INTRODUCTION:Hypercortisolism requires a prompt therapeutic management to reduce the risk of development of a potential fatal emergency. A synchronous bilateral adrenalectomy (SBA) is effective in recovering hypercortisolism. However, specific indications for an SBA are not available. We aimed to evaluate the outcome of patients who underwent an SBA and to identify biomarkers able to predict the requirements of an SBA.PATIENTS AND METHODS:A mono-centric and longitudinal study was conducted on 19 consecutive patients who underwent SBA for ACTH-dependent hypercortisolism between December 2003 and December 2017. This study population was compared to two control groups composed of patients cured after the resection of the ACTH secreting pituitary adenoma (Group A: 44 patients) and of the ACTH-secreting neuroendocrine tumours (Group B: 8 patients).RESULTS:Short- or long-term SBA complications or the recurrence of hypercortisolism did not occur. A single patient experienced Nelson syndrome. Clinical features after SBA showed improvement in the glico-metabolic assessment, hypertension, bone metabolism and the occurrence of hypokalaemia and infections. The younger the age at the time of Cushing's disease diagnosis, the longer the duration of active hypercortisolism, higher values of plasmatic ACTH and Cortisol (1 month after pituitary neurosurgery) and higher values of Ki67 in pituitary adenomas were detected in this study population as compared to Group A.CONCLUSIONS:SBA is an effective and safe treatment for patients with unmanageable ACTH-dependent hypercortisolism. A multidisciplinary team in a referral centre with a high volume of patients is strongly recommended for the management of these patients and the identification of patients, for better surgical timing.

Skeletal fragility with high risk of vertebral fractures is an emerging complication of acromegaly in close relationship with duration of active disease. The aim of this cross-sectional study was to evaluate the prevalence and determinants of vertebral fractures in males and females with a history of long-standing active acromegaly undergoing treatment with Pegvisomant.

Introduction: Acromegaly, caused in most cases by Growth Hormone (GH)-secreting pituitary adenomas, is characterized by increased skeletal growth and enlargement of the soft tissue, because GH and its effector Insulin-like Growth factor-1 are important regulators of bone homeostasis and have a central role in the longitudinal bone growth and maintenance of bone mass.Areas covered: Despite the anabolic effect of these hormones is well known, as a result of the stimulation of bone turnover and especially of bone formation, many acromegalic patients are suffering from a form of secondary osteoporosis with increased risk of fractures.Expert commentary: In this review, we summarize the pathophysiology, diagnosis, clinical picture, disease course and management of skeletal complications of acromegaly, focusing in particular on secondary osteoporosis and fracture risk in acromegaly.

PurposeAt present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn's disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard.Material & MethodsWe recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts' score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids).ResultsB-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT > 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (> 2.5 mm) was the only B-US characteristic significantly (P < 0.0001) and independently (OR = 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR.ConclusionB-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy. PurposeAt present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn's disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard. At present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn's disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard. Material & MethodsWe recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts' score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids). We recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts' score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids). ResultsB-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT > 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (> 2.5 mm) was the only B-US characteristic significantly (P < 0.0001) and independently (OR = 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR. B-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT > 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (> 2.5 mm) was the only B-US characteristic significantly (P < 0.0001) and independently (OR = 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR. ConclusionB-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy. B-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy.

Several studies reporting preliminary long-term survival data after laparoscopic resections for colonic adenocarcinoma did not show any detrimental effect in comparison with historic studies of laparotomies. A previous randomized study has reported an unforeseen better long-term survival for node-positive patients treated by laparoscopic colectomy.

OBJECTIVE:To evaluate the short and long-term results of surgical treatment of calcifying chronic pancreatitis in our center.PATIENTS AND METHODS:We studied 55 consecutive patients operated on for chronic calcifying pancreatitis during a period of 12 years. The mean follow-up period was 6.2 years. Main outcome measures were operative mortality and morbidity, degree of pain control, diabetes onset, survival, and causes of death.RESULTS:The etiology was alcoholic in 48 patients and idiopathic in seven patients. A resection was performed in 78% of cases and a by-pass procedure was performed in 22%. Operative mortality was 3.6%; morbidity was 21.8%. A ductal adenocarcinoma was found in 3.6% of cases. The alcohol withdrawal rate was 78%. Complete pain control was achieved in 71.4% of the patients. Among diabetes, cirrhosis, type of surgery, smoking and alcohol abuse history, only alcohol withdrawal was associated with pain control (p < 0.03). A late reintervention was needed in only one patient in the by-pass group. Five and 10-year survival rates for the entire population were 80% and 61%, respectively. Among alcohol, cirrhosis, diabetes, and type of surgery, only the former was associated with survival (p < 0.003). Five-year actuarial survival was 55.6% for patients who continued drinking compared with 86.3% for ex-alcoholics.CONCLUSIONS:Surgical resection should be performed when required by the anatomical conditions because it was associated with good long-term pain control and low postoperative and late morbidity. Alcohol withdrawal has a key role for effective control of pain and prolonged survival.