Showing papers by "Omar Serri published in 2006"

The influences of hyperprolactinemia and obesity on cardiovascular risk markers: effects of cabergoline therapy

Abstract: Summary Objective In view of the association of hyperprolactinaemia with insulin resistance, we hypothesized that patients with hyperprolactinaemia may present increased cardiovascular risk markers. Design Descriptive clinical trial. Methods Serum glucose, insulin, insulin resistance, lipids, high sensitivity C-reactive protein (hsCRP), interleukin (IL)-6, tumour necrosis factor (TNF)-α and soluble E-selectin (sELAM-1) serum levels were determined in 15 patients with hyperprolactinaemia at baseline (compared with 20 healthy subjects) and after 12 weeks of cabergoline therapy (0·5–1 mg twice per week). We also measured mononuclear cell NF-κB activation and TNF-α production in a subset of subjects. Results Serum levels of prolactin (PRL), insulin, insulin resistance (HOMA-IR) index and hsCRP were significantly higher in patients than in control subjects. Markers of mononuclear cell activation did not differ between the groups. Hyperprolactinaemia, BMI and age were predictors of hsCRP. BMI was the only predictor of HOMA-IR. Cabergoline therapy significantly reduced serum PRL, insulin, hsCRP and sELAM-1 levels. Conclusions These data suggest that hyperprolactinaemia is associated with insulin resistance related to increased BMI and low-grade inflammation independently of BMI. Short-term cabergoline therapy can reduce the inflammatory markers.

Canadian consensus guidelines for the diagnosis and management of acromegaly.

Abstract: Acromegaly is a chronic condition associated with considerably increased morbidity and mortality if left unchecked. In December 2004, a national meeting was held to discuss the diversity in clinical practice across the country in diagnosing and treating patients with acromegaly, as well as to seek consensus on a number of management principles. The group reviewed recent guidelines and discussed issues of diagnosis, treatment, monitoring and treating comorbidities to seek a Canadian consensus on the management of this rare disorder. Consensus was that diagnosis should include clinical and biochemical findings, but is hinged on establishing GH hypersecretion with IGF-I and OGTT testing. Treatment has traditionally included surgical resection or debulking, along with adjunctive medical therapy (primarily somatostatin analogues), if necessary, to normalize GH levels. The option of primary medical therapy in managing this condition has recently emerged and can be justified for non-surgical candidates or for those in whom surgery is not expected to be curative. Overall, improved screening practices and superior epidemiological data are required, since timely diagnosis and appropriate treatment are crucial for reducing the potentially debilitating effects of this chronic, progressive disease. The current evidence also supports the need for long-term follow-up of disease activity and comorbidities in diagnosed patients. A national meeting was held to discuss the diversity in clinical practice across the country in diagnosing and treating patients with acromegaly, as well as to seek consensus on a number of management principles. After brief reviews of the most recent Canadian guidelines and the 2004 guidelines published by the American Association of Clinical Endocrinologists, the group was asked to specifically examine the issues of diagnosis, treatment, monitoring and treating comorbidities and seek a Canadian consensus on practice. This paper summarizes the working group's findings and the points of consensus that were achieved.

Canadian guidelines for the management of adult growth hormone deficiency.

Abstract: Purpose: To develop guidelines for the management of growth hormone (GH) deficiency in Canadian adults to facilitate rational use of GH in appropriate indications. Methods: The guidelines were developed by group of endocrinologists and an endocrine specialist nurse with an interest in neuroendocrine disorders, representing all regions of Canada and practicing in a variety of settings. A steering committee with broad expertise undertook a systematic review of the evidence relating to adult GHD and GH replacement. This evidence was reviewed by the whole group, and guidelines were developed using a consensus approach. Results: The document addresses the causes and clinical characteristics of GHD in adults and reviews the evidence in support of GH replacement in this group. The authors provide recommendations for the identification of adult GHD, and guidelines for GH replacement in appropriate patients. Also, access to GH therapy across Canada is reviewed. Growth hormone deficiency (GHD) in adults has been a subject of increasing interest in the past two decades. Evidence has accumulated of the adverse consequences of adult GHD, as well as of the benefits of long-term growth hormone (GH) replacement. The use of GH in adults in clinical practice is expanding and widespread concern has been raised about ethical and pharmacoeconomic issues relating to its use and misuse in different clinical and non-clinical scenarios. Such concerns are accentuated by the lack of clear-cut national guidelines, and the authors believe that the development of such guidelines will facilitate rational use of GH in appropriate indications. These guidelines were developed by a consensus group of endocrinologists and an endocrine specialist nurse with an interest in neuroendocrine disorders, representing all regions of Canada and practicing in a variety of settings. A steering committee with broad expertise (the authors of this document) undertook a systematic review of the evidence relating to adult GHD and GH replacement. This evidence was reviewed by the whole group, and guidelines were developed using a consensus approach. The document addresses the causes and clinical characteristics of GHD in adults, and reviews the evidence in support of GH replacement in this group. The authors provide recommendations for the identification of adult GHD, and guidelines for GH replacement in appropriate patients. The paper also reviews access to GH therapy across Canada. Emphasis was placed on newer diagnostic and management strategies with the understanding that adult GHD is a distinct patho-physiological entity not related to the physiological GH decline associated with normal aging. In this context GH is increasingly suggested as a potential treatment for age-related frailty, osteoporosis, morbid obesity, cardiac failure, and various catabolic conditions. The available placebo controlled studies in these contexts have not reported significant beneficial effects. The use of GH for non-GH deficient subjects as part of an anti-aging regiment is strongly discouraged since there are no human studies that indicate efficacy in this regard. Moreover, compelling data from animal studies suggests that lower GH levels are positively correlated with longevity whereas higher GH levels are associated with a shortened life-span.