Hormonal Symptoms Research Articles

Self-Reported Burden in Elderly Patients With Localized Prostate Cancer Treated With Stereotactic Body Radiation Therapy (SBRT).

Purpose: Retaining quality of life in patients treated with SBRT for prostate cancer remains paramount. As such, balancing the benefits of treatment against the effects of therapy on elderly patients is essential. The EORTC QLQ-ELD14 (ELD-14) is a validated questionnaire with a domain dedicated to burden of illness and treatment in the elderly. The Expanded Prostate Cancer Index Composite (EPIC)-26 is a validated questionnaire which measures urinary, bowel, sexual, and hormonal symptoms. This study reports trends in self-reported burden in patients with prostate cancer treated with SBRT and reveals convergence of self-reported burden with treatment related side effects obtained from the EPIC-26 questionnaire.Methods: All patients ≥70 years old, with localized prostate cancer treated with SBRT ± ADT at Medstar Georgetown University Hospital from 2013 to 2018 and had completed the ELD-14 were eligible for inclusion in this cross-sectional cohort study. Percentage of responses to questions related to disease and treatment burden were counted for each category (“not at all” and “a little” vs. “quite a bit” and “very much”). Additional demographic features were derived from available medical records. A total of 111 patients (median age of 74) responded to the ELD-14 questionnaire at onset of treatment and at the 2-year mark. Responses to EPIC questionnaires at matched follow-ups were scored and correlated with the self-reported burden domain of the ELD-14 using the Spearman correlation coefficient.Results: Number of patients reporting “quite a bit” or “very much” burden from prostate cancer was 6.3% prior to treatment. This was highest at 1-month (10.8%) and decreased to 9.0% at 24 months post-SBRT (X2 = 3.836, p = 0.6986). By comparison, 3.6 and 5.4% reported “quite a bit” or “very much” burden from treatment at start of treatment and 24 months, respectively (X2 = 1.046, p = 0.9838). Patient reported treatment burden was found to converge well with individual domains of EPIC-26. Patients undergoing ADT experienced more burden than their non-ADT counterparts.Conclusions: This cross-sectional study suggests a minority of patients reported high burden from their clinically localized prostate cancer or from their SBRT treatment. Self-reported burden converged well with lower EPIC scores in multiple domains.

Non-functioning pituitary adenomas: epidemiology, clinical and postoperative outcome

Non-functioning pituitary adenomas are the most frequent tumor group in the sellar region. They are usually benign neoplasms diagnosed after visual or hormonal symptoms, although it is not uncommon to detect them as a casual finding. To analyze the clinical aspects found in this disease and its response after surgical treatment. In a series of 100 cases, epidemiological, clinical, endocrinological, visual and radiological data were analyzed before and after surgical treatment, as well as the complications related to surgery and long-term follow-up. The most frequent symptom at the time of diagnosis was visual field involvement (62%), and only the 7% of adenomas were a casual finding. The most common hormonal deficit was hypogonadotropic hypogonadism (48%). After surgery, complete recovery of the visual field defect was observed in 54.8% of the patients, only 1% worsening after surgery, and the incidence of diabetes insipidus was 4%. The resection was superior to 95% in 63% of cases, although the percentage of adenomas with invasion of the cavernous sinus in Knosp grades 3 and 4 it was high (45%). Although the most frequent symptom of non-functioning pituitary adenomas is campimetric involvement, it has an excellent response to surgery if it is performed within the appropriate time. The grade of invasion of the cavernous sinus is the most limiting factor for a complete surgical resection.

Single Centre Based Clinicopathological Experience of Adrenal Tumours Including Some Rare Entities

