Paolo Cirillo
@unicampania.it
Department of Advanced Medical and Surgical Sciences
University of Campania "Luigi Vanvitelli"
Scopus Publications
Scopus Publications
M. Longo, P. Caruso, C. Varro, M. Tomasuolo, P. Cirillo, L. Scappaticcio, L. Romano, D. Arcaniolo, M. I. Maiorino, G. Bellastella,et al.
Springer Science and Business Media LLC
Abstract 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.
Miriam Longo, Lorenzo Scappaticcio, Simona Signoriello, Paola Caruso, Antonietta Maio, Graziella Botta, Stefania Arena, Paolo Cirillo, Michela Petrizzo, Giuseppe Bellastella,et al.
Elsevier BV
Paola Caruso, Maria Ida Maiorino, Lorenzo Scappaticcio, Chiara Porcellini, Rita Matrone, Paolo Cirillo, Margherita Macera, Maurizio Gicchino, Maria Teresa Vietri, Giuseppe Bellastella,et al.
Wiley
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.
Giuseppe Bellastella, Paolo Cirillo, Carla Carbone, Lorenzo Scappaticcio, Antonietta Maio, Graziella Botta, Maria Tomasuolo, Miriam Longo, Alessandro Pontillo, Antonio Bellastella,et al.
MDPI AG
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.
Antonietta Maio, Maria Ida Maiorino, Miriam Longo, Lorenzo Scappaticcio, Vlenia Pernice, Paolo Cirillo, Paola Caruso, Vanda Amoresano Paglionico, Giuseppe Bellastella, and Katherine Esposito
The Endocrine Society
Abstract Context Endothelial progenitor cells (EPCs), which are involved in the mechanisms of vascular repair and sexual function, are decreased in diabetic women compared with general population. Objective This work aimed to investigate the circulating levels of EPCs and the change in sexual function during the menstrual cycle in women with type 1 diabetes (T1DM) compared with healthy women. Methods This case-control observational study was conducted at the Unit of Endocrinology and Metabolic Diseases at University Hospital “Luigi Vanvitelli’’ of Naples. Participants included 36 women with T1DM and 64 age-matched healthy controls. EPCs were quantified by flow cytometry and sexual function was assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale. All assessments were made at the follicular, ovulatory, and luteal phases of the same menstrual cycle. Main outcome measures included differences in EPCs levels and sexual function between patients and controls. Results Compared with controls, women with T1DM showed significantly lower levels of both CD34 + (P &lt; .001) and CD34 + CD133 + cells (P &lt; .001) in the ovulatory phase, and CD34 + KDR + cells both in the ovulatory phase and in the luteal phase (P &lt; .001 for both). Diabetic women showed significantly lower total FSFI scores and higher FSDS score than control women in all phases of the menstrual cycle. FSFI total score was predicted by both CD34 + CD133 + and CD34 + KDR + cells in the follicular phase, CD34 + and CD34 + KDR + CD133 + cells in the ovulatory phase, and CD34 + KDR + and CD34 + KDR + CD133 + cells in the luteal phase. Conclusion Women with T1DM show lower levels of EPCs during the menstrual cycle compared with controls. EPCs count predicts sexual function in this selected population.
Lorenzo Onorato, Margherita Macera, Federica Calò, Paolo Cirillo, Giovanni Di Caprio, and Nicola Coppola
Elsevier BV
Miriam Longo, Lorenzo Scappaticcio, Paolo Cirillo, Antonietta Maio, Raffaela Carotenuto, Maria Ida Maiorino, Giuseppe Bellastella, and Katherine Esposito
MDPI AG
Cardiovascular diseases are the leading cause of death in people with diabetes. Diabetic cardiomyopathy (DC) is an important complication of diabetes and represents a distinct subtype of heart failure that occurs in absence of cardiovascular diseases. Chronic hyperglycemia and hyperinsulinemia along with insulin resistance and inflammatory milieu are the main mechanisms involved in the pathophysiology of DC. Changes in lifestyle favoring healthy dietary patterns and physical activity, combined with more innovative anti-diabetes therapies, are the current treatment strategies to safeguard the cardiovascular system. This review aims at providing an updated comprehensive overview of clinical, pathogenetic, and molecular aspects of DC, with a focus on the effects of anti-hyperglycemic drugs on the prevention of pump dysfunction and consequently on cardiovascular health in type 2 diabetes.
