Islet Autoantibodies in Adult With Pituitary and Ovarian Autoimmunity: Implications for Type 1 Diabetes Screening Giuseppe Bellastella, Michela di Nuzzo, Miriam Longo, Paolo Cirillo, Antonietta Maio, Nicole Di Martino, Silvia Angelino, Paola Caruso, Lorenzo Scappaticcio, Maria Teresa Vietri, Maria Ida Maiorino, Katherine Esposito Diabetes Obesity and Metabolism, 2026 Purpose Type 1 diabetes is a chronic autoimmune disease characterised by progressive pancreatic β‐cell destruction and the early appearance of islet autoantibodies (islet‐AAb) during the pre‐symptomatic phases. Given the growing interest in screening and prevention of type 1 diabetes, this study aimed to assess the prevalence of pancreatic autoimmunity in adults with other organ‐specific autoantibodies in order to identify potential target populations for screening programs. Methods Adults previously tested for autoantibodies against specific endocrine glands and/or gastric parietal cells by indirect immunofluorescence were divided into two groups (Autoimmunity group and Control group), according to the presence of at least one organ‐specific autoantibody. Stored serum samples from all participants were re‐evaluated for islet‐AAb and comparisons were performed between groups and, within the Autoimmunity group (Group A), across different patterns of organ‐specific autoimmunity. Results Positivity for at least one islet‐AAb was significantly higher in Group A than in Control Group (40.3% vs. 21.0%; p = 0.007). Double and triple islet‐AAb positivity were less common overall, but occurred more frequently in Group A. Moreover, in Group A, a significantly higher prevalence of multiple positivity (≥ 2 islet‐AAb) was observed in subjects with ovarian autoimmunity and in those with combined pituitary and ovarian autoimmunity than in those with other endocrine autoimmune involvement. Conclusion Adults with specific autoimmunity disorders, particularly those affecting ovarian and/or pituitary glands, have a higher prevalence of pancreatic autoimmunity. These subjects may benefit from targeted screening to identify the pre‐symptomatic stage of T1D and potentially delay progression to clinical disease.
Periorbital and Central Nervous System Infection Due to Arcanobacterium haemolyticum: Case Report and Review of the Literature Pierangelo Chinello, Alessandro Capone, Samir Al Moghazi, Paolo Cirillo, Carla Fontana, Stefania Cicalini Microorganisms, 2025 Arcanobacterium haemolyticum is a facultative anaerobe, catalase-negative, Gram-positive pleomorphic rod, most commonly responsible for pharyngeal infections. Invasive A. haemolyticum infections are rare and typically involve immunocompromised patients; however, severe and invasive infections in immunocompetent patients have also been reported. Here we describe a case of sinusitis complicated by periorbital cellulitis, subdural empyema and cerebritis due to A. haemolyticum in an immunocompetent patient. The patient was initially treated with daptomycin + piperacillin/tazobactam and subsequently with linezolid + meropenem and required multiple surgical interventions to attain source control. Although uncommon, A. haemolyticum should be considered as a causative agent of severe infections complicating pharyngitis or sinusitis that may result from local extension or haematogenous spread, even in an immunocompetent host. We also present a literature review on central nervous system involvement by A. haemolyticum infection.
The Glycemia Risk Index (GRI) as a Biomarker for Subclinical Endothelial Dysfunction in Type 1 Diabetes: A Cross-Sectional Study Nicole Di Martino, Silvia Angelino, Antonietta Maio, Paolo Cirillo, Alessandro Pontillo, Mariangela Caputo, Lorenzo Scappaticcio, Paola Caruso, Miriam Longo, Giuseppe Bellastella, Maria Ida Maiorino, Katherine Esposito International Journal of Molecular Sciences, 2025 Circulating levels of endothelial progenitor cells (EPCs) involved in endothelial homeostasis are often reduced in people with type 1 diabetes (T1D). The Glycemia Risk Index (GRI) quantifies the quality of glucose control by assessing both hypo- and hyperglycemia risk. We aim to investigate the association between the GRI and circulating EPC levels in people with T1D. This cross-sectional study included 132 adults with T1D, on intensive insulin therapy. We calculated GRI from 14 days continuous glucose monitoring-derived metrics and quantified EPCs count by flow cytometry, stratifying results by GRI zones, ranging from A (lowest risk) to E (highest risk). Higher GRI scores were significantly associated with poorer metabolic parameters. Circulating levels of CD34+, CD133+, KDR+, and CD34+KDR+ cells were lower in participants with a worse GRI compared to adults with a better GRI. Linear regression analyses showed a negative association between GRI and CD34+ (β = −1.079, p = 0.006), CD34+CD133+ (β = −0.581, p = 0.008), and CD34+KDR+ (β = −0.147, p = 0.010). No significant association was found between HbA1c and any EPC phenotype. Adults with T1D and a high GRI level had a lower EPCs count. GRI was significantly associated with certain EPC phenotypes, suggesting its potential role as a biomarker for cardiovascular risk assessment.