Adrenal tumours are relatively uncommon neoplasms, broadly divided into adrenal cortical and medullary tumours. They show bimodal age distribution. This is a retrospective case series of 36 cases of adrenal tumours over three years (September 2016- August 2019) in NRS Medical College Kolkata, West Bengal, India. Apart from Haematoxylin and Eosin (H&E) staining relevant Immunohistochemistry (IHC) (synaptophysin, Ki-67, Human Melanoma Black 45 (HMB 45) were done for proper histopathological diagnosis. Amongst 36 cases, 12 cases (34%) were myelolipoma, five cases (14%) were neuroblastoma, six cases (17%) of adrenocortical adenoma, two cases (06%) adrenocortical carcinoma, five cases (14%) pheochromocytoma, two cases (06%) mature teratoma, one case (03%) of epitheiloid PECOMA (Perivascular epithelioid cell tumour), one case haemorrhagic pseudocyst (03%) and two cases (06%) were metastasis from renal cell carcinoma. Eleven patients had specific hormonal symptoms. Bimodal age distribution with 10 cases in younger than 14 years, eight cases in more than 50 years and rest 18 cases were in range of 14-50 years. Overall male: female ratio is 5:4 but myelolipoma was common in female. We have encountered few rare entities-Epithelioid PECOMA (angiomyolipoma), Pheochromocytoma with Von Hippel-Lindau (VHL), Receptor for Neurotrophic Factor (RET) Mutation and uncommon presentation with Cushing’s Syndrome, one Adrenal Oncocytoma and two Mature Teratoma.

Patient-reported outcome measures after treatment for prostate cancer: Results from the Danish Prostate Cancer Registry (DAPROCAdata)

PurposeThis study compares the side effects of active surveillance, prostatectomy, radiation with or without adjuvant endocrine therapy, watchful waiting, and palliative therapy on patient-reported outcomes in a nationwide, population-based cohort of Danish men with prostate cancer. MethodsA total of 15,465 participants completed questionnaires over a 5 year period (2011–2016). Condition-specific quality of life, focusing on urinary function, bowel incontinence, sexual function, and hormonal symptoms were investigated using the validated EPIC-26 questionnaire at diagnosis, 1 year- and 3- year follow-up. Patients were identified from the Danish Prostate Cancer Registry with data-linked to several national healthcare registries. Longitudinal analysis with linear mixed effects models were fitted to compare changes over time on quality of life symptom scores for five treatment modalities, adjusting for age, clinical TNM stage, PSA value, Gleason score, Charlson Comorbidity score, education, disposable income, and urbanization measured at time of prostate cancer diagnosis. ResultsThere was a more than10-point decrease in mean scores across all symptom domains at 1-year follow-up. Thereafter mean scores for all symptom domains improved marginally and remained relatively unchanged at 3-year follow-up. Prostatectomy had the greatest negative effect on sexual function and urinary incontinence. Overall quality of life was most adversely affected by sexual function, regardless of treatment modality. ConclusionClinical interventions for improving symptoms should focus particularly on the first year after prostate cancer diagnosis. Greater emphasis on improving sexual function should be practiced in clinical and rehabilitative care, since this area has the single greatest impact on symptom-specific QoL after primary treatment for prostate cancer.

Carcinoid Syndrome: Updates and Review of Current Therapy.

Carcinoid syndrome (CS) is a complex disorder caused by functional neuroendocrine tumors (NETs). This debilitating disease is characterized by hyper-secretion of biologically active substances eliciting major hormonal symptoms burden and fibrotic changes that are often challenging for management. There have been a number of insights that have substantially advanced treatments since the introduction of somatostatin analogs (SSAs). Second-line treatments are needed in a substantial proportion of patients with advanced disease that have uncontrolled hormone secretion on the highest labeled doses of SSAs. International guidelines suggest several available options including dose escalation of SSAs, interferon alpha, everolimus, radionuclide therapy, liver-directed therapies, and the novel tryptophan hydroxylase 1 inhibitor, telotristat ethyl. The clear preference of one second-line therapy over the other is not stated since their relative and long-term efficacy are largely unknown, and standardized approach of hormonal response assessment is lacking in the literature. In the clinical setting, the treatment of CS is guided in conjunction with patients' performance status, tumor origin, grade, stage, and growth rate, with regard to both anti-hormonal, as well as anti-proliferative effect. There is an unmet need for further well-designed randomized placebo-controlled and head-to-head studies that systematically assess CS symptom control and biochemical response following a specific intervention.

