Papers by Andromachi Vryonidou
Background and importance. This case highlights that acute pituitary apoplexy is possible to be c... more Background and importance. This case highlights that acute pituitary apoplexy is possible to be confused and misdiagnosed with other entities with similar symptoms, such as meningitis or subarachnoid hemorrhage. Clinical presentation. A young patient presented with sudden and severe frontal headache, fever, blurred vision, nausea, confusion, as well as oculomotor palsy (CN III) with partial ptosis of the left eyelid, dilated left pupil and left eye globe deviation inferiorly and laterally. The final diagnosis was acute pituitary apoplexy complicating a pituitary macroadenoma. In this setting, headache is usually present due to stretching and irritation of the dura mater, while fever due to meningeal irritation or upward expansion leading to hypothalamic dysfunction. Decreased visual acuity and defects in visual fields are caused by upward expansion, which compresses the optic chiasm. Ophthalmoplegia can also be observed due to lateral expansion with invasion of the cavernous sinus. Conclusion. Medical professionals involved in the care of emergencies should be aware of this clinical entity and collaborate with endocrinologists during a multidisciplinary team approach for prompt diagnosis and appropriate treatment of such patients.
13th European Congress of Endocrinology, Apr 1, 2011
Endocrine
Secondary diabetes mellitus (DM) in secretory pheochromocytomas and paragangliomas (PPGLs) is enc... more Secondary diabetes mellitus (DM) in secretory pheochromocytomas and paragangliomas (PPGLs) is encountered in up to 50% of cases, with its presentation ranging from mild, insulin resistant forms to profound insulin deficiency states, such as diabetic ketoacidosis and hyperglycemic hyperosmolar state. PPGLs represent hypermetabolic states, in which adrenaline and noradrenaline induce insulin resistance in target tissues characterized by aerobic glycolysis, excessive lipolysis, altered adipokine expression, subclinical inflammation, as well as enhanced gluconeogenesis and glucogenolysis. These effects are mediated both directly, upon adrenergic receptor stimulation, and indirectly, via increased glucagon secretion. Impaired insulin secretion is the principal pathogenetic mechanism of secondary DM in this setting; yet, this is relevant for tumors with adrenergic phenotype, arising from direct inhibitory actions in beta pancreatic cells and incretin effect impairment. In contrast, insuli...
Annals of The Royal College of Surgeons of England, Apr 1, 2022
Bilateral neck exploration (BNE) has been the gold standard for the treatment of primary hyperpar... more Bilateral neck exploration (BNE) has been the gold standard for the treatment of primary hyperparathyroidism (PHPT). Minimally invasive parathyroidectomy (MIP) has emerged as an alternative procedure for localised solitary adenomas. The most popular MIP techniques are the open MIP (OMIP) and the minimally invasive video-assisted parathyroidectomy (MIVAP). This study aims to assess whether we achieved a smooth transition from OMIP to MIVAP without compromising the results or increasing the cost. A parathyroid adenoma was successfully localised preoperatively in 77/86 patients with PHPT. MIP was contraindicated in 27/86 cases. For MIVAP, a 5mm, 30 degree camera was employed, along with special instruments. Median preoperative parathyroid hormone (PTH) level was 145.9pg/dl (59-2,151) and median calcium (Ca) was 10.8mg/dl (9.3-19). Comparing MIVAP (N=31) with OMIP (N=28), there was no significant difference in the age, sex, location of the adenoma, preoperative PTH and Ca levels as well as in all the other factors compared, apart from the size of adenomas, which were bigger in the OMIP group (1.85cm vs 1.4cm, p=0.032). Moreover, cure rates, operating time, hospital stay and rates of postoperative normocalcaemia were similar between the two groups. Despite the learning curve, MIVAP was not found to be inferior to OMIP for localised adenomas. The final cost was no higher for MIVAP than OMIP with the use of common reusable instruments. This, along with surgeons' experience in parathyroid and endoscopic surgery facilitates a smooth and cost-effective transition from OMIP to MIVAP.