Unilateral Graves' disease: a case report with concomitant thyroid cancer and systematic review of literature Lorenzo SCAPPATICCIO, Paola CARUSO, Miriam LONGO, Alessandra VOLATILE, Paolo CIRILLO, Francesco DI MAIO, Claudia VARRO, Vanda AMORESANO PAGLIONICO, Sium WOLDE SELLASIE, Maria I. MAIORINO, Katherine ESPOSITO, Giuseppe BELLASTELLA Minerva Surgery, 2025 INTRODUCTION Unilateral uptake (i.e., increased radiotracer in one lobe) on a thyroid scan in a patient with Graves' disease (GD) is the distinctive feature of unilateral GD (UGD), representing a rare entity and variant of GD with few documented cases to date. Considering the diagnostic and therapeutical implications of the knowledge of this form of GD, this study was designed to bring more light on the UGD entity within the bilobar thyroid gland. EVIDENCE ACQUISITION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in reporting this systematic review. We developed a search strategy combining terms for Graves or Hyperthyroidism and unilateral systematically and searched PubMed from inception through August 25, 2024. The inclusion criteria were: 1) patients with Graves' hyperthyroidism due to a unilateral involvement in bilobar thyroid gland; 2) articles written in English or any language with an English abstract. EVIDENCE SYNTHESIS A total of 10 articles met inclusion criteria, in addition to our institutional experience (comprising 27 individual patients in total). All the included studies were case reports/series. Of the 27 patient cases, 20 (74.1%) were female and the mean age of patients was 44.5±10.6 years. 24 patients (88.9%) had overt hyperthyroidism, two (7.4%) subclinical hyperthyroidism, one (3.7%) had initially normal thyroid function. Orbitopathy was present in two cases out of ten (20%). thyrotropin receptor antibodies (TRAb) or thyroid stimulating immunoglobulin (TSI) were positive in 9 cases out of 12 (75%). Right thyroid lobe was involved in 17 cases (63.0%), while the left one in 10 cases (37.0%). Antithyroid drugs ATDs were adopted by 13 patients (68.4%). Four patients (21.1%) underwent surgery, while radioactive iodine (RAI) was performed in two cases. Two cases (15.4%) received a 12-month course of ATD therapy, one of whom recurred. In two out of three cases after hemithyroidectomy hyperthyroidism recurred due to the involvement of the contralateral lobe of the thyroid gland. CONCLUSIONS Clinicians should be aware of the possibility that GD can present in the bilobar thyroid gland with unilateral gland involvement at scintigraphy. Ultrasound examination is indicated to detect the presence of contralateral thyroid tissue, and to exclude the possibility of a hyperfunctioning nodule or hemiagenesis. When choosing surgery, total thyroidectomy seems to be the appropriate treatment. Further investigation is needed to determine the natural course of UGD and its best management. Future guidelines should consider this form of GD.
Thyroid Hormones in Early Pregnancy and Birth Weight: A Retrospective Study Marco La Verde, Pasquale De Franciscis, Rossella Molitierno, Florindo Mario Caniglia, Mario Fordellone, Eleonora Braca, Carla Carbone, Claudia Varro, Paolo Cirillo, Lorenzo Scappaticcio, Giuseppe Bellastella Biomedicines, 2025 Background/Objectives: Various factors influence intrauterine growth and birth weight. We investigated the possible association between first-trimester pregnancy thyroid functions and birth weight. Methods: A retrospective observational study was conducted from 31 March 2021 to 30 September 2022. Ninety-eight low-risk pregnant women were evaluated. To obtain a homogeneous population, we included only patients with no maternal or fetal comorbidities. TSH, FT3, and FT4 levels in the first trimester and birth weight were recorded and analyzed. Results: The average maternal age was 33.37 years (IQR = 8.67), with a median BMI of 24.98 kg/m2 (IQR = 5.66). The average gestational week of pregnancy was 39.40 weeks (IQR = 2.10). Linear regression for birth weight according to TSH effects adjusted by sociodemographic and clinical factors did not show any associations between birth weight and TSH, age, ethnicity, BMI, smoking, or weight gain. Pregnancy duration was associated with birth weight: β = 172.027, p-value < 0.001. A negative significant correlation between FT3 and birth weight was found (beta = −118.901 95% CI: −222.942 to −14.859, p = 0.026). Age, ethnicity, BMI, smoking, and weight showed non-significant associations with birth weight. The FT3 scatterplot showed a negative correlation of FT3 levels with birth weight. Higher values of FT3 were associated with a low birth weight (R = −0.22, p = 0.029). Conclusions: Our study, focused on the first trimester, found a negative correlation between FT3 variations and birth weight.
