NO BENEFIT OF DEDICATED THYROID NODULE SCREENING IN PATIENTS WITH ACROMEGALY.

Objective: Acromegaly results from the excessive production of growth hormone and insulin-like growth factor-1. While there is up to a 2-fold increased prevalence of thyroid nodules in patients with acromegaly, the incidence of thyroid cancer in this population varies from 1.6 to 10.6% in several European studies. The goal of our study was to determine the prevalence of thyroid nodules and thyroid cancer among patients with acromegaly at a large urban academic medical center in the United States (U.S.). Methods: A retrospective chart review was performed of all patients with acromegaly between 2006-2015 within the University of California, Los Angeles health system. Data were collected regarding patient demographics, thyroid ultrasounds, thyroid nodule fine needle aspiration (FNA) biopsy cytology, and thyroid surgical pathology. Results: In this cohort (n = 221, 49.3% women, mean age 53.8 ± 15.2 [SD] years, 55.2% Caucasian), 102 patients (46.2%) underwent a thyroid ultrasound, from which 71 patients (52.1% women, mean age 52.9 ± 15.2 [SD] years, 56.3% Caucasian) were found to have a thyroid nodule. Seventeen patients underwent a thyroid nodule FNA biopsy and the results revealed 12 benign biopsies, 1 follicular neoplasm, 3 suspicious for malignancy, and 1 papillary thyroid cancer (PTC), from which 6 underwent thyroidectomy; PTC was confirmed by surgical pathology for all cases (8.5% of all nodules observed). Conclusion: In this sample, the prevalence of thyroid cancer in patients with acromegaly and coexisting thyroid nodules is similar to that reported in the general U.S. population with thyroid nodules (7 to 15%). These findings suggest that there is no benefit of dedicated thyroid nodule screening in patients newly diagnosed with acromegaly. Abbreviations: AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; DTC = differentiated thyroid cancer; FNA = fine needle aspiration; GH = growth hormone; IGF-1 = insulin-like growth factor-1; PTC = papillary thyroid cancer; U.S. = United States.

Cholinergic enhancement increases the effects of voluntary attention but does not affect involuntary attention.

Voluntary visual spatial attention can be allocated in a goal-oriented manner to locations containing behaviorally relevant information. In contrast, involuntary attention is automatically captured by salient events. Allocation of attention is known to be modulated by release of the neurotransmitter acetylcholine (ACh) in cerebral cortex. We used an anti-predictive spatial cueing task to assess the effects of pharmacological enhancement of cholinergic transmission on behavioral measures of voluntary and involuntary attention in healthy human participants. Each trial began with the presentation of a cue in a peripheral location. In 80% of the trials, a target then appeared in a location opposite the cue. In the remaining 20% of trials, the target appeared in the cue location. For trials with short stimulus onset asynchrony (SOA) between cue and target, involuntary capture of attention resulted in shorter reaction times (RTs) to targets presented at the cue location. For long SOA trials, allocation of voluntary attention resulted in the opposite pattern: RTs were shorter when the target appeared in the expected (opposite) location. Each subject participated in two sessions: one in which the cholinesterase inhibitor donepezil was administered to increase synaptic ACh levels and one in which placebo was administered. Donepezil selectively improved performance (reduced RT) for long SOA trials in which targets appeared in the expected location. Thus, cholinergic enhancement augments the benefits of voluntary attention but does not affect involuntary attention, suggesting that they rely on different neurochemical mechanisms.