Endocrine Abstracts, 2019
Background and importance. This case highlights that acute pituitary apoplexy is possible to be c... more Background and importance. This case highlights that acute pituitary apoplexy is possible to be confused and misdiagnosed with other entities with similar symptoms, such as meningitis or subarachnoid hemorrhage. Clinical presentation. A young patient presented with sudden and severe frontal headache, fever, blurred vision, nausea, confusion, as well as oculomotor palsy (CN III) with partial ptosis of the left eyelid, dilated left pupil and left eye globe deviation inferiorly and laterally. The final diagnosis was acute pituitary apoplexy complicating a pituitary macroadenoma. In this setting, headache is usually present due to stretching and irritation of the dura mater, while fever due to meningeal irritation or upward expansion leading to hypothalamic dysfunction. Decreased visual acuity and defects in visual fields are caused by upward expansion, which compresses the optic chiasm. Ophthalmoplegia can also be observed due to lateral expansion with invasion of the cavernous sinus. ...
European Heart Journal, 2019
Background Arterial stiffness flags increased cardiovascular disease risk in type 2 diabetes mell... more Background Arterial stiffness flags increased cardiovascular disease risk in type 2 diabetes mellitus (T2DM) patients. There is limited data on how novel anti-diabetic agents affect arterial stiffness. Purpose To investigate the effects of novel anti-diabetic agents on arterial stiffness in T2DM patients. Patients and methods We enrolled 64 consecutive patients under stable antidiabetic therapy who did not achieve therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=21), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=21) or long-acting insulin (n=8). Glycosylated hemoglobin (HbA1c) as well as carotid-femoral pulse wave velocity (PWV) and augmentation index (Alx) were measured (as indices of arterial stiffness) were measured at baseline and 3 months after treatment intensification. Results There were no differences be...
European Heart Journal, 2019
Background Patients with type 2 diabetes mellitus (T2DM) are at higher risk for thrombotic events... more Background Patients with type 2 diabetes mellitus (T2DM) are at higher risk for thrombotic events. Platelet function may be used to assess prothrombotic state in patients with cardiovascular disease. Purpose We aimed to investigate whether the administration of novel antidiabetic agents influence platelet function in TDM2 patients. Patients and methods We 60 enrolled consecutive patients with T2DM, on stable antidiabetic therapy, who did not achieve therapeutic targets. Subjects were assessed to receive an additional anti-diabetic agent; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=24), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=22). Platelet reactivity was measured with PFA-200 collagen/epinephrine (c-EPI) and PFA-200 collagen/ADP (c-ADP) closure time. Glycosylated hemoglobin (HbA1c), c-EPI and c-ADP were assessed at baseline and 3 months after treatment intensification. Results There was no difference between the stud...
Endocrine Abstracts, 2019
Endocrine Practice, 2020
Objective. To investigate possible causes of menstrual disorders and androgen-related traits in y... more Objective. To investigate possible causes of menstrual disorders and androgen-related traits in young women with T1DM. Patients and Methods. Fifty-three women with T1DM (duration 8.0±5.6 years), 41 women with PCOS and 51 controls matched for age (19.4±4.3 vs. 21.2±2.7 vs. 20.8±3.1 years, p>0.05) and BMI (22.2±2.7 vs. 21.9±2.0 vs. 21.4±1.9 kg/m2, p>0.05) were prospectively recruited. Results. Two women (3.8%) in the T1DM group had not experienced menarche (at 15.5 and 16.6 years); of the rest, 23.5% had oligomenorrhea, 32.1% hirsutism, 45.3% acne. The age at menarche was delayed in the T1DM group compared to controls (12.7±1.3 vs. 12.0±1.0 years, p=0.004), while no difference was observed with the PCOS group (12.4±1.2 years). There were no differences in total testosterone (0.43±0.14 vs. 0.39±0.14 ng/ml,…
Journal of endocrinological investigation, Jun 15, 2024
European Thyroid Journal, 2019