Semen quality and metabolic profile in people with type 1 diabetes with and without erectile dysfunction: a cross-sectional study M. Longo, P. Caruso, C. Varro, M. Tomasuolo, P. Cirillo, L. Scappaticcio, L. Romano, D. Arcaniolo, M. I. Maiorino, G. Bellastella, M. De Sio, K. Esposito Journal of Endocrinological Investigation, 2024 Purpose The aim of the present study is to evaluate the association of metabolic and glycemic variables with semen parameters in patients with type 1 diabetes (T1D) with and without erectile dysfunction (ED). Methods The study population included 88 adults with T1D using a continuous glucose monitoring, of whom 28 with ED (ED group) and 60 without it (NO ED group). All men completed the International Index of Erectile Function (IIEF-5) and underwent body composition analysis (BIA) and semen analysis. Results ED group showed worse HbA1c levels [median (IQR), 8.4 (7.7, 9.9) vs 7.4 (7, 8.2) %, P < 0.001)], higher insulin dose [60 (51, 65) vs 45 (38, 56) UI/die, P = 0.004)] and a higher total body water and intracellular water as compared with ED group. Men in the ED group presented higher semen volume [2.8 (2.6, 4.2) vs 2.5 (2.2, 2.7) mL, P < 0.001] and sperm concentration [24 (19, 29) vs 20 (12, 23) mil/mL, P = 0.010], but reduced sperm progressive motility [28 (25, 35) vs 35 (25, 36) %, P = 0.011], higher rate of non-progressive motility [15 (10, 15) vs 10 (5, 10) %, P < 0.001] and higher rate of typical morphology [7(5, 8) vs 5 (4, 5) %, P = 0.001]. Based on multivariate logistic regression analysis performed to assess the association between clinical variables and ED, intracellular water (OR 3.829, 95% CI 1.205, 12.163, P = 0.023) resulted as the only independent predictor of ED. Conclusion Men with T1D and ED showed worse metabolic profile which is associated with poor semen quality, as compared with those without ED.
Impact of liver fibrosis on COVID-19 in-hospital mortality in Southern Italy Raffaele Galiero, Giuseppe Loffredo, Vittorio Simeon, Alfredo Caturano, Erica Vetrano, Giulia Medicamento, Maria Alfano, Domenico Beccia, Chiara Brin, Sara Colantuoni, Jessica Di Salvo, Raffaella Epifani, Riccardo Nevola, Raffaele Marfella, Celestino Sardu, Carmine Coppola, Ferdinando Scarano, Paolo Maggi, Cecilia Calabrese, Pellegrino De Lucia Sposito, Carolina Rescigno, Costanza Sbreglia, Fiorentino Fraganza, Roberto Parrella, Annamaria Romano, Giosuele Calabria, Benedetto Polverino, Antonio Pagano, Fabio Numis, Carolina Bologna, Mariagrazia Nunziata, Vincenzo Esposito, Nicola Coppola, Nicola Maturo, Rodolfo Nasti, Pierpaolo Di Micco, Alessandro Perrella, Luigi Elio Adinolfi, Paolo Chiodini, Marina Di Domenico, Luca Rinaldi, Ferdinando Carlo Sasso, and Plos One, 2024 Background & aims SARS-Cov-2 infection manifests as a wide spectrum of clinical presentation and even now, despite the global spread of the vaccine, contagiousness is still elevated. The aim of the study was the evaluation of the impact of liver fibrosis assessed by FIB-4 and liver impairment, assessed by cytolysis indices, on intrahospital mortality in COVID-19 subjects. Methods This is a retrospective observational cohort study, which involved 23 COVID Hospital Units in Campania Region, Italy. Exposure variables were collected during hospital admission and at discharge. According to FIB-4 values, we subdivided the overall population in three groups (FIB-4<1.45; 1.45<FIB-4<3.25; FIB-4>3.25), respectively group 1,2,3. Results At the end of the study, 938 individuals had complete discharged/dead data. At admission, 428 patients were in group 1 (45.6%), 387 in group 2 (41.3%) and 123 in group 3 (13.1%). Among them, 758 (81%) subjects were discharged, while the remaining 180 (19%) individuals died. Multivariable Cox’s regression model showed a significant association between mortality risk and severity of FIB-4 stages (group 3 vs group 1, HR 2.12, 95%CI 1.38–3.28, p<0.001). Moreover, Kaplan-Meier analysis described a progressive and statistically significant difference (p<0.001 Log-rank test) in mortality according to FIB-4 groups. Among discharged subjects, 507 showed a FIB-4<1.45 (66.9%, group 1), 182 a value 1.45<FIB-4<3.25 (24.1%, group 2) and 69 a FIB-4>3.25 (9.0%, group 3). Among dead subjects, 42 showed a FIB-4<1.45 (23.3%, group 1), 62 a value 1.45<FIB-4<3.25 (34.4%, group 2) and 76 a FIB-4>3.25 (42.3%, group 3). Conclusions FIB-4 value is significantly associated with intrahospital mortality of COVID-19 patients. During hospitalization, particularly in patients with worse outcomes, COVID-19 seems to increase the risk of acute progression of liver damage.
