Showing papers by "Niki Karavitaki published in 2021"
TL;DR: The annual incidence of Cushing's syndrome ranges between 1.8 and 3.2 cases per million population as mentioned in this paper, and the main cause of death is cardiovascular disease highlighting the negative impact of cortisol excess on cardiovascular risk factors.
28 citations
Ludwig Maximilian University of Munich1, University of Paris2, Mayo Clinic3, French Institute of Health and Medical Research4, University of Padua5, University of Würzburg6, University of Bologna7, Sofia Medical University8, Medical College of Wisconsin9, Queen Mary University of London10, University of Mississippi Medical Center11, University of California, Los Angeles12, University of Tübingen13, University Hospitals Birmingham NHS Foundation Trust14, HealthPartners15, University of Birmingham16, Université de Montréal17, Brigham and Women's Hospital18, Vita-Salute San Raffaele University19, Tokyo Medical and Dental University20, University of Sheffield21, University of Milan22, University of Naples Federico II23, University of Michigan24, National Institutes of Health25, Erasmus University Rotterdam26
TL;DR: In this article, a systematic literature search was performed focusing on clinical studies and case series (≥5 patients). Definition, cumulative incidence, treatment and long-term outcomes of CTP/NS after BADX were analyzed using descriptive statistics.
Abstract: Background Corticotroph tumor progression (CTP) leading to Nelson's syndrome (NS) is a severe and difficult-to-treat complication subsequent to bilateral adrenalectomy (BADX) for Cushing's disease. Its characteristics are not well described, and consensus recommendations for diagnosis and treatment are missing. Methods A systematic literature search was performed focusing on clinical studies and case series (≥5 patients). Definition, cumulative incidence, treatment and long-term outcomes of CTP/NS after BADX were analyzed using descriptive statistics. The results were presented and discussed at an interdisciplinary consensus workshop attended by international pituitary experts in Munich on October 28, 2018. Results Data covered definition and cumulative incidence (34 studies, 1275 patients), surgical outcome (12 studies, 187 patients), outcome of radiation therapy (21 studies, 273 patients), and medical therapy (15 studies, 72 patients). Conclusions We endorse the definition of CTP-BADX/NS as radiological progression or new detection of a pituitary tumor on thin-section MRI. We recommend surveillance by MRI after 3 months and every 12 months for the first 3 years after BADX. Subsequently, we suggest clinical evaluation every 12 months and MRI at increasing intervals every 2-4 years (depending on ACTH and clinical parameters). We recommend pituitary surgery as first-line therapy in patients with CTP-BADX/NS. Surgery should be performed before extrasellar expansion of the tumor to obtain complete and long-term remission. Conventional radiotherapy or stereotactic radiosurgery should be utilized as second-line treatment for remnant tumor tissue showing extrasellar extension.
25 citations
Garvan Institute of Medical Research1, Oregon Health & Science University2, Brigham and Women's Hospital3, Johns Hopkins University School of Medicine4, Aix-Marseille University5, University of Virginia6, Yale University7, Northwestern University8, University of Michigan9, Federal University of Rio de Janeiro10, Ludwig Maximilian University of Munich11, Queen Mary University of London12, University of Santiago, Chile13, Churchill Hospital14, Cedars-Sinai Medical Center15, Stanford University16, Erasmus University Medical Center17, Rutgers University18, Federal University of Paraná19, University of Oslo20, Emory University21, Royal Veterinary College22, Rabin Medical Center23, Kobe University24, Leiden University Medical Center25, Tel Aviv Sourasky Medical Center26, University of California, Los Angeles27, University of Cambridge28, University of Gothenburg29, Keio University30, University of Ferrara31, Université Paris-Saclay32, University of North Carolina at Chapel Hill33, University of Birmingham34, University of São Paulo35, University of Manchester36
TL;DR: The PANOMEN workshop as mentioned in this paper recommended that the term adenoma be retained and that the topic be revisited as new evidence on pituitary neoplasm biology emerges.
