Endoscopic vs. Microscopic Transsphenoidal Surgery for the Treatment of Pituitary Adenoma

This article was originally published here

Front Surg. 2022 Feb 2;8:806855. doi: 10.3389/fsurg.2021.806855. eCollection 2021.

ABSTRACT

PURPOSE: Currently, endoscopic transsphenoidal surgery (ETS) and microscopic transsphenoidal surgery (MTS) are commonly applied treatments for patients with pituitary adenomas. This meta-analysis was conducted to evaluate the efficacy and safety of ETS and MTS for these patients.

METHODS: A computer search of Pubmed, Embase, Cochrane library, Web of Science, and Google Scholar databases was conducted for studies investigating ETS and MTS for patients with pituitary adenomas. The deadline is March 01, 2021. RevMan5.1 software was used to complete this meta-analysis after literature screening, data extraction, and literature quality evaluation.

RESULTS: A total of 37 studies including 5,591 patients were included. There was no significant difference in gross tumor removal (GTR) and hormone-excess secretion remission (HES remission) between two groups [RR = 1.10, 95% CI (0.99-1.22), P = 0.07; RR = 1.09, 95% CI (1.00-1.20), P = 0.05]. ETS was associated with lower incidence of diabetes insipidus (DI) [RR = 0.71, 95% CI (0.58-0.87), P = 0.0008], hypothyroidism [RR = 0.64, 95% CI (0.47-0.89), P = 0.007], and septal perforation [RR = 0.32, 95% CI (0.13-0.79), P = 0.01] than those with MTS.

CONCLUSION: This meta-analysis indicated that ETS cannot significantly improve GTR and HES remission. However, ETS could reduce the incidence of DI, hypothyroidism, and septal perforation without increasing the rate of other complications.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42021241217.

PMID:35187049 | PMC:PMC8847202 | DOI:10.3389/fsurg.2021.806855

First Adrenal Insufficiency Patient Dosed in Phase 2 Study

Diurnal’s pioneering phase 2 study evaluates modified-release hydrocortisone for adrenal insufficiency

Diurnal has announced that the first patient has been dosed in its phase 2 European clinical trial of modified-release hydrocortisone.

It is treating people with adrenal insufficiency (AI), also known as Addison’s disease, while the trial also represents a significant marketing opportunity for the company across Europe and throughout the UK.

The CHAMPAIN phase 2 study aims to evaluate the efficacy, safety and tolerability of modified-release hydrocortisone versus Plenadren in AI. It is anticipated that it will take six months to reach completion.

Modified-release hydrocortisone is a preparation of hydrocortisone that has been specifically designed for patients with diseases of cortisol deficiency–such as AI–and additionally for congenital adrenal hyperplasia (CAH). It is approved for the latter disease in Europe and the UK under the commercial name Efmody.

AI is a long-term endocrine disorder, which affects approximately 298,000 patients in Europe and the UK. It is caused by inadequate production of steroid hormones in the cortex of the adrenal glands. AI can result in severe fatigue and–if left untreated–adrenal crisis may be life-threatening.

Martin Whitaker, CEO of Diurnal, commented: “We are pleased to have dosed our first patient in the CHAMPAIN phase 2 study for adults with AI as we seek to explore the efficacy of modified-release hydrocortisone in diseases of cortisol deficiency.

“There is a high unmet need for adult patients suffering from AI across Europe with current treatment options leading to poor quality of life. We believe modified-release hydrocortisone has the potential to replicate the physiological overnight rise of cortisol in these patients and we look forward to the data readout from the CHAMPAIN study in H2 2022,” he added.

From https://www.pharmatimes.com/news/first_adrenal_insufficiency_patient_dosed_in_phase_ii_study_1387551

What Do *You* Think? Smartwatch Measures Cortisone

Share your thoughts here.

The human body responds to stress, from the everyday to the extreme, by producing a hormone called cortisol.

