@article{DetomasRitzelNasiKordhishtietal.2022, author = {Detomas, Mario and Ritzel, Katrin and Nasi-Kordhishti, Isabella and Wolfsberger, Stefan and Quinkler, Marcus and Losa, Marco and Tr{\"o}ger, Viola and Kroiss, Matthias and Fassnacht, Martin and Vila, Greisa and Honegger, J{\"u}rgen Bernd and Reincke, Martin and Deutschbein, Timo}, title = {Outcome of CRH stimulation test and overnight 8 mg dexamethasone suppression test in 469 patients with ACTH-dependent Cushing's syndrome}, series = {Frontiers in Endocrinology}, volume = {13}, journal = {Frontiers in Endocrinology}, issn = {1664-2392}, doi = {10.3389/fendo.2022.955945}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-289450}, year = {2022}, abstract = {Objective To evaluate diagnostic accuracy of the corticotropin-releasing hormone (CRH) stimulation test and the overnight 8 mg dexamethasone suppression test (DST) for the differentiation of Cushing's disease (CD) and ectopic Cushing's syndrome (ECS). Methods Retrospective study in 6 European centers. Inclusion criteria: patients with a) overt adrenocorticotropin (ACTH)-dependent Cushing's syndrome at the time of dynamic testing, b) histopathological confirmed tumors and/or c) postoperative biochemical remission and/or adrenal insufficiency. Optimal cut-offs were calculated via receiver operating characteristic (ROC) analysis using CD as reference. Results 469 patients were analyzed [78\% females; median age 43 years (IQR 19)]. CRH test and overnight 8 mg DST were performed in 420 [CD, n=394 (94\%); ECS, n=26 (6\%)] and 237 patients [228 CD (96\%), 9 ECS (4\%)]. Both tests were performed in 205 patients (44\%). The post-CRH \%-increase at 30 minutes of both ACTH (cut-off ≥31\%, sensitivity 83\%, specificity 85\%, AUC 0.81) and cortisol (cut-off ≥12\%, sensitivity 82\%, specificity 89\%, AUC 0.86) discriminated best between CD and ECS. A test duration of >60 minutes did not improve diagnostic performance of the CRH test. The optimal cortisol cut-off for the \%-suppression during the 8 mg DST was ≥55\% (sensitivity 80\%, specificity 78\%, AUC 0.75). Conclusion The CRH test has equivalent sensitivity but higher specificity than the 8 mg DST and is therefore the test of first choice. The diagnostic outcome of ACTH and cortisol is well comparable, however, sampling beyond 60 minutes post-CRH does not provide diagnostic benefits.}, language = {en} } @article{DetomasPivonelloPellegrinietal.2022, author = {Detomas, Mario and Pivonello, Claudia and Pellegrini, Bianca and Landwehr, Laura-Sophie and Sbiera, Silviu and Pivonello, Rosario and Ronchi, Cristina L. and Colao, Annamaria and Altieri, Barbara and De Martino, Maria Cristina}, title = {MicroRNAs and long non-coding RNAs in adrenocortical carcinoma}, series = {Cells}, volume = {11}, journal = {Cells}, number = {14}, issn = {2073-4409}, doi = {10.3390/cells11142234}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-281795}, year = {2022}, 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.}, language = {en} } @article{DetomasAltieriDeutschbeinetal.2022, author = {Detomas, Mario and Altieri, Barbara and Deutschbein, Timo and Fassnacht, Martin and Dischinger, Ulrich}, title = {Metyrapone versus osilodrostat in the short-term therapy of endogenous Cushing's syndrome: results from a single center cohort study}, series = {Frontiers in Endocrinology}, volume = {13}, journal = {Frontiers in Endocrinology}, issn = {1664-2392}, doi = {10.3389/fendo.2022.903545}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-277477}, year = {2022}, abstract = {Background Although surgery is considered the first-line treatment for patients with endogenous Cushing's syndrome (CS), medical therapy is often required to control severe hypercortisolism. Metyrapone and osilodrostat are both steroidogenic inhibitors targeting the 