Showing papers by "Niki Karavitaki published in 2023"
TL;DR: In this article , a small subset of lactotroph adenomas is resistant to dopamine agonists (DA) and can also demonstrate aggressive or even malignant behavior, and switching to another DA could be the first option to consider.
Abstract: A small subset of lactotroph adenomas is resistant to dopamine agonists (DA) and can also demonstrate aggressive or even malignant behavior. The implicated mechanisms are not clearly defined. Management can be challenging and requires a multidisciplinary approach. In DA resistant prolactinomas, switching to another DA could be the first option to consider. Further strategies include surgery and radiotherapy used alone or in combination. In cases of aggressive or malignant prolactinomas, temozolomide could be offered. Immune checkpoint inhibitors have been also recently proposed as an alternative approach. The place of other treatments (e.g., metformin, selective estrogen modulators, somatostatin analogues, tyrosine kinase inhibitors, inhibitors of mammalian target of rapamycin and peptide radio-receptor therapy) remains to be carefully assessed.
1 citations
TL;DR: A searchable abstracts of presentations at key conferences in endocrinology can be found in this article , where the abstracts are extracted from the corresponding abstracts from the conference proceedings.
Abstract: Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
TL;DR: In this article , a retrospective review of patients with pheochromocytoma seen between January 2010 and October 2022 at a large tertiary care center was conducted, where the diagnosis was confirmed histologically or by the combined presence of increased plasma and/or urinary metanephrines, indeterminate adrenal mass on crosssectional imaging, and metaiodobenzylguanidine avidity.
Abstract: BACKGROUND
Pheochromocytomas are increasingly diagnosed in incidentally detected adrenal masses. However, the characteristics of incidental pheochromocytomas are unclear.
METHODS
Retrospective review of patients with pheochromocytoma seen between January 2010 and October 2022 at a large tertiary care center. The diagnosis was confirmed histologically or by the combined presence of increased plasma and/or urinary metanephrines, indeterminate adrenal mass on cross-sectional imaging, and metaiodobenzylguanidine avidity.
RESULTS
We identified 167 patients with pheochromocytoma; 144 (86.2%) underwent adrenalectomy, for 23 (13.8%) surgery was either awaited, deemed unsuitable due to frailty or other metastatic malignancy, or declined by the patients.Excluding pheochromocytomas diagnosed via screening genetically predisposed individuals (N=20), 37/132 (28.0%) presented with adrenergic symptoms and/or uncontrolled hypertension while 91/132 (69.0%) patients presented with an incidentally detected adrenal mass. Incidentally detected patients were older (median 62 years) than those detected due to clinical suspicion (42 years) or after genetic screening (33 years) (all p<0.05). Incidentally detected pheochromocytomas were smaller (median 42 mm) than tumors detected due to adrenergic symptoms/uncontrolled hypertension (60 mm), but larger than tumors identified by genetic screening (30 mm) (all p<0.05). Increased metanephrines excretion showed a similar pattern (symptomatic/uncontrolled hypertension > incidental > genetic screening) (all p<0.05). Hereditary predisposition was detected in 20.4% of patients (incidental, 15.3%; symptomatic, 42.9%).
CONCLUSIONS
The majority of pheochromocytomas are diagnosed incidentally and have distinct clinical, radiological, biochemical, and genetic features. Their detection at older age but smaller size may point to a different underlying tumor biology.
TL;DR: In this article , the authors presented the clinical course of FGA-induced ovarian hyperstimulation syndrome (OHSS) cases as identified by some of the largest UK pituitary endocrine tertiary centres with a view to increasing awareness and improving diagnosis and management of women with FGA.
Abstract: OBJECTIVE
Functioning gonadotroph adenomas (FGAs) are rare pituitary tumours stimulating ovarian function with potential life-threatening consequences in women. However, a lack of aggregated clinical experience of FGAs impairs management in affected women. The aim of this study is to present the clinical course of FGA-induced ovarian hyperstimulation syndrome (OHSS) cases as identified by some of the largest UK pituitary endocrine tertiary centres with a view to increasing awareness and improving diagnosis and management of women with FGA.
DESIGN
A retrospective observational study; audit of eight UK regional pituitary centres for cases of FGAs.
SETTING
Specialist neuroendocrine centres in the United Kingdom.
PATIENTS AND MEASUREMENTS
Women diagnosed with FGA-induced OHSS. Description of their clinical course.