To date, it has been impractical to measure cortisol as a way to potentially identify conditions such as depression and post-traumatic stress, in which levels of the hormone are elevated. Cortisol levels traditionally have been evaluated through blood samples by professional labs, and while those measurements can be useful for diagnosing certain diseases, they fail to capture changes in cortisol levels over time.

Now, a UCLA research team has developed a device that could be a major step forward: A smartwatch that assesses cortisol levels found in sweat—accurately, noninvasively and in real time. Described in a study published in Science Advances, the technology could offer wearers the ability to read and react to an essential biochemical indicator of stress.

“I anticipate that the ability to monitor variations in cortisol closely across time will be very instructive for people with psychiatric disorders,” said co-corresponding author Anne Andrews, a UCLA professor of psychiatry and biobehavioral sciences, member of the California NanoSystems Institute at UCLA and member of the Semel Institute for Neuroscience and Human Behavior. “They may be able to see something coming or monitor changes in their own personal patterns.”

Cortisol is well-suited for measurement through sweat, according to co-corresponding author Sam Emaminejad, an associate professor of electrical and computer engineering at the UCLA Samueli School of Engineering, and a member of CNSI.

“We determined that by tracking cortisol in sweat, we would be able to monitor such changes in a wearable format, as we have shown before for other small molecules such as metabolites and pharmaceuticals,” he said. “Because of its small molecular size, cortisol diffuses in sweat with concentration levels that closely reflect its circulating levels.”

The technology capitalizes on previous advances in wearable bioelectronics and biosensing transistors made by Emaminejad, Andrews and their research teams.

In the new smartwatch, a strip of specialized thin adhesive film collects tiny volumes of sweat, measurable in millionths of a liter. An attached sensor detects cortisol using engineered strands of DNA, called aptamers, which are designed so that a cortisol molecule will fit into each aptamer like a key fits a lock. When cortisol attaches, the aptamer changes shape in a way that alters electric fields at the surface of a transistor.

The invention—along with a 2021 study that demonstrated the ability to measure key chemicals in the brain using probes—is the culmination of a long scientific quest for Andrews. Over more than 20 years, she has spearheaded efforts to monitor molecules such as serotonin, a chemical messenger in the brain tied to mood regulation, in living things, despite transistors’ vulnerability to wet, salty biological environments.

Sweating the small stuff: Smartwatch developed at UCLA measures key stress hormone
The technology capitalizes on previous work by Sam Emaminejad, Anne Andrews and their UCLA research teams. Credit: Emaminejad Lab and Andrews Lab/UCLA

In 1999, she proposed using nucleic acids—rather than proteins, the standard mechanism—to recognize specific molecules.

“That strategy led us to crack a fundamental physics problem: how to make transistors work for electronic measurements in biological fluids,” said Andrews, who is also a professor of chemistry and biochemistry.

Meanwhile, Emaminejad has had a vision of ubiquitous personal health monitoring. His lab is pioneering wearable devices with biosensors that track the levels of certain molecules that are related to specific health measures.

“We’re entering the era of point-of-person monitoring, where instead of going to a doctor to get checked out, the doctor is basically always with us,” he said. “The data are collected, analyzed and provided right on the body, giving us real-time feedback to improve our health and well-being.”

Emaminejad’s lab had previously demonstrated that a disposable version of the specialized adhesive film enables smartwatches to analyze chemicals from sweat, as well as a technology that prompts small amounts of sweat even when the wearer is still. Earlier studies showed that sensors developed by Emaminejad’s group could be useful for diagnosing diseases such as cystic fibrosis and for personalizing drug dosages.

One challenge in using cortisol levels to diagnose depression and other disorders is that levels of the hormone can vary widely from person to person—so doctors can’t learn very much from any single measurement. But the authors foresee that tracking individual cortisol levels over time using the smartwatch may alert wearers, and their physicians, to changes that could be clinically significant for diagnosis or monitoring the effects of treatment.

Among the study’s other authors is Janet Tomiyama, a UCLA associate professor of psychology, who has collaborated with Emaminejad’s lab over the years to test his wearable devices in clinical settings.