Giuseppe Bellastella, Raffaela Carotenuto, Francesco Caiazzo, Miriam Longo, Paolo Cirillo, Lorenzo Scappaticcio, Carla Carbone, Davide Arcaniolo, Maria Ida Maiorino, and Katherine Esposito
Frontiers Media SA
Varicocele affects 15% of male population but it is more frequently identified in patients searching medical care for infertility. The impact of varicocele on semen production and fertility is known, but the relationship between clinical varicocele and impaired hormonal production is not clear. In published literature there are some studies regarding hormonal alterations in patients with varicocele but no review in which all the hormonal findings are explained. The aim of this review is to evaluate, by most common search engine, what is known about hormonal alterations in varicocele-bearing patients, to verify if a cause-effect relationship is documented and to give a useful contribution to in clinical management of this kind of patients. We found contradictory results about hormonal status from literature. Some studies confirmed a decrease of testosterone levels and higher FSH and LH levels that normalize after varicocelectomy, others found lower than normal levels of dihydrotestosterone due to decreased activity of epididymal 5-α-reductase. Lower circulating Anti-Müllerian Hormone levels, accompanied by a decreased Inhibin-B level, were reported as indicators of the decreased Sertoli cells function in varicocele-bearing adult patients. The finding of higher basal 17-OH-progesterone concentrations in patients with varicocele was explained by some authors with a testicular C-17,20-lyase deficiency. There is no doubt that varicocele could led to hormonal alterations. This review proposes that the impaired free sexual steroid levels are the result of a slight, deep-rooted defect in the testes of a certain amount of men with varicocele but further multicentre, randomized controlled studies remain mandatory to better clarify the hormonal features of patients with varicocele and to assess the utility of hormonal evaluation for establishing the duration of varicocele and for better identifying patients who need surgical correction.
Celeste Manfredi, Davide Arcaniolo, Ugo Amicuzi, Lorenzo Spirito, Luigi Napolitano, Fabio Crocerossa, Marco Paoletta, Stefano Gisone, Paolo Cirillo, Felice Crocetto,et al.
Wiley
INTRODUCTION
Extracorporeal shock wave therapy (ESWT) is an established treatment for erectile dysfunction (ED) and Peyronie's disease (PD). Concerns regarding the safety of ESWT for andrological purposes on testicular function were raised by animal studies.
AIM
To evaluate the impact of ESWT for ED or PD on reproductive and hormonal testicular function.
METHODS
We designed a prospective controlled study in which consecutive patients were enrolled. Males aged between 18 and 40 years with mild vasculogenic ED or acute inflammatory PD and normozoospermia were included. All enrolled patients were offered ESWT, and subjects who refused ESWT for any reason were considered as the Control group. All patients in the Intervention group were treated with DUOLITH SD1 T-TOP by a single expert urologist. Semen analysis and serum total testosterone dosage were performed before the start (T0) and 3 months after the end of ESWT (T1) in Intervention group. The same parameters were evaluated after the ESWT refusal (T0) and at the end of the following 3 months (T1) in Control group. Normozoospermia was chosen as the primary outcome, serum total testosterone concentration was selected as the secondary outcome.
RESULTS
A total of 94 patients were enrolled in the study (48 Group A, 46 Group B). At T0, all patients were normozoospermic in both groups (p = 0.563), and no significant difference in mean ± SD total testosterone levels was recorded between the groups (582.5 ± 107.2 vs. 634.6 ± 108.4 ng/dL; p = 0.221). At T1, no significant deterioration (p>0.05) in semen parameters was recorded in both groups. Only a statistically significant reduction in seminal pH was found after ESWT compared to baseline (7.9 ± 0.3 vs. 7.5 ± 0.2; p<0.001) and untreated patients (7.8 ± 0.2 vs. 7.5 ± 0.2; p<0.001). No significant difference in total testosterone levels was recorded in Intervention group after ESWT compared to baseline (p = 0.584).
