Flavia Prodam

Publications (85) View all

• Article: Unusual metastases from tall cell variant (TCV) of papillary thyroid cancer (PTC).

  Loredana Pagano, Marina Caputo, Maria Teresa Samà, Marco Zavattaro, Flavia Prodam, Maria Grazia Mauri, Francesco Pia, Amedeo Alonzo, Guido Valente, Gianluca Aimaretti
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  ABSTRACT: Background: TCV is considered more aggressive than classical variant of PTC. Distant metastases are more common among this variant and affect survival. Little is known about the molecular pattern of this histotype. Methods: We reported 2 cases of unusual metastases from TCV, BRAF V600E positive. Results: A 38-years-old-woman developed subcutaneous metastases during short term follow-up; at medium term follow-up, patient showed detectable stimulated serum Thyroglobulin without disease evidence at imaging. A 33 years-old-man, presented incidental thymic metastases at time of surgical treatment; this is the first case of not-ectopic thymic metastases from PTC. Conclusions: TCV may present with unusual metastases already during early follow-up. The more aggressive behavior could be linked to the higher prevalence of BRAF point mutations, but only a long-term follow-up might clarify if this association could worsen the prognosis. Moreover, skin metastases have been predictive factors of worse outcome in our patient, while not thymic metastates. Head Neck, 2013.
  Head & Neck 04/2013; · 2.40 Impact Factor
• Article: High end of normal ACTH and cortisol levels are associated with specific cardiovascular risk factors in pediatric obesity: a cross-sectional study.

  Flavia Prodam, Roberta Ricotti, Valentina Agarla, Silvia Parlamento, Giulia Genoni, Caterina Balossini, Gillian E Walker, Gianluca Aimaretti, Gianni Bona, Simonetta Bellone
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  ABSTRACT: BACKGROUND: The hypothalamic-pituitary-adrenal (HPA) axis, and in particular cortisol, has been reported to be involved in obesity-associated metabolic disturbances in adults and in selected populations of adolescents. The aim of this study was to investigate the association between morning adrenocorticotropic hormone (ACTH) and cortisol levels and cardiovascular risk factors in overweight or obese Caucasian children and adolescents. METHODS: This cross-sectional study of 450 obese children and adolescents (aged 4 to 18 years) was performed in a tertiary referral center. ACTH, cortisol, cardiovascular risk factors (fasting and post-challenge glucose, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, triglycerides, and hypertension) and insulin resistance were evaluated. All analyses were corrected for confounding factors (sex, age, puberty, body mass index), and odds ratios were determined. RESULTS: ACTH and cortisol levels were positively associated with systolic and diastolic blood pressure, triglycerides, fasting glucose and insulin resistance. Cortisol, but not ACTH, was also positively associated with LDL-cholesterol. When adjusted for confounding factors, an association between ACTH and 2 h post-oral glucose tolerance test glucose was revealed. After stratification according to cardiovascular risk factors and adjustment for possible confounding factors, ACTH levels were significantly higher in subjects with triglycerides [greater than or equal to]90th percentile (P <0.02) and impaired fasting glucose or glucose tolerance (P <0.001). Higher cortisol levels were found in subjects with blood pressure [greater than or equal to]95th percentile and LDL-cholesterol [greater than or equal to]90th percentile. Overall, the highest tertiles of ACTH (>5.92 pmol/l) and cortisol (>383.5 nmol/l) although within the normal range were associated with increases in cardiovascular risk factors in this population. CONCLUSIONS: In obese children and adolescents, high morning ACTH and cortisol levels are associated with cardiovascular risk factors. High ACTH levels are associated with high triglyceride levels and hyperglycemia, while high cortisol is associated with hypertension and high LDL-cholesterol. These specific relationships suggest complex mechanisms through which the HPA axis may contribute to metabolic impairments in obesity, and merit further investigations.
  BMC Medicine 02/2013; 11(1):44. · 6.03 Impact Factor
• Article: Could zinc supplementation improve bone status in growth hormone (GH) deficient children?

  Flavia Prodam, Gianluca Aimaretti
  Endocrine 01/2013; · 1.42 Impact Factor
• Article: Acylated and unacylated ghrelin impair skeletal muscle atrophy in mice.