“This work turned into an important paper by drawing together disparate parts of UCLA,” said Paul Weiss, a UCLA distinguished professor of chemistry and biochemistry and of materials science and engineering, a member of CNSI, and a co-author of the paper. “It comes from us being close in proximity, not having ego problems and being excited about working together. We can solve each other’s problems and take this technology in new directions.”

The paper’s co-first authors are UCLA postdoctoral scholar Bo Wang and Chuanzhen Zhao, a former UCLA graduate student. Other co-authors are Zhaoqing Wang, Xuanbing Cheng, Wenfei Liu, Wenzhuo Yu, Shuyu Lin, Yichao Zhao, Kevin Cheung and Haisong Lin, all of UCLA; and Milan Stojanović and Kyung-Ae Yang of Columbia University.

From https://techxplore.com/news/2022-02-small-newly-smartwatch-key-stress.html

What Is Facial Plethora?

What does it mean to have facial plethora? 

Facial plethora involves facial swelling and redness. It’s a symptom of another condition, rather than a condition itself.

It occurs when blood flow to your face increases. It can also happen when the amount of blood in your body increases.

The underlying causes of facial plethora vary greatly, and treatment depends on the specific cause.

 What can cause a plethoric face? 

Several possible conditions can cause facial plethora. They include:

Cushing syndrome

Facial plethora is a main symptom of  Cushing syndrome , a rare condition that’s caused by high levels of cortisol, known as the stress hormone.

The hormone cortisol is produced by your adrenal gland. It’s involved in bodily functions like the stress response, metabolism, and inflammation.

 Too much cortisol  can happen if you have a tumor in the pituitary or adrenal gland. The tumor causes your body to overproduce cortisol, leading to high levels. It can also happen after taking  corticosteroid  drugs, like prednisone.

High levels of cortisol can increase blood pressure. This increases blood flow in the skin on your face, resulting in facial plethora.

Superior vena cava syndrome

T he superior vena cava (SVC) is a major vein in your body. It brings blood to your heart from your chest, head, neck, and arms.

Some types of cancer, like lung cancer, can partially or completely block the SCV. A blood clot can also block the SCV. If this happens, a group of symptoms called superior vena cava syndrome (SCVS) may develop.

In SCVS, the blockage of blood flow causes upper body swelling. This can lead to symptoms like facial plethora. 

Carcinoid syndrome

Neuroendocrine cells are involved in basic bodily functions. They work by sending information via hormones.

If neuroendocrine cells develop into a tumor, it’s called a carcinoid tumor. Carcinoid syndrome happens when the tumor spreads to your liver and makes too much serotonin.

The tumor releases chemicals into the bloodstream, causing a range of symptoms. Some chemicals widen the blood vessels and increase blood flow, resulting in facial swelling.

Polycythemia vera

Polycythemia vera is a rare blood disorder that causes excess production of red blood cells. This increases red blood cell mass, causing thickened blood and swelling.

The swelling can lead to plethora of the face and palms.

Rosacea

Rosacea is a chronic inflammatory skin disorder. The inflammation can cause facial flushing and swelling.

In people with lighter skin tones, the flushing appears red. In those with darker skin tones, it may look like brown discoloration.

Other symptoms of rosacea include:

  • acne-like breakouts
  • thickening skin
  • burning
  • warm skin

Sunburn

sunburn happens when ultraviolet rays from the sun damage skin cells. This causes your body to release inflammatory substances, resulting in dilated blood vessels and increased blood flow.

The increased blood flow leads to swelling and redness, or facial plethora.

 Is facial plethora a symptom of a syndrome? 

In some cases, facial plethora may indicate a syndrome.

According to a 2015 study, facial plethora is one of the first identified symptoms of Cushing syndrome. It’s also one of the first symptoms to get better as Cushing syndrome is treated.

Facial plethora may also be caused by SVCS or carcinoid syndrome.

 What are the features of facial plethora? 

Facial plethora involves a group of features, rather than a single characteristic. It generally involves facial symptoms like:

  • swelling and increased roundness
  • increased puffiness in your cheeks
  • redness (on lighter skin tones)
  • brown discoloration (on darker skin tones)

VIEW GALLERY2
 Does facial plethora pose other health risks? 