CONCLUSION
ESWT in ED and PD patients does not seem to affect reproductive and hormonal testicular function. This article is protected by copyright. All rights reserved.
Annamaria De Bellis, Giuseppe Bellastella, Vlenia Pernice, Paolo Cirillo, Miriam Longo, Antonietta Maio, Lorenzo Scappaticcio, Maria Ida Maiorino, Antonio Bellastella, Katherine Esposito,et al.
The Endocrine Society
Abstract Context Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe chronic illness that reduces the quality of life. A potential role of neuroendocrine autoimmune dysfunction has been hypothesized. Objective This work aims to investigate the occurrence of antipituitary (APA) and antihypothalamic (AHA) antibodies and possible related hypothalamic/pituitary dysfunctions in ME/CSF patients. Methods This is a case-control study conducted in a university hospital setting (Stanford, California, USA; and Naples, Italy). Thirty women with ME/CSF (group 1) diagnosed according to Fukuda, Canadian, and Institute of Medicine criteria, at Stanford University, were enrolled and compared with 25 age-matched healthy controls. APA and AHA were detected by immunofluorescence; moreover, we investigated hormonal secretions of anterior pituitary and respective target glands. APA and AHA titers both were assessed and the prevalence of pituitary hormone deficiencies was also investigated. Results Patients in group 1 showed a high prevalence of AHA (33%) and APA (56%) and significantly lower levels of adrenocorticotropin (ACTH)/cortisol, and growth hormone (GH) peak/insulin-like growth factor-1 (IGF-1) vs controls (all AHA/APA negative). Patients in group 1A (13 patients positive at high titers, ≥ 1:32) showed ACTH/cortisol and GH peak/IGF-1 levels significantly lower and more severe forms of ME/CFS with respect to patients in group 1B (7 positive at middle/low titers, 1:16-1:8) and 1C (10 antibody-negative patients). Conclusion Both AHA and/or APA at high titers were associated with hypothalamic/pituitary dysfunction, suggesting that hypothalamic/pituitary autoimmunity may play an important role in the manifestations of ME/CFS, especially in its more severe forms.
Pia Clara Pafundi, Raffaele Galiero, Vittorio Simeon, Luca Rinaldi, Alessandro Perrella, Erica Vetrano, Alfredo Caturano, Maria Alfano, Domenico Beccia, Riccardo Nevola,et al.
Public Library of Science (PLoS)
Introduction During COVID-19 pandemic, the use of several drugs has represented the worldwide clinical practice. However, though the current increase of knowledge about the disease, there is still no effective treatment for the usage of drugs. Thus, we retrospectively assessed use and effects of therapeutic regimens in hospitalized patients on in-hospital mortality. Methods COVOCA is a retrospective observational cohort study on 18 COVID centres throughout Campania Region Hospitals. We included adult patients with confirmed SARS-CoV-2 infection, discharged/dead between March/June 2020. Results 618 patients were included, with an overall in-hospital cumulative mortality incidence of 23.1%. Most prescribed early treatments were antivirals (72%), antibiotics (65%) and hydroxychloroquine/anticoagulants (≈50%). Tocilizumab, indeed, was largely prescribed late during hospitalization. Multivariable models, with a cut-off at day 2 for early COVID-19 therapy administration, did not disclose any significant association of a single drug administration on the clinical outcome. Discussion COVOCA represents the first multicenter database in Campania region. None drug class used during the pandemic significantly modified the outcome, regardless of therapy beginning, both overall and net of those already in non-invasive ventilation (NIV)/ orotracheal intubation (OTI) at hospitalization. Our cumulative incidence of mortality seems lower than other described during the same period, particularly in Northern Italy.