11β-hydroxylase, however, their therapeutic effectiveness has not yet been directly compared. This study aimed to evaluate metyrapone and osilodrostat in the short-term therapy of CS. Methods Retrospective analysis of patients with endogenous CS treated with metyrapone or osilodrostat as monotherapy for at least 4 weeks. Main outcome measures were serum cortisol and 24h urinary free cortisol (UFC) at baseline (T0) and after 2 (T1), 4 (T2), and 12 weeks (T3) of therapy. Results 16 patients with endogenous CS were identified (pituitary n=7, adrenal n=4, ectopic CS n=5). Each 8 patients were treated with metyrapone and osilodrostat. Despite heterogeneity, both groups showed comparable mean UFC levels at T0 (metyrapone: 758 µg/24h vs osilodrostat: 817 µg/24h; p=0.93). From T0 to T1, the decrease of UFC was less pronounced under metyrapone than osilodrostat (-21.3\% vs -68.4\%; median daily drug dose: 1000 mg vs 4 mg). This tendency persisted at T2 (-37.3\% vs -50.1\%; median drug dose: 1250 mg vs 6 mg) while at T3 a decrease in UFC from T0 was more pronounced in the metyrapone group (-71.5\% vs -51.5\%; median dose 1250 mg vs 7 mg). Under osilodrostat, a QTc-interval prolongation was identified at T3 (mean 432 ms vs 455 ms). From T0 to T2, the number of antihypertensive drugs remained comparable under metyrapone and decreased under osilodrostat (n= -0.3 vs n= -1.0). Conclusion Although both drugs show comparable therapeutic efficacy, osilodrostat seems to reduce cortisol levels and to control blood pressure faster.}, language = {en} } @article{AmerellerDeutschbeinJoshietal.2022, author = {Amereller, Felix and Deutschbein, Timo and Joshi, Mamta and Schopohl, Jochen and Schilbach, Katharina and Detomas, Mario and Duffy, Leo and Carroll, Paul and Papa, Sophie and St{\"o}rmann, Sylv{\`e}re}, title = {Differences between immunotherapy-induced and primary hypophysitis—a multicenter retrospective study}, series = {Pituitary}, volume = {25}, journal = {Pituitary}, number = {1}, issn = {1386-341X}, doi = {10.1007/s11102-021-01182-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-308704}, pages = {152-158}, year = {2022}, abstract = {Objective Immune checkpoint inhibitors can cause various immune-related adverse events including secondary hypophysitis. We compared clinical characteristics of immunotherapy-induced hypophysitis (IIH) and primary hypophysitis (PH) Design Retrospective multicenter cohort study including 56 patients with IIH and 60 patients with PH. Methods All patients underwent extensive endocrine testing. Data on age, gender, symptoms, endocrine dysfunction, MRI, immunotherapeutic agents and autoimmune diseases were collected. Results Median time of follow-up was 18 months in IIH and 69 months in PH. The median time from initiation of immunotherapy to IIH diagnosis was 3 months. IIH affected males more frequently than PH (p < 0.001) and led to more impaired pituitary axes in males (p < 0.001). The distribution of deficient adenohypophysial axes was comparable between both entities, however, central hypocortisolism was more frequent (p < 0.001) and diabetes insipidus considerably less frequent in IIH (p < 0.001). Symptoms were similar except that visual impairment occurred more rarely in IIH (p < 0.001). 20 \% of IIH patients reported no symptoms at all. Regarding MRI, pituitary stalk thickening was less frequent in IIH (p = 0.009). Concomitant autoimmune diseases were more prevalent in PH patients before the diagnosis of hypophysitis (p = 0.003) and more frequent in IIH during follow-up (p = 0.002). Conclusions Clinically, IIH and PH present with similar symptoms. Diabetes insipidus very rarely occurs in IIH. Central hypocortisolism, in contrast, is a typical feature of IIH. Preexisting autoimmunity seems not to be indicative of developing IIH.}, language = {en} }