Glucose control during breakthrough SARS-CoV-2 infections in vaccinated patients with type 1 diabetes Miriam Longo, Lorenzo Scappaticcio, Simona Signoriello, Paola Caruso, Antonietta Maio, Graziella Botta, Stefania Arena, Paolo Cirillo, Michela Petrizzo, Giuseppe Bellastella, Maria Ida Maiorino, Paolo Chiodini, Katherine Esposito, Filomena Castaldo, Mariluce Barrasso, Maurizio Gicchino, Nicole Di Martino, Concetta Di Lorenzo, Annarita Palmieri, Mariangela Caputo, Concetta Verazzo Diabetes Research and Clinical Practice, 2024 AIMS: This study aims at evaluating the trend of glycemic control metrics during the infection of SARS-CoV-2 in individuals with Type 1 Diabetes (T1D) using a Continuous Glucose Monitoring (CGM) system and vaccinated against COVID-19. MATERIALS AND METHODS: This is a retrospective study of T1D subjects who got a breakthrough SARS-CoV-2 infection between November 2021 and February 2022. Data of glycemic control of CGM-derived metrics were compared 14 days before COVID-19 (Time 1), 14 days during COVID-19 (Time 2) and 14 days after COVID-19 (Time 3). RESULTS: A total of 106 patients with T1D and breakthrough SARS-CoV-2 infection was included in the analysis. A significant reduction of GMI [%, 7.41 ± 1.60 vs 7.52 ± 1.63, P = 0.006)] and increase of TIR [%, 54.6 ± 20.4 vs 52.1 ± 19.7, P = 0.026] were observed at Time 3 as compared with Time 2. There was a significant reduction of SD (P < 0.001) and CV (P < 0.001) at Time 3 and Time 2 as compared with Time 1, associated with significant changes of mean glucose levels, TBR level 1 and total daily insulin doses. CONCLUSIONS: Breakthrough SARS-CoV-2 infection did not worsen glycemic control in vaccinated people with T1D.
Biochemical predictors of diabetic foot osteomyelitis: A potential diagnostic role for parathormone Paola Caruso, Maria Ida Maiorino, Lorenzo Scappaticcio, Chiara Porcellini, Rita Matrone, Paolo Cirillo, Margherita Macera, Maurizio Gicchino, Maria Teresa Vietri, Giuseppe Bellastella, Nicola Coppola, Katherine Esposito Diabetes Metabolism Research and Reviews, 2023 AIM The aims of this study were to evaluate parathormone (PTH) levels in people with diabetic foot ulcers (DFU) and investigate the relationship between PTH levels and osteomyelitis (OM) in this population. MATERIALS AND METHODS Eighty-eight patients were admitted for DFU in a tertiary-care center from October 2021 to May 2022. OM was diagnosed by clinical, laboratory and radiological evaluations. Laboratory measurements and clinical parameters were collected from medical records. Participants in the study were divided in two groups according to the diagnosis of OM [patients with OM, group 1 (n=54), and patients without OM, group 2 (n= 34)]. RESULTS Compared with group 2, patients in group 1 were younger and had a longer duration of diabetes. Erythrocyte sedimentation rate and fibrinogen were significantly higher in group 1 compared with group 2. PTH levels resulted significantly lower [group 1 vs group 2, median (interquartile range) 16.2 (11.6, 31.0) vs 23.7 (17.0, 38.1), P = 0.008] and alkaline phosphatase was significantly higher [97.0 (79.0, 112.0) vs 88.0 (630, 107.0), P = 0.031] in group 1. In the multiple linear regression analysis the only independent predictors of PTH concentrations were alkaline phosphatase levels (β-coefficient 0.441, P <0.001) and the presence of OM (β-coefficient -0.290, P = 0.038). CONCLUSIONS In a population of patients with diabetes and OM admitted in a tertiary university-center, PTH levels were lower as compared with diabetic individuals without OM. The OM and alkaline phosphatase levels were independent predictors of PTH levels in this selected population. This article is protected by copyright. All rights reserved.