Paola Caruso, Paolo Cirillo, Carla Carbone, Annalisa Sarnataro, Maria Ida Maiorino, Giuseppe Bellastella, and Katherine Esposito
Springer Science and Business Media LLC
Abstract Purpose Erectile dysfunction (ED) and premature ejaculation (PE) are common sexual disorders in people with diabetes. Glucose variability (GV) has been recognized as a predictor of microvascular complications. The aim of this study was to investigate the relationship between glucose variability and sexual dysfunctions in young men with type 1 diabetes. Methods One hundred and twelve patients with type 1 diabetes, aged 18–30 years, were enrolled. Patients were divided into two groups according to glucose variability [group 1 (high GV with coefficient of variation ≥ 36%)] and group 2 (low GV with coefficient of variation < 36%)). The presence of sexual dysfunctions was investigated with validated questionnaires. Results ED and PE prevalence rates in group 1 were 26% and 13%, respectively. Similarly, in group 2, the prevalence of ED was 24%, and the prevalence of PE was 13%. In both groups, no significant associations between sexual dysfunctions and parameters of glucose variability were found. Multiple regression analysis identified age and depression as independent predictors of ED and PE. Conclusion Young male patients affected by type 1 diabetes with high or low glucose variability show a similar prevalence of sexual dysfunctions. ED is the most common sexual dysfunction in diabetic men. Age and depression were the only independent predictive factors for sexual dysfunctions in this population.
Giuseppe Bellastella, Carla Carbone, Lorenzo Scappaticcio, Paolo Cirillo, Teresa Troiani, Floriana Morgillo, Maria Teresa Vietri, Carminia Maria Della Corte, Vincenzo De Falco, Stefania Napolitano,et al.
MDPI AG
Background: Autoimmune hypophysitis is a frequent immune-related adverse event (irAE) in cancer patients treated with immunecheckpoint inhibitors. Studies seeking anti-pituitary (APA) and anti-hypothalamus (AHA) antibodies in patients treated with anti-PD-1 and anti-PD-L1 are scarce. The aim of this study is to search for APA and AHA and related pituitary dysfunction in patients treated with these agents. Methods:Cross-sectional and preliminary longitudinal studies were conducted at the Medical Oncology Unit and Endocrinology and Metabolic Diseases Unit of the University of Campania “Luigi Vanvitelli”. Fifty-four cancer patients on treatments with anti-PD-1 or anti-PD-L1 (Group 1) and 50 healthy controls were enrolled for a cross-sectional study; 13 cancer patients (Group 2) were enrolled for our preliminary longitudinal study. APA/AHA titers and changes in biochemical and hormonal profile were evaluated in Group 1; in Group 2, they were evaluated before and after nine weeks from the start of immunotherapy. Results: Patients of Group 1 showed a higher prevalence of APA and AHA than controls: 21 of them had APA, 16 had AHA, and 11 had both autoantibodies. In total, 7 of 13 patients in Group 2 became APA-positive and 3 became AHA-positive after nine weeks of immunotherapy, showing an increase in prolactin and a decrease in ACTH and IGF-1 levels compared with basal values. Conclusions:Anti-pituitary and anti-hypothalamus antibodies seem to play a pivotal role in hypothalamic–pituitary autoimmunity and secondary endocrine-related alterations evoked by anti-PD-1 and PD-L1 antibodies.
Mustafa Sait Gonen, Annamaria De Bellis, Emre Durcan, Giuseppe Bellastella, Paolo Cirillo, Lorenzo Scappaticcio, Miriam Longo, Basak Ecem Bircan, Serdar Sahin, Cem Sulu,et al.
Georg Thieme Verlag KG
AbstractSARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, in particular, secondary adrenal insufficiency, using a dynamic test and the role of autoimmunity in pituitary dysfunction in patients with COVID-19. The single-center, prospective, case-control study included patients with polymerase chain reaction (PCR)-confirmed COVID-19 and healthy controls. Basal hormone levels were measured, and the adrenocorticotropic hormone (ACTH) stimulation test was performed. Antipituitary (APA) and antihypothalamic antibodies (AHA) were also determined. We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. Patients with COVID-19 had lower free T3, IGF-1, and total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. In conclusion, COVID-19 may result in adrenal insufficiency, thus routine screening of adrenal functions in these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormalities in COVID-19.
