[Efficacy of external conventional radiotherapy in short and long term control of acromegaly; a comparison with stereotactic irradiation]. / Efficacia della Radioterapia Convenzionale nel controllo abreve e a lungo termine della malattia acromegalica: confrontocon la metodica stereotassica.

AIMS: The aim of this study was to follow up two groups of patients with active acromegaly, who underwent to external irradiation and radio-surgery and to value the efficacy of irradiation in the control of the growth of the adenoma, hypersecretion and incidence of adverse events. MATERIALS AND METHODS: In 2 groups of patients, (A) of 47 subjects treated with conventional irradiation at a dose of 45 Gy, (B) of 6 subjects irradiated with stereo taxis radiotherapy at a dose of 15-20 Gy, were evaluated GH, IGF1 levels and pituitary function at 2, 5, 10 and 15 years after treatment. A cerebral MRI scan with detailed study of the sellar region was performed every year. RESULTS: Group (A): decrease of GH levels in 9% of patients after 2 years from therapy, 29% after 5 years, 52% after 10 years, 77% after 15 years; normalization of IGF1 levels in 8% of cases after 2 years, 23%, 42% and 61% respectively after 5, 10 and 15 years; hypopituitarism in 57, 78, 85% of patients, respectively after 5, 10 and 15 years. Group (B):normalization of IGF1 levels in 4 of 6 patients after 5 years and in all subjects after 10 and 15 years; progressive decrease of GH levels in all patients and GH normalization in 2 of 6 cases after 10 years; hypopituitarism in 1 patient after 2 years. CONCLUSIONS: We confirm the long term efficacy of external Radiotherapy in active acromegaly. Stereo taxis annuls the risks of neurological and neurovascular complications of conventional RT. Although comparison between the two techniques is not statistical significant in our cases we can affirm a faster normalization of IGF1 levels after stereotactic treatment.

Prevalence of celiac disease in patients with autoimmune thyroiditis.

AIM: Many autoimmune disorders are associated to celiac disease (CD) but the association with autoimmune thyroiditis has been more frequently documented; this is in part explained by a shared immunogenetic make-up, and in part caused to time gluten-exposition, as suggested by the significant correlation observed in celiac patients between the increase occurrence of autoimmune diseases and the length of exposure to gluten. The aim of this study was to establish the prevalence of celiac disease in a group of subjects with autoimmune thyroiditis newly diagnosed on the basis of antibodies anti-peroxidase (TPO). METHODS: A total of 113 untreated patients with TPO >70 IU/mL were enrolled. CD was screened by measuring anti-endomysial antibodies (EMA) both IgA and IgG; an high prevalence of positive serology was resulting in this group, justified, in part, from EMA IgG investigation. RESULTS: In fact 31/113 patients showed IgA and/or IgG positivity and were diagnosed as celiacs with jejunal biopsy. CONCLUSION: On the basis of this paper, such as in according to current research-setting studies, the greater frequency of CD in association to autoimmune thyroid disease suggests that all subjects with TPO should be routinely screened for CD, through EMA IgA and IgG. However, the performance of this screening has never been evaluated until now, even if it could, in fact, be valid in order to increment diagnosis of CD, today still undiagnosed.