7-LB: Dichloroacetate Improves Cognitive Function during Hypoglycemia in T1DM Patients

Magnetic Resonance Spectroscopy (MRS) studies have suggested that exposure to recurrent hypoglycemia (RH) reduces brain cortical Pyruvate Dehydrogenase (PDH) flux in animal models. Examination of rat cortical RNA for inhibitory PDH kinase (PDK) isoform expression patterns identified a two-fold upregulation of PDK4 (p>0.01) after three episodes of hypoglycemia. To date no study has examined the functional role of PDH complex inhibition in the cognitive deficits associated with hypo in patients with T1DM. In a randomized controlled cross-over trial of 11 intensively treated T1DM subjects we examined whether PDK inhibition by dichloroacetate (DCA; 12.5mg/kg), which maintains PDH in its active state might restore cognitive function, counterregulatory hormonal responses and symptoms during clamped hypoglycemia (target 50mg/dL). Cognitive testing included measures of visual matching ability and short term visual and auditory memory as well as the ability to manage conflicting information while ignoring task-irrelevant information. Symptom ratings during hypoglycemia were measured using a modified Edinburgh scale. We found that DCA ingestion is associated with increased performance related to visual memory (DCA: 89% correct vs. Placebo: 69% correct, p=0.049), as well as a faster response time during the multitasking test (549ms DCA vs. 603ms placebo; p=0.028). On the Edinburgh scale, patients reported lower ratings of warmness during hypoglycemia with DCA vs. Placebo (2.5 vs. 3.6; p=0.075). Furthermore, we did not observe an effect of DCA on CRR hormonal responses. These results suggest that inhibition of PDH flux by enhanced PDK activity significantly contributes to cognitive impairment under hypoglycemia and may contribute to subjective symptoms and possibly hypoglycemia awareness. We therefore conclude that strategies focusing on reactivation of oxidative glucose metabolism in the brain may play an important role in mitigating the negative impact of hypoglycemia on cognitive function. Disclosure D. Groskreutz: None. D. Trico: None. N. Tai: None. R. Belfort-DeAguiar: Research Support; Self; Silver Palate Kitchens, Inc. J. Leventhal: None. W. Lam: None. M. Knight: None. J. Gannon: None. R.I. Herzog: Consultant; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc. Funding JDRF

MON-391 A Rare Case of Giant Composite Pheochromocytoma with Unusual Clinical Presentation

Introduction With increasing access to imaging, more Pheochromocytomas are being diagnosed in the workup of adrenal incidentalomas. We present a rare case of a giant composite pheochromocytoma with unusual clinical presentation and discuss the importance of suspecting such lesions even in the absence of classical clinical presentation. Case Presentation A 37-year-old female had an accidental finding of a right adrenal incidentaloma measuring 5 cm in size in 2015. The patient was asymptomatic. Her outpatient workup revealed 4 and 10-fold elevation of urinary and plasma metanephrines respectively, highly suspicious for pheochromocytoma. The patient was lost to follow up. She presented two years later with severe right-sided flank pain and headache. Repeat MRI abdomen revealed 9 cm right adrenal mass with central necrosis and interval enlargement compared to MRI in 2015. Clinically patient had a non-functioning adrenal mass with borderline low blood pressure and normal Heart rate. Repeat hormonal levels confirmed Pheochromocytoma. Dexamethasone suppression test was normal which ruled out Cushing’s syndrome. Clonidine suppression test consistent with Pheochromocytoma. She underwent right robotic adrenalectomy after adequate alpha blockage and volume repletion. She had uneventful postoperative periods and no immediate complications. Histopathology of the specimen revealed a composite pheochromocytoma with ganglioneuroma component. Discussion Pheochromocytoma can be incidentally discovered as an adrenal mass. The incidence of normotension in Pheochromocytoma is 5-15%. Even if clinically silent, mass should be carefully screened for the possibility of functional activity. Patients with composite tumor can present as normotensive or hypotensive. A possible hypothesis is that ganglioneuroma component of the mass may modify the hormonal symptoms of Pheochromocytoma by metabolizing the catecholamine. It is speculated that a larger proportion of ganglioneuroma component will produce a greater regulation effect. Pheochromocytoma-ganglioneuroma composites are clinically and radiologically indistinguishable from Pheochromocytomas and need to be managed similarly. Such cases need to be treated even if clinically silent because of the risk of life-threatening hypertensive crisis in future Conclusion Hormone screening evaluation is necessary for all adrenal incidentalomas. All clinically diagnosed pheochromocytomas should be surgically excised to prevent lethal outcomes.