RESULTS
Seven cases of FGA were identified in women, all causing OHSS. Mean age was 33.4 years at diagnosis. Abdominal pain, irregular periods, headache, and visual disturbances were reported at presentation by 100%, 71%, 57% and 43% of women, respectively. Three of seven women underwent ovarian surgery before FGA diagnosis. Six women underwent transsphenoidal surgery (TSS) with incomplete tumour resection in five of those, but all showed improvement or resolution in symptoms and biochemistry postoperatively.
CONCLUSION
FGA is a rare cause of spontaneous OHSS. TSS improves clinical and biochemical features of ovarian hyperstimulation in FGAs. Improved awareness of FGA will prevent inappropriate emergency ovarian surgery.
TL;DR: The optimal approach to the surveillance of nonfunctioning pituitary microadenomas (micro-NFPAs) is not clearly established as mentioned in this paper , and the optimal approach for surveillance of micro-NFAs is not clear.
Abstract: The optimal approach to the surveillance of non-functioning pituitary microadenomas (micro-NFPAs) is not clearly established. Our aim was to generate evidence on the natural history of micro-NFPAs to support patient care.Multi-centre, retrospective, cohort study involving 23 endocrine departments (UK NFPA consortium).Clinical, imaging, and hormonal data of micro-NFPA cases between 1/1/2008 and 21/12/2021 were analysed.Data for 459 patients were retrieved [median age at detection 44 years [interquartile range (IQR) 31-57) - 152 males/307 females]. 419 patients had more than two MRIs [median imaging monitoring 3.5 years (IQR 1.71-6.1)]. One case developed apoplexy. Cumulative probability of micro-NFPA growth was 7.8% (95%CI 4.9%-8.1%) and 14.5% (95%CI 10.2%-18.8%) at 3 and 5 years, respectively, and of reduction 14.1% (95%CI 10.4-17.8%) and 21.3% (95%CI 16.4-26.2%) at 3 and 5 years, respectively. Median tumour enlargement was 2 mm (IQR 1-3) and 49% of micro-NFPAs that grew became macroadenomas (nearly all >5 mm at detection). Eight (1.9%) patients received surgery (only one had visual compromise with surgery required >3 years after micro-NFPA detection). Sex, age, size at baseline were not predictors of enlargement/reduction. At time of detection, 7.2%, 1.7% and 1.5% patients had secondary hypogonadism, hypothyroidism and hypoadrenalism, respectively. Two (0.6%) developed hypopituitarism during follow-up (after progression to macroadenoma).Probability of micro-NFPA growth is low and development of new hypopituitarism is rare. Delaying first follow-up MRI to three years and avoiding hormonal re-evaluation in absence of tumour growth or clinical manifestations is a safe approach for micro-NFPA surveillance.
TL;DR: Simulation via Instant Messaging-Birmingham Advance (SIMBA) as discussed by the authors is a simulation-based learning platform for postgraduate healthcare professionals to support continuing medical education (CME) through WhatsApp and Zoom.
Abstract: BACKGROUND
Simulation via Instant Messaging-Birmingham Advance (SIMBA) delivers simulation-based learning through WhatsApp and Zoom, helping to sustain continuing medical education (CME) for postgraduate healthcare professionals otherwise disrupted by the coronavirus (COVID-19) pandemic. This study aimed to assess whether SIMBA helped to improve clinical knowledge and if this improvement in knowledge was sustained over time.
METHODS
Two SIMBA sessions-thyroid and pituitary-were conducted in July-August 2020. Each session included simulation of various real-life cases and interactive discussion. Participants' self-reported confidence, acceptance, and knowledge were measured using surveys and multiple-choice questions pre- and post-simulation and in a 6- to 12-week follow-up period. The evaluation surveys were designed using Moore's 7 Levels of CME Outcomes Framework.
RESULTS
A total of 116 participants were included in the analysis. Significant improvement was observed in participants' self-reported confidence in approach to simulated cases (thyroid, n = 37, P < .0001; pituitary, n = 79, P < .0001). Significant improvement in clinical knowledge was observed following simulation (thyroid, n = 37, P < .0001; pituitary, n = 79, P < .0001). For both sessions, retention of confidence and knowledge was seen at 6-12 weeks' follow-up.
CONCLUSIONS
SIMBA increased participants' clinical knowledge on simulated cases and this improvement was retained up to 6-12 weeks after the session. Further studies are required to explore long-term retention and whether it translates to improved real-world clinical practice.
TL;DR: A searchable abstracts of presentations at key conferences in endocrinology can be found in this article , where the abstracts are extracted from the corresponding abstracts from the conference proceedings.
Abstract: Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)