Abstract: The WHO Classification of Endocrine Tumours designates pituitary neoplasms as adenomas. A proposed nomenclature change to pituitary neuroendocrine tumors (PitNETs) has been met with concern by some stakeholder groups. The Pituitary Society coordinated the Pituitary Neoplasm Nomenclature (PANOMEN) workshop to address the topic. Experts in pituitary developmental biology, pathology, neurosurgery, endocrinology, and oncology, including representatives nominated by the Endocrine Society, European Society of Endocrinology, European Neuroendocrine Association, Growth Hormone Research Society, and International Society of Pituitary Surgeons. Clinical epidemiology, disease phenotype, management, and prognosis of pituitary adenomas differ from that of most NETs. The vast majority of pituitary adenomas are benign and do not adversely impact life expectancy. A nomenclature change to PitNET does not address the main challenge of prognostic prediction, assigns an uncertain malignancy designation to benign pituitary adenomas, and may adversely affect patients. Due to pandemic restrictions, the workshop was conducted virtually, with audiovisual lectures and written precis on each topic provided to all participants. Feedback was collated and summarized by Content Chairs and discussed during a virtual writing meeting moderated by Session Chairs, which yielded an evidence-based draft document sent to all participants for review and approval. There is not yet a case for adopting the PitNET nomenclature. The PANOMEN Workshop recommends that the term adenoma be retained and that the topic be revisited as new evidence on pituitary neoplasm biology emerges.
22 citations
TL;DR: Minimizing the duration and extent of exposure to hypercortisolaemia by early diagnosis and rapid, effective therapeutic interventions, as well as close monitoring and aggressive control of cardiovascular risk factors are vital for improving outcomes of the patients.
Abstract: Cushing’s disease is a rare condition of cortisol excess attributed to a
pituitary adenoma with an annual incidence of 1.2–2.4 cases per million
population. It is associated with several co-morbidities leading to increased
mortality predominantly due to cardiovascular disease. Despite the advances in
its diagnosis and management, survival can be compromised even after apparent
successful treatment. Minimizing the duration and extent of exposure to
hypercortisolaemia by early diagnosis and rapid, effective therapeutic
interventions, as well as close monitoring and aggressive control of
cardiovascular risk factors are vital for improving outcomes of the
patients.
8 citations
01 Jan 2021
TL;DR: Assessment of cortisol status in the early postoperative period in patients with Cushing's disease is of major importance for determining further management plans and monitoring of fluid balance together with measurement of serum electrolytes and plasma/urine osmolality are required.
Abstract: Pituitary surgery is the first-line treatment for the majority of pituitary adenomas; close monitoring and safe management of the endocrine status of the patients is a vital element of their peri- and early postoperative care. Consensus on the optimal strategy of assessment and management of central adrenal insufficiency is not currently available and various approaches are adopted ranging from perioperative stress dose glucocorticoids with gradual tapering, to steroid-sparing protocols with careful observation. Water balance disorders, mainly diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion, are also relatively common in the early postoperative period. Monitoring of fluid balance together with measurement of serum electrolytes and plasma/urine osmolality (or urinary specific gravity) are required for prompt recognition and treatment of these disorders. Finally, reliable assessment of cortisol status in the early postoperative period in patients with Cushing's disease is of major importance for determining further management plans.