Uğur Türe, Annamaria De Bellis, Mehmet Volkan Harput, Giuseppe Bellastella, Melih Topcuoglu, Cumhur Kaan Yaltirik, Paolo Cirillo, Rima Nur Yola, Aydın Sav, and Fahrettin Kelestimur
The Endocrine Society
Abstract Context The relationship between the endocrine system and autoimmunity has been recognized for a long time and one of the best examples of autoimmune endocrine disease is autoimmune hypophysitis. A better understanding of autoimmune mechanisms and radiological, biochemical, and immunological developments has given rise to the definition of new autoimmune disorders including autoimmunity-related hypothalamic–pituitary disorders. However, whether hypothalamitis may occur as a distinct entity is still a matter of debate. Evidence Acquisition Here we describe a 35-year-old woman with growing suprasellar mass, partial empty sella, central diabetes insipidus, hypopituitarism, and hyperprolactinemia. Evidence Synthesis Histopathologic examination of surgically removed suprasellar mass revealed lymphocytic infiltrate suggestive of an autoimmune disease with hypothalamic involvement. The presence of antihypothalamus antibodies to arginine vasopressin (AVP)-secreting cells (AVPcAb) at high titers and the absence of antipituitary antibodies suggested the diagnosis of isolated hypothalamitis. Some similar conditions have sometimes been reported in the literature but the simultaneous double finding of lymphocytic infiltrate and the presence of AVPcAb so far has never been reported. Conclusions We think that the hypothalamitis can be considered a new isolated autoimmune disease affecting the hypothalamus while the lymphocytic infundibuloneurohypophysitis can be a consequence of hypothalamitis with subsequent autoimmune involvement of the pituitary. To our knowledge this is the first observation of autoimmune hypothalamic involvement with central diabetes insipidus, partial empty sella, antihypothalamic antibodies and hypopituitarism.
Miriam Longo, Paolo Cirillo, Lorenzo Scappaticcio, Maria Tomasuolo, Vlenia Pernice, Paola Caruso, Giuseppe Bellastella, Maria Ida Maiorino, and Katherine Esposito
Elsevier BV
Paola CARUSO, Mariangela CAPUTO, Paolo CIRILLO, Lorenzo SCAPPATICCIO, Miriam LONGO, Maria Ida MAIORINO, Giuseppe BELLASTELLA, and Katherine ESPOSITO
Edizioni Minerva Medica
BACKGROUND
Dietary regimens have so far been studied as possible determinants of semen quality and fertility. The aim of this study was to evaluate the effects of a Mediterranean diet, as compared with a low-fat diet, on seminal parameters of young healthy adults from southern Italy.
METHODS
In a randomized controlled trial, 160 young adults aged 18-30 years were assigned to Mediterranean diet (N.=80) or a low-fat diet (N.=80). The primary outcome measures were changes in semen parameters after six months.
RESULTS
Mean age of participants in the study was 24.7 years. There was no difference in baseline semen parameters of men randomized to Mediterranean diet or low-fat diet. After the entire follow-up, participants in both groups showed a significant increase in sperm concentration and sperm total count, with significant differences favoring the Mediterranean diet group (sperm concentration, 1.93 M/mL 95% CI [1.22 to 3.64], P=0.027; total sperm count 8.02 M 95% CI [1.51 to 15.45], P=0.035). No differences in other semen parameters were found between groups.
CONCLUSIONS
In healthy young adults, the consumption of Mediterranean diet was associated with an improvement of both sperm concentration and total count, as compared with a low-fat diet.