Background: The incidence and prevalence of hypothyroidism are increasing and the threshold for t... more Background: The incidence and prevalence of hypothyroidism are increasing and the threshold for the treatment of hypothyroid as well as individuals without evident thyroid disease with thyroid hormone is declining. Objective: To investigate endocrinologists’ use of thyroid hormones in hypothyroid and euthyroid patients in Italy, a country where different formulations of levothyroxine (LT4; tablet, liquid solution and soft-gel capsule) are available on the market. Methods: Members of the Associazione Medici Endocrinologi (Italian Association of Clinical Endocrinologists) were invited to participate in a web-based survey investigating the topic. Results: A total of 797 of 2,028 (39.3%) members completed all the sections of the survey; 98.7% declared that the treatment of choice for hypothyroidism is LT4. A significant minority (37.3%) indicated that LT4 may be considered in infertile euthyroid women seeking pregnancy and harbouring positive thyroperoxidase antibodies (TPOAb) and in goitre increasing in size (18.1%). LT4 + LT3 was considered by 43.2% for LT4-replaced patients and normal TSH, if they reported persistent symptoms. High percentages of respondents chose LT4 in a liquid solution or soft-gel capsules when taken together with other drugs interfering with LT4 absorption (81.8%), in patients with a history of celiac disease, malabsorption, lactose intolerance, intolerance to common excipients (96.6%), or unexplained poor biochemical control of hypothyroidism (74.4%), or in patients not able to adhere to ingesting LT4 fasted and/or separated from food/drink (98.9%). In total, 43.6% of responders would use LT4 in a liquid solution or soft-gel capsules for hypothyroid patients with biochemical euthyroidism on LT4, who had persistent symptoms. Conclusions: The preferred treatment for hypothyroidism is LT4; LT3 + LT4 combination treatment is mainly considered in patients with persistent symptoms. A significant minority would offer LT4 to euthyroid women with positive TPOAb and infertility and to euthyroid patients with progressive simple goitre. Alternative LT4 formulations like liquid solution or soft-gel capsules are largely reserved for specific conditions (interfering drugs, actual or suspected malabsorption, inability to take LT4 in the fasting state, unexplained poor biochemical control of hypothyroidism).
Journal of Hepatology, 2007
Background/Aims: Insulin resistance is a common feature of both nonalcoholic fatty liver disease ... more Background/Aims: Insulin resistance is a common feature of both nonalcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS), therefore, we hypothesize that PCOS and NAFLD may coexist. The aim of the present study was to determine the frequency and characteristics of NAFLD in women with PCOS. Methods: A prospective study of patients with PCOS and no current pharmacological treatment was conducted. NAFLD was diagnosed by abdominal ultrasound following exclusion of alcohol consumption, viral, or autoimmune liver disease. Anthropometric variables, serum levels of glucose, insulin, lipids and aminotransferases, and HOMA index were determined. Results: Forty-one PCOS patients (mean age: 24.6 ± 7.2 yr, mean body mass index [BMI]: 30.3 ± 7.0 kg/m 2) were included; 26 of 41 PCOS patients (63.4%) had insulin resistance and 17 (41.5%) had NAFLD. Nine of the NAFLD patients (64%) also had abnormal aminotransferases. Women with NAFLD and PCOS had a higher HOMA index and a higher waist-hip ratio than those with normal ultrasound. Patients with PCOS showed a higher frequency of NAFLD (41% vs. 19%) and insulin resistance (63% vs. 35.5%) than a control group. Conclusions: NAFLD is frequent in patients with PCOS confirming a relevant clinical association between these two conditions. Women with PCOS should be screened for liver disease.
12th European Congress of Endocrinology, Apr 1, 2010
Endocrine Abstracts, Nov 19, 2019
Endocrine Abstracts, May 2, 2023
PLOS ONE, Mar 19, 2015
Objectives Several studies have demonstrated associations of birth weight with metabolic and repr... more Objectives Several studies have demonstrated associations of birth weight with metabolic and reproductive abnormalities in adults. The aim of this study was to investigate the birth weight in women with PCOS and its correlation with clinical and biochemical characteristics of the syndrome. Materials and Methods We studied 288 women with PCOS according to the NIH criteria and 166 women with normal cycle and without clinical hyperandrogenism. Birth weight and anthropometric characteristics were recorded, and levels of serum androgens, SHBG, insulin and fasting glucose were measured. Results Birth weight data were available for 243/288 women with PCOS and age-and BMI-matched 101/166 controls. No differences were found (p> 0.05) in birth weight among women with PCOS and normal controls. Birth weight of PCOS women was negatively correlated with DHEAS levels (p = 0.031, r =-0.143) and positively correlated with waist circumference (p <0.001, r = 0.297) and body mass index (BMI) (p = 0.040, r = 0.132). Birth weight of controls was negatively correlated with SHBG levels (p = 0.021, r =-0.234). Women from both groups were further divided in 6 categories according to birth weight (A.