SAT-487 Unusual Case of Plurihormonal Pituitary Macroadenoma

Introduction Plurihormonal Pituitary adenoma is defined as an adenoma that expresses more than one hormone on immunohistochemistry. The most common combination in these adenomas includes growth hormone (GH) and prolactin (PRL). Case Description: A 65-year-old woman known to have known to have type 2 diabetes, hypertension, and class-III obesity, presented with an intractable headache and blurring vision. She also had significant worsening of her diabetes control recently despite being on insulin. CT brain and later Magnetic resonance imaging (MRI) pituitary showed a large sellar mass which measured 2.9 cm x 1.5 cm, compressing the neurophysis and the optic chiasm. Her initial investigations showed elevated corticotrophin (ACTH) level 33.6 pmol/L (1.03 - 10.7), prolactin level was high at 66.3 ng/ml (5.18 - 26.53ng/ml) and the rest of anterior pituitary hormones and IGF-1 were normal apart from primary hypothyroidism. She didn’t particularly look cushingoid, apart from the rounded face and central obesity. Cushing’s disease was confirmed on a failure of cortisol to suppress to 1mg dexamethasone (serum cortisol 783 nmol/L) and high 24-hour urinary free Cortisol at 391 ug/24 (6-123. She underwent transsphenoidal surgery (TSS) for decompression of the optic chiasm which was successful to normalize the visual fields, however, a residual tumor was still present on follow up MRI after 3 months. Interestingly, immunohistochemistry showed staining for ACTH, GH, and prolactin, Ki67 was less than 2%. Follow up evaluation showed a normal response to 1 mg suppression test and normal 24-hour urinary free cortisol. Conclusions: We present a very interesting case of plurihormonal pituitary adenoma with triple immunohistochemical stating for ACTH, GH, and Prolactin, This triple immunostaining combination is very rare and only reported in the literature once. In contrast to the other case, our patient is diagnosed in a post-menopausal woman who didn't experience florid cushingoid symptoms and she never experienced any hormonal symptoms of acromegaly or hyperprolactinemia

Ectopic adrenal adenoma causing gross hematuria: Steroidogenic enzyme profiling and literature review

IntroductionAberrant cortical adrenal tissues are not generally identified in adults. Herein, we present a very rare case of an ectopic adrenal tumor located in the renal hilum that caused gross hematuria.Case presentationA 33‐year‐old man suddenly presented with asymptomatic gross hematuria. Abdominal computed tomography revealed a 35‐mm mass in the left renal hilum encroaching the renal vein. Following the surgical removal with frozen section of the mass, his gross hematuria immediately improved. Pathological analysis of the specimen revealed the features adrenal adenoma. Immunohistochemical staining for key steroidogenic enzymes confirmed the adrenocortical origin without excessive hormone production.ConclusionThis is the first case of an ectopic adrenocortical adenoma in the renal hilum that caused gross hematuria without hormonal symptoms.

Association between urinary, bowel, and hormonal treatment-related symptoms and clinical outcomes in nonmetastatic castration-resistant prostate cancer (nmCRPC): PROSPER study.

233 Background: PROSPER data were analyzed to assess the relationship between time to worsening of urinary, bowel, and hormonal treatment-related symptoms and prostate-specific antigen (PSA) response, and the longitudinal association between symptom changes and metastasis-free survival (MFS). Methods: 1401 patients (pts) with nmCRPC at high metastasis risk were randomized 2:1 to enzalutamide (ENZA) or placebo. Urinary, bowel, and hormonal treatment-related symptoms were assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-PR25) at baseline (BL) and every 16 weeks. The association between time to first clinically meaningful symptom worsening and PSA response (≥50% decline from BL) was analyzed with stratified Cox regression using treatment as a covariate. Longitudinal symptom changes and MFS were evaluated in joint models using symptom scores as covariates, adjusted for treatment and clinical/demographic variables. The proportion of pts with improvement, no change, or deterioration at metastasis were analyzed by treatment group. Results: 723/1401 (52%) pts were PSA responders, including >90% of ENZA pts. PSA responders were significantly less likely to develop urinary, bowel, and hormone treatment-related symptoms vs. non-responders (hazard ratio [HR] 0.58 [95% confidence interval 0.41, 0.81]; 0.59 [0.43, 0.80]; and 0.70 [0.51, 0.97], respectively). Every 9-point increase in urinary symptom score was associated with a 10% increased metastasis risk (HR 1.1 [1.05, 1.15]). Bowel and hormonal symptoms did not predict metastasis. Most pts reported no EORTC score changes at metastasis and maintained stable urinary/bowel symptoms, with no major observed symptom differences between treatment groups. Conclusions: ENZA delays metastasis and extends time to symptom worsening. A ≥50% PSA reduction from BL is associated with a reduction in risk for urinary, bowel, and hormonal treatment-related symptom worsening; changes in urinary symptoms from BL also predict metastases. Clinical trial information: NCT02003924 (PROSPER).