  Paolo E Porporato, Nicoletta Filigheddu, Simone Reano, Michele Ferrara, Elia Angelino, Viola F Gnocchi, Flavia Prodam, Giulia Ronchi, Sharmila Fagoonee, Michele Fornaro, Federica Chianale, Gianluca Baldanzi, Nicola Surico, Fabiola Sinigaglia, Isabelle Perroteau, Roy G Smith, Yuxiang Sun, Stefano Geuna, Andrea Graziani
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  ABSTRACT: Cachexia is a wasting syndrome associated with cancer, AIDS, multiple sclerosis, and several other disease states. It is characterized by weight loss, fatigue, loss of appetite, and skeletal muscle atrophy and is associated with poor patient prognosis, making it an important treatment target. Ghrelin is a peptide hormone that stimulates growth hormone (GH) release and positive energy balance through binding to the receptor GHSR-1a. Only acylated ghrelin (AG), but not the unacylated form (UnAG), can bind GHSR-1a; however, UnAG and AG share several GHSR-1a-independent biological activities. Here we investigated whether UnAG and AG could protect against skeletal muscle atrophy in a GHSR-1a-independent manner. We found that both AG and UnAG inhibited dexamethasone-induced skeletal muscle atrophy and atrogene expression through PI3Kβ-, mTORC2-, and p38-mediated pathways in myotubes. Upregulation of circulating UnAG in mice impaired skeletal muscle atrophy induced by either fasting or denervation without stimulating muscle hypertrophy and GHSR-1a-mediated activation of the GH/IGF-1 axis. In Ghsr-deficient mice, both AG and UnAG induced phosphorylation of Akt in skeletal muscle and impaired fasting-induced atrophy. These results demonstrate that AG and UnAG act on a common, unidentified receptor to block skeletal muscle atrophy in a GH-independent manner.
  The Journal of clinical investigation 01/2013; · 15.39 Impact Factor
• Article: Hypocortisolism in Noncomatose Patients during the Acute Phase of Subarachnoid Hemorrhage.

  Luigi A Lanterna, Veronica Spreafico, Paolo Gritti, Flavia Prodam, Antonio Signorelli, Francesco Biroli, Gianluca Aimaretti
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  ABSTRACT: BACKGROUND: Hypopituitarism represents a common long-term complication of subarachnoid hemorrhage (SAH). The incidence of hypocortisolism may be higher during the acute phase of SAH. Although hypocortisolism may be harmful in critically ill SAH patients, data are still lacking. The primary objective of this study was to investigate the incidence of hypocortisolism during the acute phase of SAH (15 days). Secondary objectives included an analysis of the relationship between hypocortisolism and outcome and the computation of the cortisol-time secretion curve. METHODS: Clinical data of a consecutive series of 26 noncomatose patients with aneurysmal SAH were collected prospectively. The sample size was calculated considering an expected proportion of hypocortisolism of 30%, a confidence level of 95%, and a total width of confidence interval of 0.35. The definition of hypocortisolism (as taken from a statement from the critical care medicine task forces) includes random total cortisol <10 μg/dL or a Δtotal serum cortisol <9 μg/dL after 1 μg of corticotrophin hormone. RESULTS: Hypocortisolism was diagnosed in 11 patients (42.3%). Cortisol increment after stimulation test was always >9 μg/dl, suggesting a hypothalamic-pituitary impairment. Hypocortisolism was independently associated with a higher risk of poor outcome (P = .046) even after adjusting for age and Hunt and Hess grade. The cortisol-time secretion curve showed a peak at day 5 and a minimum at day 8. The peak at day 5 correlated with the risk of delayed cerebral ischemia (P = .001), and the cortisol concentration slope between days 1 and 8 correlated with the risk of poor outcome (P = .033). CONCLUSIONS: Patients with SAH are at high risk of secondary hypocortisolism during the first 15 days after bleeding. Hypocortisolism independently increases the risk of poor outcome. The acute phase of hypothalamo-pituitary dysfunction, as reflected by an abnormal day-by-day cortisol secretion pattern, may affect the risk of delayed cerebral ischemia.
  Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 12/2012;