European Journal of Surgical Oncology, 2019
Background: Total thyroidectomy is the most common procedure for patients with malignant as well ... more Background: Total thyroidectomy is the most common procedure for patients with malignant as well as benign thyroid disease. The workup of patients with thyroid nodules aim to identify or exclude malignancy and this can be well achieved with the combination of US and FNA cytology. In the literature it is reported that in the specimens for benign thyroid disease there is a 5-10% incidence of occult cancer. In reality this incidence seems to be higher, at least in Greece. Our aim was to compare the pathology specimens of occult well differentiated thyroid cancer with those of cancers diagnosed preoperatively and assess if there are any similarities, differences or peculiarities. Material and methods: We studied 317 consecutive cases with a mean age of 52.81 years (14-86) who underwent total thyroidectomy for benign disease or malignancy. A total of 140 cancer were eventually diagnosed. Microcarcinomas were found in 29% and macrocarcinomas in 17.5%. In 105 cases (group A) the preoperative workup did not confirm malignancy but occult cancer was found. In 35 cases we had confirmed preoperative diagnosis of well differentiated thyroid cancer (group B). We compared the 2 groups to see if there were differences between the two entities. Results: The mean age of the 140 patients with cancer on final histology was 50.83 (SD¼14.1) years. There were no significant differences in the demographics, the height and width of the gland, the size of the cancer, the size of the largest nodule, the percentage of multifocality and the percentage of microcarcinomas. Moreover there were no differences in the percentage of retrosternal goiter. No differences were found in the postoperative calcium level, in the days of hospitalization and in the duration of the disease prior to the operation. There were statistically significant differences in the weight of the gland (p¼0.002. Group A¼43.5 gr vs B¼ 24.6 gr) in the anterio-posterior dimension of the gland (p<0.02) and the background thyroid pathology. In group A there were more patients with nodular hyperplasia (40.4% vs 14.8%) while in group B there were more patients with lymphocytic thyroiditis (51.9% vs 77.8%), p¼0,026. In group B the US showed indiscrete margins of the lesion in higher percentage (50% vs 12.1%, p¼0.012) and higher percentage of capsule invasion (40% vs 4.8%, p¼0.001) while there was no difference in the blood supply pattern (p¼0.513) nor in the presence of microcalcifications (p¼0.065). Conclusion. The high incidence of occult malignancy in patients operated for benign thyroid disease and the similarities of this entity with preoperative diagnosed cancers justify the option of total thyroidectomy in all cases of thyroid pathology. Conflict of interest: No conflict of interest.
European Journal of Surgical Oncology (EJSO), 2016
follow up of these patients consisted of history, clinical exam and serum Ca and PTH measurements... more follow up of these patients consisted of history, clinical exam and serum Ca and PTH measurements. Only in one patient increased serum values of Ca (2.94 mmol/l) and PTH (328 pg/mL) were noticed 2 years after surgery. 18 F-fluorocholine PET/CT with 100 MBq and an additional 18 F-FDG PET/CT was performed to confirm disease recurrence and to stage the extent of the disease. Results: 18 F-fluorocholine PET/CT has shown solitary high uptake in 1 cm lesion of right upper lung lobe with SUV 4.0. The same lesion with SUV 2.0 was seen on 18 F-FDG PET/CT. The lesion was resected with 4 mm free margins via VATS approach. Histopathology confirmed a 1.3 cm parathyroid carcinoma metastasis with morphology identical to the primary tumor. Normalization of serum Ca (2.51 mmol/l) and PTH (48 pg/mL) was achieved and the patient returned to regular follow-up with no evidence of disease at the moment. Conclusions: In the future 18 F-fluorocholine PET/CT can be considered as a method of choice in a diagnostic set up of staging patients with parathyroid carcinoma. Conflict of interest: No conflict of interest.
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Papers by Andromachi Vryonidou