Neuroendocrine Liver Metastasis

Liver is the most common site of distant metastasis in patients with advanced gastroenteropancreatic neuroendocrine tumors. Presence of liver disease and grade and location of primary tumor are major determinants of prognosis. The clinical presentation of patients with neuroendocrine liver metastasis (NELM) depends on functional status of the primary tumor as well as severity of the liver disease. Various treatment modalities are available for management of patients with NELM, depending on pattern of metastasis and anatomical origin. Complete surgical resection remains the mainstay of treatment and only hope for cure. Tumor-debulking surgery might be considered in patients with extreme hormonal symptoms refractory to other treatments, with some survival benefits. Orthotopic liver transplantation also has been shown to be an accepted alternative in highly selected patients. Liver-directed treatment strategies such as radiofrequency ablation and hepatic artery-based therapies can be offered to patients who are ineligible for surgical resection. Somatostatin analogs, peptide receptor radiotherapy, cytotoxic chemotherapeutics, and novel molecular-targeted drugs embrace the mainstay of systemic therapy in NELM. In this chapter, we review the clinical presentation, diagnosis, and recent developments in management of patients with NELM. This review contains 9 figures, 5 tables, and 50 references. Key Words: ablation, chemotherapy, hepatic artery-based therapy, liver metastasis, liver transplantation, molecular-targeted therapy, neuroendocrine tumor, surgical resection

Neuroendocrine Liver Metastasis

Liver is the most common site of distant metastasis in patients with advanced gastroenteropancreatic neuroendocrine tumors. Presence of liver disease and grade and location of primary tumor are major determinants of prognosis. The clinical presentation of patients with neuroendocrine liver metastasis (NELM) depends on functional status of the primary tumor as well as severity of the liver disease. Various treatment modalities are available for management of patients with NELM, depending on pattern of metastasis and anatomical origin. Complete surgical resection remains the mainstay of treatment and only hope for cure. Tumor-debulking surgery might be considered in patients with extreme hormonal symptoms refractory to other treatments, with some survival benefits. Orthotopic liver transplantation also has been shown to be an accepted alternative in highly selected patients. Liver-directed treatment strategies such as radiofrequency ablation and hepatic artery-based therapies can be offered to patients who are ineligible for surgical resection. Somatostatin analogs, peptide receptor radiotherapy, cytotoxic chemotherapeutics, and novel molecular-targeted drugs embrace the mainstay of systemic therapy in NELM. In this chapter, we review the clinical presentation, diagnosis, and recent developments in management of patients with NELM. This review contains 9 figures, 5 tables, and 50 references. Key Words: ablation, chemotherapy, hepatic artery-based therapy, liver metastasis, liver transplantation, molecular-targeted therapy, neuroendocrine tumor, surgical resection

Sertoli-Leydig cell tumour (SLCT) – the case of a 15 cm diameter ovarian tumour with negative markers and absent hormonal symptoms

