich in omega-6 (ω-6) and a depletion of omega-3 (ω-3) fatty acids (FAs) in our food has led to an imbalance between ω-3 and ω-6. In particular, eicosapentaenoic (EPA)/ ... ...

Abstract	Massive changes have occurred in our diet. A growing consumption of vegetal oils rich in omega-6 (ω-6) and a depletion of omega-3 (ω-3) fatty acids (FAs) in our food has led to an imbalance between ω-3 and ω-6. In particular, eicosapentaenoic (EPA)/arachidonic acid (AA) ratio seems to be an indicator of this derangement, whose reduction is associated to the development of metabolic diseases, such as diabetes mellitus. Our aim was therefore to investigate the literature on the effects of ω-3 and ω-6 FAs on glucose metabolism. We discussed emerging evidence from pre-clinical studies and from clinical trials. Notably, conflicting results emerged. Source of ω-3, sample size, ethnicity, study duration and food cooking method may be responsible for the lack of univocal results. High EPA/AA ratio seems to be a promising indicator of better glycemic control and reduced inflammation. On the other hand, linoleic acid (LA) appears to be also associated to a minor incidence of type 2 diabetes mellitus, although it is still not clear if the outcome is related to a reduced production of AA or to its intrinsic effect. More data derived from multicenter, prospective randomized clinical trials are needed.
MeSH term(s)	Humans ; Prospective Studies ; Diabetes Mellitus, Type 2 ; Fatty Acids, Omega-3 ; Fatty Acids, Omega-6 ; Arachidonic Acid/metabolism ; Glucose ; Eicosapentaenoic Acid/pharmacology ; Fatty Acids ; Multicenter Studies as Topic
Chemical Substances	Fatty Acids, Omega-3 ; Fatty Acids, Omega-6 ; Arachidonic Acid (27YG812J1I) ; Glucose (IY9XDZ35W2) ; Eicosapentaenoic Acid (AAN7QOV9EA) ; Fatty Acids
Language	English
Publishing date	2023-06-08
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu15122672
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Article ; Online: Mild hyponatremia is not associated with degradation of trabecular bone microarchitecture despite bone mass loss.

Bioletto, Fabio / Sibilla, Michela / Berton, Alessandro Maria / Prencipe, Nunzia / Varaldo, Emanuele / Maiorino, Federica / Cuboni, Daniela / Pusterla, Alessia / Gasco, Valentina / Grottoli, Silvia / Ghigo, Ezio / Arvat, Emanuela / Procopio, Massimo / Barale, Marco

The Journal of clinical endocrinology and metabolism

2024

Abstract: Context: Hyponatremia is associated with increased risk of osteoporosis and fractures. The impact of hyponatremia on non-invasive indices of bone quality, however, is unknown.: Objective: To evaluate whether trabecular bone microarchitecture, ... ...

Abstract	Context: Hyponatremia is associated with increased risk of osteoporosis and fractures. The impact of hyponatremia on non-invasive indices of bone quality, however, is unknown. Objective: To evaluate whether trabecular bone microarchitecture, assessed non-invasively by trabecular bone score (TBS), is altered in patients with hyponatremia. Methods: We conducted a cross-sectional analysis of the population-based 2005-2008 cycles of the National Health and Nutrition Examination Survey (NHANES), in which TBS measurement was performed. The main outcome measures were TBS values and bone mineral density (BMD) T-scores at the lumbar spine, total hip and femoral neck. Results: A total of 4204 subjects aged 50 years or older were included (4041 normonatremic, 163 hyponatremic - 90.8% with mild hyponatremia). Univariate analyses did not show any difference in TBS between patients with and without hyponatremia (1.308 ± 0.145 vs 1.311 ± 0.141, p = 0.806). Hyponatremic subjects had lower BMD T-score at total hip (-0.70 ± 1.46 vs -0.13 ± 1.32, p < 0.001) and femoral neck (-1.11 ± 1.26 vs -0.72 ± 1.14, p = 0.004), while no difference was observed at lumbar spine (-0.27 ± 1.63 vs -0.31 ± 1.51, p = 0.772). After adjustment for relevant confounders, hyponatremia was confirmed as an independent predictor of lower BMD T-score at the total hip (β=-0.20, 95%CI:[-0.39, -0.02], p = 0.029), while the significance was lost at the femoral neck (p = 0.308). Again, no association between hyponatremia and lumbar spine BMD (p = 0.236) or TBS (p = 0.346) was observed. Conclusions: Hyponatremia, at least in mild forms, is not associated with a degradation of trabecular microarchitecture, assessed non-invasively by TBS. An independent association between hyponatremia and loss of bone mass is confirmed, particularly at the total hip.
Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/clinem/dgae234
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Article: Effectiveness of Copeptin, MR-proADM and MR-proANP in Predicting Adverse Outcomes, Alone and in Combination with Traditional Severity Scores, a Secondary Analysis in COVID-19 Patients Requiring Intensive Care Admission.

Varaldo, Emanuele / Rumbolo, Francesca / Prencipe, Nunzia / Bioletto, Fabio / Settanni, Fabio / Mengozzi, Giulio / Grottoli, Silvia / Ghigo, Ezio / Brazzi, Luca / Montrucchio, Giorgia / Berton, Alessandro Maria

Journal of clinical medicine

2024 Volume 13, Issue 7

Abstract: Objective: ...

Abstract	Objective:
Language	English
Publishing date	2024-03-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13072019
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Article ; Online: Prolactin-secreting tumors, dopamine agonists and pregnancy: a longitudinal experience of a tertiary neuroendocrine center.

