ABSTRACT
OBJECTIVE: Our aim was to characterise a cohort of patients with Cushing's disease (CD) who did not present pituitary adenoma in magnetic resonance imaging (MRI), needing a catheterisation of the inferior petrosal sinus (CIPS), and to study the pathological findings of the pituitary gland in these subjects after transsphenoidal surgery in order to establish the aetiology of CD. Furthermore, we evaluated possible differences in the features of the diagnosis between hyperplasia and adenoma. SUBJECTS AND METHODS: We included 16 subjects. 17 CIPS were done. Hormonal parameters were measured using standard methods. A microscopic histochemical study following standard procedures and immunohistochemical analysis was performed. The diagnostic criteria for adenoma and hyperplasia were based on the WHO classification. RESULTS: One patient was excluded for presenting an ACTH-producing bronchial neuroendocrine tumour. The 15 subjects with CD have a positive CIPS test indicating hypophyseal ACTH production. After transsphenoidal surgery, 12 patients showed a microadenoma and three (20%) a corticotroph cell hyperplasia. We found four recurrences after the transsphenoidal surgery (26%), with a mean time for recurrence of 105 months. We found that recurrence was more frequent in subjects with hyperplasia, and in those subjects with lower right/left ACTH ratio. CONCLUSION: Our study, which was focused on patients with CD with no pituitary adenoma detected by MRI and a positive CRH test after CIPS, has found that 20% showed corticotroph cell hyperplasia as the cause of CD. Right/left ACTH ratio after CIPS was useful to differentiate adenoma from hyperplasia. This finding may have important prognostic and treatment implications. More studies are necessary to confirm our result.
Subject(s)
Adenoma , Cushing Syndrome , Pituitary Neoplasms , Humans , Cushing Syndrome/diagnosis , Cushing Syndrome/etiology , Adrenocorticotropic Hormone , Hyperplasia/pathology , Corticotrophs/metabolism , Corticotrophs/pathology , Pituitary Neoplasms/pathology , Adenoma/diagnosis , Adenoma/diagnostic imagingABSTRACT
Antecedentes. La arteriosclerosis se considera una enfermedad inflamatoria crónica influenciada por múltiples factores de riesgo. Diferentes estudios prospectivos han mostrado que los niveles plasmáticos de moléculas inflamatorias se relacionan con la presencia de arteriosclerosis y el desarrollo de enfermedad cardiovascular. Objetivo. Evaluar si los valores plasmáticos de interleucina 18 (IL-18) están modulados por single nucleotide polymorphisms (SNP) del gen de IL-18 y su posible asociación con los niveles de insulina y otros factores de riesgo cardiovascular. Materiales y métodos. Se estudiaron 746 individuos, seleccionados de forma oportunística entre los pacientes que acudieron a diversas consultas del área metropolitana de Valencia durante 2 años. Se determinaron mediante metodología estándar parámetros del metabolismo lipídico e hidrocarbonado. La IL-18 se determinó mediante ELISA. Resultados. Los sujetos con resistencia a la insulina (RI) presentaron niveles de IL-18 significativamente superiores que los individuos sin RI. Los niveles de IL-18 se correlacionaron de forma significativa con los niveles de insulina y con otros factores de riesgo cardiovascular. El genotipo CC del SNP rs1834481 se asoció de forma significativa con menores niveles plasmáticos de IL-18. Por el contrario, el genotipo GG del SNP rs7559479 se asoció con niveles significativamente superiores de IL-18. Conclusiones. Los niveles de IL-18 se relacionan con la presencia de RI y otros factores de riesgo cardiovascular, estando modulados dichos niveles genéticamente
Introduction. Atherosclerosis is an inflammatory chronic disease influenced by multiple factors. Different prospective studies have shown that plasmatic levels of inflammatory markers were related to atherosclerosis and cardiovascular disease. Objective. To evaluate whether plasmatic levels of interleukin 18 (IL-18) are modulated by SNPs (single nucleotide polymorphisms) of the IL 18 gene and its possible association with insulin levels and other cardiovascular risk factors. Methods. 746 individuals were studied for a period of two years by opportunistic selection in the metropolitan area of Valencia. Parameters of lipid and glucose metabolism were analyzed by standard methodology. IL-18 was measured by ELISA. Results. Individuals with insulin resistance showed significant higher levels of IL-18. IL 18 was significantly correlated with insulin levels and other cardiovascular risk factors. The CC genotype of the rs1834481 SNP was significantly associated with lower levels of IL-18. However, the GG genotype of the rs7559479 was associated with significant higher levels of IL-18. Conclusion. IL-18 is associated with insulin resistance and other cardiovascular risk factors, being those levels genetically regulated
Subject(s)
Female , Humans , Male , Interleukin-18 , Interleukin-18/metabolism , Amplified Fragment Length Polymorphism Analysis/methods , Arteriosclerosis/diagnosis , Arteriosclerosis/genetics , Enzyme-Linked Immunosorbent Assay/instrumentation , Enzyme-Linked Immunosorbent Assay/methods , Risk Factors , Insulin Resistance/genetics , Insulin Resistance/immunology , Prospective Studies , Medical History Taking/methods , Anthropometry/methods , Carotid Artery Diseases/pathology , Carotid Artery Diseases , Genotyping Techniques/methodsABSTRACT
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Subject(s)
Adult , Humans , Male , Pneumonia, Lipid/chemically induced , Pneumonia, Lipid/complications , Pneumonia, Lipid/diagnosis , Paraffin/toxicity , Radiography, Thoracic/methods , Radiography, Thoracic/trends , Prednisone/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Pneumonia, Lipid/drug therapy , Pneumonia, Lipid/physiopathology , Dyspnea/complications , Dyspnea/diagnosis , Bronchoscopy/methodsABSTRACT
INTRODUCTION: Atherosclerosis is an inflammatory chronic disease influenced by multiple factors. Different prospective studies have shown that plasmatic levels of inflammatory markers were related to atherosclerosis and cardiovascular disease. OBJECTIVE: To evaluate whether plasmatic levels of interleukin 18 (IL-18) are modulated by SNPs (single nucleotide polymorphisms) of the IL 18 gene and its possible association with insulin levels and other cardiovascular risk factors. METHODS: 746 individuals were studied for a period of two years by opportunistic selection in the metropolitan area of Valencia. Parameters of lipid and glucose metabolism were analyzed by standard methodology. IL-18 was measured by ELISA. RESULTS: Individuals with insulin resistance showed significant higher levels of IL-18. IL 18 was significantly correlated with insulin levels and other cardiovascular risk factors. The CC genotype of the rs1834481 SNP was significantly associated with lower levels of IL-18. However, the GG genotype of the rs7559479 was associated with significant higher levels of IL-18. CONCLUSION: IL-18 is associated with insulin resistance and other cardiovascular risk factors, being those levels genetically regulated.