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Ciebiera M, Baran A, Słabuszewska-Jóźwiak A, Wojtyła C, Jakiel G. Sertoli-Leydig cell tumour (SLCT) – the case of a 15 cm diameter ovarian tumour with negative markers and absent hormonal symptoms. Journal of Health Inequalities. 2019;5(1):117-119. doi:10.5114/jhi.2019.87847. APA Ciebiera, M., Baran, A., Słabuszewska-Jóźwiak, A., Wojtyła, C., & Jakiel, G. (2019). Sertoli-Leydig cell tumour (SLCT) – the case of a 15 cm diameter ovarian tumour with negative markers and absent hormonal symptoms. Journal of Health Inequalities, 5(1), 117-119. https://doi.org/10.5114/jhi.2019.87847 Chicago Ciebiera, Michał, Arkadiusz Baran, Aneta Słabuszewska-Jóźwiak, Cezary Wojtyła, and Grzegorz Jakiel. 2019. "Sertoli-Leydig cell tumour (SLCT) – the case of a 15 cm diameter ovarian tumour with negative markers and absent hormonal symptoms". Journal of Health Inequalities 5 (1): 117-119. doi:10.5114/jhi.2019.87847. Harvard Ciebiera, M., Baran, A., Słabuszewska-Jóźwiak, A., Wojtyła, C., and Jakiel, G. (2019). Sertoli-Leydig cell tumour (SLCT) – the case of a 15 cm diameter ovarian tumour with negative markers and absent hormonal symptoms. Journal of Health Inequalities, 5(1), pp.117-119. https://doi.org/10.5114/jhi.2019.87847 MLA Ciebiera, Michał et al. "Sertoli-Leydig cell tumour (SLCT) – the case of a 15 cm diameter ovarian tumour with negative markers and absent hormonal symptoms." Journal of Health Inequalities, vol. 5, no. 1, 2019, pp. 117-119. doi:10.5114/jhi.2019.87847. Vancouver Ciebiera M, Baran A, Słabuszewska-Jóźwiak A, Wojtyła C, Jakiel G. Sertoli-Leydig cell tumour (SLCT) – the case of a 15 cm diameter ovarian tumour with negative markers and absent hormonal symptoms. Journal of Health Inequalities. 2019;5(1):117-119. doi:10.5114/jhi.2019.87847.

Management of carcinoid syndrome: a systematic review and meta-analysis.

Carcinoid syndrome (CS) is a debilitating disease caused by functional neuroendocrine tumors. Several treatment options are available to alleviate the hormonal symptoms, but their relative efficacy is unknown. Online databases were searched for publications on the treatment of CS symptoms. Independent reviewers assessed relevant publications for study quality and outcome. Meta-analysis of the outcomes of the intervention on CS-related symptoms was stratified by the type of treatment. We found 3682 therapeutic interventions on CS-specific outcomes were collected from 93 studies. Overall, the study qualities were poor with only six randomized controlled clinical trials. The somatostatin analogs octreotide and lanreotide induced symptomatic improvement in 65-72% and biochemical response in 45-46% of patients. An increase in dose or frequency or interclass switch led to a reduction of flushes and/or diarrhea in 72-84% of cases. Retrospective, institutional series showed that liver-directed therapy can improve symptoms in 82% of CS patients with a liver-dominant disease. The serotonin synthesis inhibitor telotristat ethyl reduced bowel movements in 40% of patients with diarrhea refractory to somatostatin analogs. Interferon-alpha controlled CS symptoms in 45-63% of cases. Favorable response has been noted after radionuclide therapy in subgroup analyses of studies not specifically involving CS patients. Chemotherapy and everolimus did not induce a significant response in the CS. We conclude that several treatment lines can be offered to patients suffering from the carcinoid syndrome. Initiation of randomized controlled trials with a primary outcome on carcinoid syndrome symptoms is strongly recommended.

Pancreatic VIPomas from China: Case reports and literature review

Vasoactive intestinal polypeptide-secreting tumors (VIPomas) are rare neuroendocrine tumors that often present as watery diarrhea, hypokalemia, and achlorhydria or hypochlorhydria. In this study, we present our institutional experience of diagnosis and treatment of VIPomas, along with a review of the Chinese literature since 1980. Patient #1, diagnosed in 1984 and with intact clinical records, shows the natural history of this disease. Patient #2, diagnosed in 2015, shows the results of evaluation by nuclear medicine techniques and the outcomes of standardized treatment. Comprehensive review of 41 cases allows evaluation of clinical characteristics, treatments and outcomes of pancreatic VIPoma patients. All patients presented with watery diarrhea. The average stool volume reached 3247 mL per day. Average serum VIP level was 839.3 ng/L. Twelve of the 41 cases were reported to have metastases at diagnosis. Somatostatin receptor scintigraphy and 18FDG PET-CT are efficient methods for detection of VIPoma. Surgical excision can promptly alleviate hormonal symptoms.