The symptoms of facial plethora may be uncomfortable. But there’s no research stating that facial plethora itself is linked to complications.

However, if the underlying condition goes untreated, it may lead to complications. The condition may get worse or cause other side effects.

That’s why it’s important to contact a healthcare professional if you think you have facial plethora.

 How is facial plethora treated? 

Treatment for a plethoric face depends on the condition causing it. Treatment may include:

Medication

A healthcare professional may suggest using medication for the following conditions:

  • Cushing syndrome. A doctor can prescribe medications that lower your cortisol levels.
  • SVCS. If this condition is caused by a blood clot, a therapy called thrombolysis can be used to break down the clot. This procedure allows medication to get to the site of a blood clot and dissolve the blockage.
  • Carcinoid syndrome. Some medications can block the chemicals produced by a carcinoid tumor.
  • Polycythemia vera. If you have polycythemia vera, you might need medication to reduce red blood cell production.
  • Rosacea. A dermatologist can prescribe topical medication to manage rosacea symptoms.

Chemotherapy or radiation

Chemotherapy or radiation treatment may be used for tumors that cause:

  • Cushing syndrome
  • SVCS
  • carcinoid syndrome

Surgery

In certain cases, you might need surgery. This option may be used for tumors that cause:

  • Cushing syndrome
  • SVCS
  • carcinoid syndrome

If SCVS is caused by a blood clot, surgery may be used to insert a stent or remove the blood clot.

 Takeaway 

Facial plethora is characterized by facial swelling and puffiness. It can cause redness in lighter complexions and brown discoloration in darker skin tones.

It’s a main symptom of Cushing syndrome, but it may also be a symptom of SVCS and carcinoid syndrome. Other causes include polycythemia vera, rosacea, and sunburn.

Treatment depends on the specific cause. If you experience facial swelling and discoloration, reach out to a healthcare professional for a diagnosis.

Capillary Microarchitectural Changes in Cushing’s Syndrome

This article was originally published here

Microvasc Res. 2022 Jan 21:104323. doi: 10.1016/j.mvr.2022.104323. Online ahead of print.

ABSTRACT

PURPOSE: Macrovascular alterations are prominent in Cushing’s syndrome (CS). Microvascular abnormalities are yet to be established. This cross-sectional observational study aimed to evaluate microvascular changes in nailfold capillaries and their association with disease status and carotid intima-media thickness (CIMT) as a marker of atherosclerosis.

METHODS: A total of 70 patients with CS [46 (65.7%) ACTH-dependent pituitary adenoma and 24 (34.3%) adrenocortical adenomas] and 100 healthy controls were enrolled. The microvascular structure was evaluated using nailfold video-capillaroscopy (NVC).

RESULTS: The median number of capillaries was less [10 mm (IQR: 2, min-max:7-14) vs. 11 mm (IQR: 2, min-max:9-19) (p < 0.001)], the median limb diameter and capillary width were wider in the CS group than in the controls (p = 0.016 and p = 0.002, respectively). Microhemorrhages within limited areas were more frequent in the CS group than in the controls (p = 0.046). Observed capillary changes were similar among the patients with CS with remission or active disease. CIMT levels were higher in the CS group than in the controls and similar in subjects with active disease and remission. Univariate logistic regression analyses revealed that the number of capillaries and capillary widths were associated with body mass index (BMI), the presence of type 2 diabetes mellitus, HbA1c, and CIMT.

CONCLUSION: Morphologic alterations present similarly in nailfold capillaries in subjects with CS regardless of disease status, resembling changes in chronic atherosclerotic diseases. Microvascular changes in nailfold capillaries measured using NVC can be used as a marker in the assessment of cardiovascular risk in patients with CS.

PMID:35074338 | DOI:10.1016/j.mvr.2022.104323

From https://www.docwirenews.com/abstracts/rheumatology-abstracts/capillary-microarchitectural-changes-in-cushings-syndrome/

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