Prencipe, Nunzia / Bona, Chiara / Cuboni, Daniela / Berton, Alessandro Maria / Bioletto, Fabio / Varaldo, Emanuele / Aversa, Luigi Simone / Sibilla, Michela / Gasco, Valentina / Ghigo, Ezio / Grottoli, Silvia

Pituitary

2024

Abstract: Purpose: Prolactin (PRL)-secreting tumours are associated with infertility and can be reverted by dopamine agonist (DA) therapy. The suspension of DA is recommended once pregnancy is established, as all DAs cross the placenta. The aim of the study was ... ...

Abstract	Purpose: Prolactin (PRL)-secreting tumours are associated with infertility and can be reverted by dopamine agonist (DA) therapy. The suspension of DA is recommended once pregnancy is established, as all DAs cross the placenta. The aim of the study was to evaluate the rate of maternal-foetal complications in women treated with cabergoline (CAB) or bromocriptine (BRM) for prolactinoma during gestation and the effect of pregnancy on prolactinoma progression. Methods: This was a retrospective observational study involving 43 women affected by prolactinoma who became pregnant during therapy with CAB or BRM for a total of 58 pregnancies. For each patient, medical records were analysed by integrating the data with outpatient or telephone interview. Results: At the time of conception, 18 women were in the BRM group, while 40 were in CAB group. No differences were found in obstetric or neonatal outcomes between the two groups. There was a significant difference (p = 0.046) in child complications reported in maternal interview found exclusively in the CAB group. No further confounding factors were detected. Disease remission rate after the first pregnancy was 42.9% and the main predictor was a lower PRL nadir before pregnancy (p = 0.023). No difference was detected between the two groups in terms of tumor remission. Breastfeeding did not modify the outcome. Conclusion: Foetal exposure to DAs during the first weeks of embryogenesis is not associated with a greater risk of complications. The transient and mild developmental disorders recorded resolved spontaneously and the prevalence was substantially overlapping with that observed in the general population.
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-024-01384-1
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Article ; Online: Are prolactin levels efficient in predicting a pituitary lesion in patients with hyperprolactinemia?

Varaldo, Emanuele / Cuboni, Daniela / Prencipe, Nunzia / Aversa, Luigi Simone / Sibilla, Michela / Bioletto, Fabio / Berton, Alessandro Maria / Gasco, Valentina / Ghigo, Ezio / Grottoli, Silvia

Endocrine

2024 Volume 84, Issue 2, Page(s) 670–676

Abstract: Purpose: Data regarding the presence of a prolactin (PRL) threshold above which a pituitary magnetic resonance imaging (MRI) is mandatory in patients with hyperprolactinemia (hyperPRL) are controversial and derived primarily from studies focused on ... ...

Abstract	Purpose: Data regarding the presence of a prolactin (PRL) threshold above which a pituitary magnetic resonance imaging (MRI) is mandatory in patients with hyperprolactinemia (hyperPRL) are controversial and derived primarily from studies focused on female populations. Aim of our study was to evaluate in a cohort of patients of both sexes with confirmed hyperPRL, the possible correlation between PRL values and the presence of pituitary abnormalities. Methods: We retrospectively analyzed data from patients who underwent serial PRL sampling at our Division between January 2015 and December 2022. Patients diagnosed with monomeric hyperPRL at serial sampling and with subsequent contrast-enhanced MRI results available for the pituitary region were included in the study. Exclusion criteria were prior pituitary disease, severe renal insufficiency, liver cirrhosis, uncompensated primary hypothyroidism and ongoing therapy with hyperprolactinemic drugs. Physiological causes of hyperPRL were also ruled out. Results: Out of the 1253 patients who underwent serial PRL sampling, 139 patients (101 women and 38 men) met the inclusion criteria: 106 (76.3%) patients had some form of pituitary disease, with microlesions observed in 69.8%, macrolesions in 25.5% and other findings in 4.7% of subjects. PRL values showed a modest accuracy in predicting the presence of a pituitary abnormality and the best cut-offs identified were >25 µg/L (AUC 0.767, p = 0.003) and >44.2 µg/L (AUC 0.697, p < 0.001) in men and women, respectively; however, if only patients with PRL values > 500 µg/L were excluded from the analysis, as they were already supposed to harbor a macroprolactinoma, PRL levels were not able to predict the presence of a macrolesion neither in men nor women. Conclusion: Given the high prevalence of pituitary abnormalities in patients of both sexes with hyperPRL at serial sampling, performing a pituitary imaging in all cases of hyperPRL, even if mild, appears to be a cautious choice.
MeSH term(s)	Humans ; Hyperprolactinemia/blood ; Hyperprolactinemia/etiology ; Female ; Male ; Prolactin/blood ; Adult ; Retrospective Studies ; Middle Aged ; Magnetic Resonance Imaging ; Pituitary Gland/diagnostic imaging ; Pituitary Gland/pathology ; Young Adult ; Pituitary Diseases/blood ; Pituitary Diseases/diagnostic imaging ; Pituitary Diseases/diagnosis ; Aged ; Pituitary Neoplasms/blood ; Pituitary Neoplasms/complications ; Pituitary Neoplasms/diagnostic imaging ; Adolescent
Chemical Substances	Prolactin (9002-62-4)
Language	English
Publishing date	2024-01-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	1194484-5
ISSN	1559-0100 ; 1355-008X ; 0969-711X
ISSN (online)	1559-0100
ISSN	1355-008X ; 0969-711X
DOI	10.1007/s12020-023-03678-z
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