M. Longo, , L. Scappaticcio, F. Castaldo, A. Sarnataro, C. Carbone, P. Caruso, M. I. Maiorino, G. Bellastella, and K. Esposito
Springer Science and Business Media LLC
Female sexual dysfunctions (FSD) are complex conditions that affect women of all ages and are characterized by disturbances of the female sexual cycle responsible for sexualindividual distress [1]. Higher prevalence rates of FSD have been found in women with both type 1 and type 2 diabetes, as compared with matched healthy controls [2]. In women with type 1 diabetes, FSD have been related mainly to psychosocial issues and the occurrence of menopause [3, 4]. Type 1 diabetes is characterized by absolute insulin deficiency, marked hyperglycemia and high glucose variability (GV), representing an optimal model to study the mechanisms linking the alterations of glucose homeostasis and diabetic complications. Both cross-sectional and longitudinal observational studies did not confirm the relationship between HbA1c levels and FSD in type 1 diabetic women. Whether GV is associated with sexual dysfunctions in type 1 diabetic women is not known. Therefore, we designed a study with the aim of investigating sexual function in women with type 1 diabetes with high and low GV. Materials and methods
Celestino Sardu, Raffaele Marfella, Paolo Maggi, Vincenzo Messina, Paolo Cirillo, Vinicio Codella, Jessica Gambardella, Antonio Sardu, Gianluca Gatta, Gaetano Santulli,et al.
Springer Science and Business Media LLC
Abstract Background Hypertension is the most frequent co-morbidity in patients with covid-19 infection, and we might speculate that a specific blood group could play a key role in the clinical outcome of hypertensive patients with covid-19. Methods In this prospective study, we compared 0 vs. non-0 blood group in hypertensive patients with covid-19 infection. In these patients, we evaluated inflammatory and thrombotic status, cardiac injury, and death events. Results Patients in non-0 (n = 92) vs. 0 blood group (n = 72) had significantly different values of activated pro-thrombin time, D-dimer, and thrombotic indexes as Von Willebrand factor and Factor VIII (p < 0.05). Furthermore, patients in non-0 vs. 0 blood group had higher rate of cardiac injury (10 (13.9%) vs. 27 (29.3%)) and death, (6 (8.3%) vs. 18 (19.6%)), (p < 0.05). At the multivariate analysis, Interleukin-6 (1.118, CI 95% 1.067–1.171) and non-0 blood group (2.574, CI 95% 1.207–5.490) were independent predictors of cardiac injury in hypertensive patients with covid-19. D-dimer (1.082, CI 95% 1.027–1.140), Interleukin-6 (1.216, CI 95% 1.082–1.367) and non-0 blood group (3.706, CI 95% 1.223–11.235) were independent predictors of deaths events in hypertensive patients with covid-19. Conclusions Taken together, our data indicate that non-0 covid-19 hypertensive patients have significantly higher values of pro-thrombotic indexes, as well as higher rate of cardiac injury and deaths compared to 0 patients. Moreover, AB0 blood type influences worse prognosis in hypertensive patients with covid-19 infection.
Giuseppe Bellastella, Maria Ida Maiorino, Paolo Cirillo, Miriam Longo, Vlenia Pernice, Angela Costantino, Carmen Annunziata, Antonio Bellastella, Katherine Esposito, and Annamaria De Bellis
The Endocrine Society
Abstract Context An improvement of some autoimmune diseases associated with celiac disease (CD) has been observed after a gluten-free diet (GFD). Objective The aim of this longitudinal study was to evaluate the effect of a GFD on autoimmune pituitary impairment in patients with CD and potential/subclinical lymphocytic hypophysitis (LYH). Design Five-year longitudinal observational study. Setting Tertiary referral center for immunoendocrinology at the University of Campania “Luigi Vanvitelli”. Patients Ninety-three newly diagnosed LYH patients (high titer of antipituitary antibodies [APA] and normal or subclinically impaired pituitary function) were enrolled from 2000 to 2013 and grouped as follows: group 1, consisting of 43 patients with LYH + CD, and group 2, consisting of 50 patients with isolated LYH only. Intervention A GFD was started in patients in group 1 after the diagnosis of CD. Main outcome measures APA titers and pituitary function were evaluated at the beginning of the study and then yearly for 5 years in both groups. Patients progressing to a clinically overt LYH were excluded from the follow-up. Results Complete remission of LYH (disappearance of APA and recovery of pituitary function in patients with previous subclinical hypopituitarism) occurred in 15 patients in group 1 after a GFD (34%) and spontaneously in only 1 patient in group 2 (2%) (P &lt; .001). Two patients in group 1 and 25 in group 2 progressed to a clinically overt hypopituitarism and dropped out from the study to receive an appropriate replacement therapy. The presence of CD was the only independent predictor of pituitary function recovery (hazard ratio [HR] 0.059, 95% confidence interval [CI] 0.01–0.54, P = .012). Conclusion In patients with LYH and CD, a GFD may be able to induce remission of subclinical LYH, or prevent the progression to clinical stage of this disease.