Neuroimmunoendocrinology of SARS-CoV-2 Infection Giuseppe Bellastella, Paolo Cirillo, Carla Carbone, Lorenzo Scappaticcio, Antonietta Maio, Graziella Botta, Maria Tomasuolo, Miriam Longo, Alessandro Pontillo, Antonio Bellastella, Katherine Esposito, Annamaria De Bellis Biomedicines, 2022 This review is aimed at illustrating and discussing the neuroimmune endocrinological aspects of the SARS-CoV-2 infection in light of the studies on this topic that have so far appeared in the literature. The most characteristic findings and pending controversies were derived by PubMed and Scopus databases. We included original and observational studies, reviews, meta-analysis, and case reports. The entry of the coronavirus into susceptible cells is allowed by the interaction with an ecto-enzyme located on human cells, the angiotensin-converting enzyme 2 (ACE2). SARS-CoV-2 also targets the central nervous system (CNS), including hypothalamic-pituitary structures, as their tissues express ACE2, and ACE2 mRNA expression in hypothalamus and pituitary gland cells has been confirmed in an autoptic study on patients who died of COVID 19. SARS-CoV-2 infection may cause central endocrine disorders in acute phase and in post-COVID period, particularly due to the effects of this virus at CNS level involving the hypothalamic-pituitary axis. The aggression to the hypothalamus-pituitary region may also elicit an autoimmune process involving this axis, responsible consequently for functional disorders of the satellite glands. Adrenal, thyroid and gonadal dysfunctions, as well as pituitary alterations involving GH and prolactin secretions, have so far been reported. However, the extent to which COVID-19 contributes to short- and long-term effects of infection to the endocrine system is currently being discussed and deserves further detailed research.
Varicocele: An Endocrinological Perspective Giuseppe Bellastella, Raffaela Carotenuto, Francesco Caiazzo, Miriam Longo, Paolo Cirillo, Lorenzo Scappaticcio, Carla Carbone, Davide Arcaniolo, Maria Ida Maiorino, Katherine Esposito Frontiers in Reproductive Health, 2022
Lack of effect on in-hospital mortality of drugs used during COVID-19 pandemic: Findings of the retrospective multicenter COVOCA study Pia Clara Pafundi, Raffaele Galiero, Vittorio Simeon, Luca Rinaldi, Alessandro Perrella, Erica Vetrano, Alfredo Caturano, Maria Alfano, Domenico Beccia, Riccardo Nevola, Raffaele Marfella, Celestino Sardu, Carmine Coppola, Ferdinando Scarano, Paolo Maggi, Pellegrino De Lucia Sposito, Laura Vocciante, Carolina Rescigno, Costanza Sbreglia, Fiorentino Fraganza, Roberto Parrella, Annamaria Romano, Giosuele Calabria, Benedetto Polverino, Antonio Pagano, Carolina Bologna, Maria Amitrano, Vincenzo Esposito, Nicola Coppola, Nicola Maturo, Luigi Elio Adinolfi, Paolo Chiodini, Ferdinando Carlo Sasso, and Plos One, 2021
Implications of AB0 blood group in hypertensive patients with covid-19 Celestino Sardu, Raffaele Marfella, Paolo Maggi, Vincenzo Messina, Paolo Cirillo, Vinicio Codella, Jessica Gambardella, Antonio Sardu, Gianluca Gatta, Gaetano Santulli, Giuseppe Paolisso BMC Cardiovascular Disorders, 2020