2 citations
Oregon Health & Science University1, University of Michigan2, Mayo Clinic3, Cedars-Sinai Medical Center4, University of Paris5, Leiden University Medical Center6, Federal University of Paraná7, University of São Paulo8, University of Southern California9, Aix-Marseille University10, Université Paris-Saclay11, Medical College of Wisconsin12, Federal University of Rio de Janeiro13, Memorial Sloan Kettering Cancer Center14, Vita-Salute San Raffaele University15, University of Oxford16, University of London17, University of Cambridge18, Garvan Institute of Medical Research19, Emory University20, Brigham and Women's Hospital21, Harvard University22, University Hospitals Birmingham NHS Foundation Trust23, University of Birmingham24, HealthPartners25, Stanford University26, Université de Montréal27, Northwestern University28, University of Sheffield29, National Institutes of Health30, University of Duisburg-Essen31, Ludwig Maximilian University of Munich32, Johns Hopkins University33, University of Padua34, Rabin Medical Center35, University of Bordeaux36, Nara Medical University37, Medical University of Vienna38, Churchill Hospital39, Autonomous University of Barcelona40, University of Ferrara41
TL;DR: The Pituitary Society of America's Virtual Workshop on Cushing's Disease as discussed by the authors discussed the application of recent evidence to clinical practice and provided recommendations regarding use of laboratory tests, imaging, and treatment options.
1 citations
TL;DR: Response to Letter to the Editor: “Prevention of Adrenal Crisis: Cortisol Response to Major Stress Compared to Stress Dose Hydrocortisone Delivery”
Abstract: Response to Letter to the Editor: “Prevention of Adrenal Crisis: Cortisol Response to Major Stress Compared to Stress Dose Hydrocortisone Delivery” Alessandro Prete, Angela E. Taylor, Irina Bancos, David J. Smith, Mark A. Foster, Sibylle Kohler, Violet Fazal-Sanderson, John Komninos, Donna M. O’Neil, Dimitra A. Vassiliadi, Christopher J. Mowatt, Radu Mihai, Joanne L. Fallowfield, Djillali Annane, Janet M. Lord, Brian G. Keevil, John A. H. Wass, Niki Karavitaki, and Wiebke Arlt Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2GW, UK; Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA; School of Mathematics, University of Birmingham, Birmingham, B15 2TT, UK; Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2WB, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, B15 2GW, UK; Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, B15 2GW, UK; Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK; Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, 106 76, Greece; Department of Anaesthesiology, Royal Shrewsbury Hospital, The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, SY3 8XQ, UK; Department of Endocrine Surgery, Churchill Hospital, Oxford, UK; Institute of Naval Medicine, Alverstoke, PO12 2DL, UK; Critical Care Department, Hôpital Raymond-Poincaré, Laboratory of Infection & Inflammation U1173 INSERM/University Paris Saclay-UVSQ, Garches, 92380, France; Department of Clinical Biochemistry, University Hospital of South Manchester, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; and NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
1 citations
01 Jan 2021
TL;DR: In order to maximize the benefits of integrated care in patients with pituitary tumors, pituitsary MDT should function within a Pituitary Tumor Center of Excellence, and have its activity, performance, and adherence to pathways and guidelines regularly monitored.
Abstract: Optimal care of patients with pituitary tumors is best provided in a multidisciplinary collaborative environment which requires a multitude of specialties working in unison. However, evidence for the role of the pituitary multidisciplinary team (MDT), its significance in improving patient care, and its ideal functionality model is extremely limited. Endocrinology and pituitary surgery are the natural leading specialties within the pituitary MDT and should be supported by specialties with significant influence on diagnosis and management of pituitary tumors, including neuroradiology, neuro-ophthalmology, neuro-oncology, and neuropathology, while pituitary nurses provide a significant role in the coordination and delivery of care. In order to maximize the benefits of integrated care in patients with pituitary tumors, pituitary MDT should function within a Pituitary Tumor Center of Excellence, and have its activity, performance, and adherence to pathways and guidelines regularly monitored.
1 citations
TL;DR: In response to COVID-19, the delivery of medical education has largely transitioned from face-to-face teaching to virtual platforms as discussed by the authors, which is a useful teaching modality to develop clinicians' knowledge and skills, while protecting patients from harm.
Abstract: In response to COVID-19, the delivery of medical education has largely transitioned from face-to-face teaching to virtual platforms. Simulation-based learning is a useful teaching modality to develop clinicians' knowledge and skills, while protecting patients from harm.[1][1] While simulation has