NEW POSSIBILITIES OF TREATMENT OF SUBCLINICAL TIEROTOXICOSIS IN SENIOR PATIENTS: PLACE AND ROLE OF PHYTOTHERAPY

The analysis of the clinical efficacy of the appointment of the dietary supplement «Thyreopharm®» to patients with subclinical thyrotoxicosis was carried out. It has been revealed that the dietary supplement «Thyreopharm®» contributes to the normalization of the hormonal thyroid status, reduces cardiac and vegetative symptoms, reduces the activity of the autoimmune process, thereby improving the morphological parameters of the thyroid tissue.

Positive and negative affect and prostate cancer-specific anxiety in Taiwanese patients and their partners.

Few studies have examined positive and negative affect and prostate cancer-specific anxiety in prostate cancer patients and their partners. Thus, this study explored positive and negative affect and prostate cancer-specific anxiety as well as their associated factors in prostate cancer patients and their partners. A prospective repeated-measures design was used. Data were collected from 48 prostate cancer patients and their partners when treatment was determined (before treatment) and at 6, 10, 18, and 24 weeks thereafter. The questionnaire included the Expanded Prostate Cancer Index Composite, the Dyadic Adjustment Scale, the Positive and Negative Affect Schedule, and the Memorial Anxiety Scale for prostate cancer. Generalized estimating equations were used for statistical analysis. Patients with lower relationship satisfaction experienced lower positive affect (β = 0.279) and higher negative affect (β = -0.323), and their partners experienced higher prostate specific antigen-related anxiety (β = -0.014). The presence of strong hormonal symptoms aggravated negative affect (β = -0.010) and prostate cancer-related anxiety (β = -0.009), but living with children and grandchildren improved prostate cancer-related anxiety (β = -0.445) and fear of cancer recurrence in patients (β = -0.232). There is an interaction between the prostate cancer-specific anxiety experienced by patients and that experienced by their partners. The emotional state of patients and their partners should be evaluated, and understandable information should be provided. Care strategies should include encouraging adult children to participate in the patients' care plan, symptom management, and the teaching of coping skills.

Examining relationships between age at diagnosis and health-related quality of life outcomes in prostate cancer survivors

BackgroundPatient reports of health related quality of life can provide important information about the long-term impact of prostate cancer. Because patient symptoms and function can differ by age of the survivor, the aim of our study was to examine patient-reported quality of life and prostate symptoms by age at diagnosis among a registry of Dutch prostate cancer survivors.MethodsA population of 617 individuals from the Patient Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship (PROFILES) database was surveyed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and prostate symptom (EORTC QLQ-PR25) scales. Age at diagnosis was the main independent variable, with three age categories: 60 years and younger, 61–70 years, and 71 years and older. Dependent variables were the EORTC-QLQ-C30 and EORTC QLQ-PR25 scales, divided into positive and negative outcomes. Positive measures of health-related quality of life included global health, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning. Negative outcomes included fatigue, nausea, pain, dyspnea, insomnia, appetite, constipation, and diarrhea. We also assessed sexual activity, and urinary, bowel and hormonal symptoms. Descriptive analyses included frequencies with chi-square tests and medians with Kruskal-Wallis tests. Multivariable adjusted analyses were conducted by median regression modeling.ResultsAmong the numerous scales showing some unadjusted association with age group, only two scales demonstrated significant differences between prostate cancer patients age 71+ compared to the youngest group (age < 61) after multivariable adjustment. On average, the oldest patients experienced an 8.3-point lower median physical functioning score (β = − 8.3; 95% CI = − 13.9, − 2.8; p = 0.003) and a 16.7-point lower median sexual activity score (β = − 16.7; 95% CI = − 24.7, − 8.6; p < 0.001) while controlling for BMI, marital status, time since diagnosis, comorbidities (heart condition), Gleason score, and treatment (prostatectomy).ConclusionsResults suggest that patient age at diagnosis should be considered among factors that contribute to health-related quality of life outcomes for prostate cancer survivors. Implications for Cancer Survivors: A possible reevaluation of screening recommendations may be appropriate to acknowledge age as a factor contributing to health-related quality of life outcomes for prostate cancer survivors.