Giuseppe Bellastella, Maria Ida Maiorino, Miriam Longo, Paolo Cirillo, Lorenzo Scappaticcio, Maria Teresa Vietri, Antonio Bellastella, Katherine Esposito, and Annamaria De Bellis
MDPI AG
Growth hormone (GH), mostly through its peripheral mediator, the insulin-like growth factor 1(IGF1), in addition to carrying out its fundamental action to promote linear bone growth, plays an important role throughout life in the regulation of intermediate metabolism, trophism and function of various organs, especially the cardiovascular, muscular and skeletal systems. Therefore, if a prepubertal GH secretory deficiency (GHD) is responsible for short stature, then a deficiency in adulthood identifies a nosographic picture classified as adult GHD syndrome, which is characterized by heart, muscle, bone, metabolic and psychic abnormalities. A GHD may occur in patients with pituitary autoimmunity; moreover, GHD may also be one of the features of some genetic syndromes in association with other neurological, somatic and immune alterations. This review will discuss the impact of pituitary autoimmunity on GHD and the occurrence of GHD in the context of some genetic disorders. Moreover, we will discuss some genetic alterations that cause GH and IGF-1 insensitivity and the arguments in favor and against the influence of GH/IGF-1 on longevity and cancer in the light of the papers on these issues that so far appear in the literature.
Miriam Longo, Lorenzo Scappaticcio, Giuseppe Bellastella, Vlenia Pernice, Paolo Cirillo, Antonietta Maio, Filomena Castaldo, Dario Giugliano, Katherine Esposito, and Maria Ida Maiorino
Informa UK Limited
Purpose Type 1 diabetes is associated with high risk of cardiovascular disease (CVD). Reduced levels of circulating progenitor cells (CPCs) and endothelial progenitor cells (EPCs) have been indicated as a risk factor for adverse cardiovascular outcomes and death in people at high cardiovascular risk. The aim of the present study was to evaluate the change in CPCs and EPCs levels in a population of young type 1 diabetic patients treated with intensive insulin regimen over a period of 2 years. Patients and Methods A total of 204 type 1 diabetic patients, of whom 84 treated with insulin pump (CSII) and 120 with multiple daily insulin injections (MDI), completed a 2-year follow-up. Clinical measurements, including the indices of glycemic control and glucose variability, were collected at baseline and after 2 years. Both CPC and EPC cell count were assessed by flow cytometry. Results Mean age of participants was 24.5 years and mean diabetes duration was 13.6 years. After 2 years, we found a significant reduction of HbA1c (−0.3% versus baseline, P <0.001), associated with decrease in mean amplitude of glucose excursion (MAGE) (−0.5 mmol/L versus baseline, P<0.001), continuous overall net glycemic action (CONGA) (−0.2 mmol/L versus baseline, P=0.006), and blood glucose standard deviation (BGSD) (−0.2 mmol/L versus baseline, P<0.001). The number of all EPCs phenotypes, but not CPC cell count, significantly raised up in the entire population, with higher increase in CSII group. MAGE resulted as an independent predictor for increased levels of both CD34+ (P = 0.020) and CD34+KDR+ (P = 0.004) cell count in the whole population. Conclusion Over a 2-year follow-up, young type 1 diabetic patients showed an increase in circulating EPCs levels, which was higher in patients with CSII. Glucose variability resulted as an independent predictor of the raised levels of EPCs in this selected population.
