ABSTRACT
Guidelines recommend adults with pituitary disease in whom GH therapy is contemplated, to be tested for GH deficiency (AGHD); however, clinical practice is not uniform. AIMS: 1) To record current practice of AGHD management throughout Europe and benchmark it against guidelines; 2) To evaluate educational status of healthcare professionals about AGHD. DESIGN: On-line survey in endocrine centres throughout Europe. PATIENTS AND METHODS: Endocrinologists voluntarily completed an electronic questionnaire regarding AGHD patients diagnosed or treated in 2017-2018. RESULTS: Twenty-eight centres from 17 European countries participated, including 2139 AGHD patients, 28% of childhood-onset GHD. Aetiology was most frequently non-functioning pituitary adenoma (26%), craniopharyngioma (13%) and genetic/congenital mid-line malformations (13%). Diagnosis of GHD was confirmed by a stimulation test in 52% (GHRH+arginine, 45%; insulin-tolerance, 42%, glucagon, 6%; GHRH alone and clonidine tests, 7%); in the remaining, ≥3 pituitary deficiencies and low serum IGF-I were diagnostic. Initial GH dose was lower in older patients, but only women <26 years were prescribed a higher dose than men; dose titration was based on normal serum IGF-I, tolerance and side-effects. In one country, AGHD treatment was not approved. Full public reimbursement was not available in four countries and only in childhood-onset GHD in another. AGHD awareness was low among non-endocrine professionals and healthcare administrators. Postgraduate AGHD curriculum training deserves being improved. CONCLUSION: Despite guideline recommendations, GH replacement in AGHD is still not available or reimbursed in all European countries. Knowledge among professionals and health administrators needs improvement to optimize care of adults with GHD.
ABSTRACT
INTRODUCTION: Amiodarone-induced thyrotoxicosis (AIT) is a common clinical disorder that may be life threatening and whose clinical manifestations and response to treatment may vary among patients. METHODS: We present three patients treated with amiodarone for atrial fibrillation who developed AIT at least 36 months after beginning the treatment. Thyrotoxicosis worsened the underlying cardiac disorders and was resistant to treatment based on the combination of dexamethasone 8-12 mg/day i.v., thioamides 45 mg/day p.o., beta blockers and potassium perchlorate at doses of 800 to 1000 mg per day p.o. Two of the patients attained sustained euthyroidism after 12 and 32 days of combined treatment, while the third required total thyroidectomy. CONCLUSION: The combination of thioamides with potassium perchlorate is an appropriate form of therapy for AIT in patients resistant to thioamides. The use of this combination should be evaluated in patients with mixed AIT or AIT of unclear etiology.
Subject(s)
Amiodarone/adverse effects , Perchlorates/therapeutic use , Potassium Compounds/therapeutic use , Thyrotoxicosis/drug therapy , Acenocoumarol/administration & dosage , Acenocoumarol/therapeutic use , Adrenergic beta-Antagonists/administration & dosage , Adrenergic beta-Antagonists/therapeutic use , Aged , Aged, 80 and over , Algorithms , Amiodarone/therapeutic use , Atrial Fibrillation/drug therapy , Cardiovascular Agents/therapeutic use , Comorbidity , Dexamethasone/administration & dosage , Dexamethasone/therapeutic use , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Pacemaker, Artificial , Perchlorates/administration & dosage , Potassium Compounds/administration & dosage , Thioamides/administration & dosage , Thioamides/therapeutic use , Thyroid Hormones/blood , Thyroidectomy , Thyrotoxicosis/blood , Thyrotoxicosis/chemically induced , Thyrotoxicosis/surgery , Thyrotropin/bloodABSTRACT
Introducción La tiroiditis inducida por amiodarona (TIA) es una entidad clínica frecuente, con distintas formas de presentación, respuesta variable al tratamiento, y que puede ser potencialmente fatal. Métodos Se presentan tres pacientes con fibrilación auricular, que desarrollaron una TIA tras al menos 36 meses de exposición al fármaco. El hipertiroidismo asociado no respondió a la terapia farmacológica convencional, conllevando un empeoramiento franco de la cardiopatía de los pacientes, lo que motivó la indicación de tiroidectomía total, previa instauración de una terapia basada en la combinación de dexametasona 8-12mg/día iv, tionamidas 45mg/día vo, beta-bloqueantes, junto perclorato potásico 0,8-1g/día vo. Dos pacientes normalizaron las hormonas tiroideas periféricas tras 12 y 32 días de terapia combinada. Conclusión La combinación de tionamidas y perclorato potásico es una alternativa terapéutica eficaz en la TIA tipo I en pacientes refractarios a terapia convencional. Debe valorarse su empleo en pacientes con TIA mixta o etiología no aclarada (AU)
Introduction: Amiodarone-induced thyrotoxicosis (AIT) is a common clinical disorder that maybe life threatening and whose clinical manifestations and response to treatment may vary among patients. Methods: We present three patients treated with amiodarone for atrial fibrillation who developed AIT at least 36 months after beginning the treatment. Thyrotoxicosis worsened the underlying cardiac disorders and was resistant to treatment based on the combination of dexamethasone 8-12 mg/day i.v., thioamides 45 mg/day p.o., beta blockers and potassium perchlorate at doses of 800 to 1000 mg per day p.o. Two of the patients attained sustained euthyroidism after 12 and 32 days of combined treatment, while the third required total thyroidectomy. Conclusion: The combination of thioamides with potassium perchlorate is an appropriate formof therapy for AIT in patients resistant to thioamides. The use of this combination should be evaluated in patients with mixed AIT or AIT of unclear etiology (AU)