Life after prostate cancer diagnosis: One step beyond.

40 Background: Prostate cancer (PCa) outcome studies are frequently restricted to specific disease stage or treatments. Interpretation may be restricted through lack of population control data &amp; selection bias. We report a whole population evaluation of health-related quality of life (HRQL) following diagnosis of PCa compared to a general population (GenPop) cohort. Methods: Cross-sectional postal survey of all men diagnosed with PCa in the UK 18-42 months earlier. Measures of generic HRQL (EQ-5D) and PCa specific outcomes (EPIC-26 &amp; interventions for erectile dysfunction), as defined in ICHOM minimum dataset, were utilized. Comparable GenPop data was collected from men never diagnosed with PCa in Northern Ireland. Results: 35,823 PCa survivors responded (60.8% response rate), median age 71, and 2,995 from the GenPop (30%). Overall HRQL was slightly lower in the PCa men than the GenPop, this difference was significant only in stage 4 disease. Men with PCa were less likely to report problems in individual EQ5D domains than men in the GenPop (62.0% vs. 68.8%). Both populations were most likely to report pain/discomfort, this was lower in PCa men than the GenPop (42.1% vs. 60.8%). Problems increased with age in all domains, with the exception of anxiety/depression. Men generally reported good function on EPIC-26; however PCa survivors reported poorer sexual function (78.9% vs 48%) except in the oldest. Medications/devices/services to aid or improve erections were offered to 45.4%, 26.0% &amp; 16.9% respectively (and considered helpful by 14.7%, 7.5% &amp; 3.2%). Men with PCa reported more problems with urinary leakage (13.1% vs. 7.1%), particularly after surgery. Hormonal symptoms were linked with receiving Androgen Deprivation Therapy and, to a lesser extent, external beam radiation. Conclusions: 18-42 months following diagnosis of PCa significant sexual and urinary morbidity is experienced relative to the GenPop. Specialist support for sexual dysfunction is not always offered. With the exception of men with stage 4 disease, overall HRQL is only mildly reduced. Funding The Life After Prostate Cancer Diagnosis study was funded by the Movember Foundation, in partnership with Prostate Cancer UK, as part of the Prostate Cancer Outcomes programme, grant number BO26/MO.

Comparison of Male and Female Prolactinoma Patients Requiring Surgical Intervention.

Objectives Prolactinomas are the most common functional pituitary adenoma. Symptoms of a prolactinoma stem from hormonal causes (menstrual irregularities, galactorrhea, and reduced libido) or from tumor mass effect (visual changes and headache). Gender differences have been noted in prolactinomas, with males presenting with larger tumors and sequelae of mass effect, while females present commonly with hormonal symptoms. The purpose of this study is to evaluate differences in patient and disease characteristics, and outcomes between male and female prolactinoma patients undergoing surgery. Design This was a retrospective chart review. Setting This was done at the tertiary medical center. Participants The medical records of prolactinomas patients who underwent endoscopic endonasal surgery between March 2008 and August 2016 were reviewed. Main Outcome Measures Demographic information, tumor characteristics, and treatment characteristics and outcomes were collected. Statistical analysis was performed using chi-squared test or Student's t -test as applicable. Results Seventy-nine patients were identified, 22 males and 57 females. The average age for males was 38 years and for females was 35 years. Males were more likely to present with decreased libido ( p < 0.0001), whereas females more often presented with galactorrhea ( p < 0.0001) and menstrual irregularities. Tumor size was larger in males ( p = 0.0044) with higher likelihood of suprasellar extension ( p = 0.0409) and cavernous sinus invasion ( p = 0.0026). Males were more likely to have a subtotal resection rather than gross total resection ( p = 0.0086) and less likely to have normalization of prolactin levels following surgery ( p = 0.0019) Conclusion Male prolactinoma patients tend to have larger tumors with more aggressive features. This may have a role in the differences in outcomes noted in this study.