Annamaria De Bellis, Giuseppe Bellastella, Maria Ida Maiorino, Angela Costantino, Paolo Cirillo, Miriam Longo, Vlenia Pernice, Antonio Bellastella, and Katherine Esposito
Springer Science and Business Media LLC
PurposeTraumatic brain injury (TBI) is one of the most common causes of mortality and long-term disability and it is associated with an increased prevalence of neuroendocrine dysfunctions. Post-traumatic hypopituitarism (PTHP) results in major physical, psychological and social consequences leading to impaired quality of life. PTHP can occur at any time after traumatic event, evolving through various ways and degrees of deficit, requiring appropriate screening for early detection and treatment. Although the PTHP pathophysiology remains to be elucitated, on the basis of proposed hypotheses it seems to be the result of combined pathological processes, with a possible role played by hypothalamic–pituitary autoimmunity (HPA). This review is aimed at focusing on this possible role in the development of PTHP and its potential clinical consequences, on the basis of the data so far appeared in the literature and of some results of personal studies on this issue.MethodsScrutinizing the data so far appeared in literature on this topic, we have found only few studies evaluating the autoimmune pattern in affected patients, searching in particular for antipituitary and antihypothalamus autoantibodies (APA and AHA, respectively) by simple indirect immunofluorescence.ResultsThe presence of APA and/or AHA at high titers was associated with an increased risk of onset/persistence of PTHP.ConclusionsHPA seems to contribute to TBI-induced pituitary damage and related PTHP. However, further prospective studies in a larger cohort of patients are needed to define etiopathogenic and diagnostic role of APA/AHA in development of post-traumatic hypothalamic/pituitary dysfunctions after a TBI.
Graziano Grugni, , Antonino Crinò, Annamaria De Bellis, Alessio Convertino, Sarah Bocchini, Sabrina Maestrini, Paolo Cirillo, Silvana De Lucia, and Maurizio Delvecchio
Springer Science and Business Media LLC
The role of antipituitary antibodies in the pathophysiology of pituitary hormone deficiency has been increasingly elucidated over the last decade. Prader-Willi syndrome is a genetic disorder which includes hypothalamic/pituitary dysfunction as one of its main features. We looked for autoimmune pituitary involvement in 55 adults with Prader-Willi syndrome, discovering that about 30% of them have a positive titer of antipituitary antibodies. Although the presence of these autoantibodies could only be an “epiphenomenon”, our results suggest that autoimmune mechanisms might contribute, at least in part, to the pituitary impairment of Prader-Willi syndrome, and in addition to genetically determined dysfunction of the central nervous system. This paper provides a new perspective on pituitary impairment in these patients, suggesting that the search for hypophisitis could be a reasonable and interesting field for further research.
Maria Ida Maiorino, Giuseppe Bellastella, Ofelia Casciano, Paolo Cirillo, Vittorio Simeon, Paolo Chiodini, Michela Petrizzo, Maurizio Gicchino, Ornella Romano, Paola Caruso,et al.
Mary Ann Liebert Inc
Abstract Background: Type 1 diabetic patients have high instability of daily glucose levels. The aim of this study was to evaluate the long-term effects of continuous subcutaneous insulin infusion (CSII) therapy, compared with multiple daily injections of insulin (MDI), on glucose variability, in young type 1 diabetic patients transitioned to the adult diabetes care. Methods: Patients aged 18–30 years and considered eligible for insulin pump therapy were included in the study. Ninety-eight patients who started CSII therapy and 125 who remained in MDI completed a 2-year follow-up. Glucose variability was assessed with continuous glucose monitoring using blood glucose standard deviation (BGSD), mean amplitude of glycemic excursion (MAGE), continuous overall net glycemic action (CONGA-2 h), low blood glucose index, high blood glucose index, and average daily risk range. Results: MAGE and BGSD decreased in both groups, with adjusted differences at 2 years of −0.74 mM (95% confidence interval [CI] −1.22 to −0....