Yona Greenman

Tel Aviv Sourasky Medical Center | TASMC

Non-functioning pituitary adenomas (NFPAs) comprise silent tumors of different pituitary lineages that tend to escape early detection and present as invasive macroadenomas with symptoms of mass effect. Incomplete surgical resection is common and may be followed by significant rates of subsequent remnant progression. Pituitary tumors are defined as...

Unlabelled: The incidence hip fractures (HF) among Ethiopian immigrants is unknown. In Israel, the incidence of HF among Ethiopian immigrants aged ≥ 50 years between 2011 and 2020 was lower than in the general Israeli population, but possibly on the rise. These data should be confirmed in other countries where the Ethiopian diaspora has settled....

Background There is recent concern regarding the documented mismatch between demand and supply, vis-à-vis the growing need for trained endocrinologists unmet by parallel rise in the world workforce of endocrinologist. Due to the increasing complexity of disease in inpatients, in recent years we have experienced a growing demand for inpatient endocr...

The objective of this study was to determine the prognostic value of lymph node (LN) involvement and the LN ratio (LNR) and their effect on recurrence rates and survival in patients with pancreatic neuroendocrine tumors (PNETs) undergoing surgery. This single-center retrospective study reviewed the medical records of 95 consecutive patients diagnos...

Background : the application of fertility preservation, initially intended for oncological patients prior to gonadotoxic treatment, has extended in recent years to transgender and gender-nonconforming individuals undergoing therapy for gender compatibility. Objectives : to examine semen quality and survival in transgender women pursuing semen cryo...

Abstract Background Transgender men are a marginalized population with unique health care needs. However, their usage of health services is low because of considerable discrimination. A major factor in their avoidance is patient-provider interactions. Methods This cross-sectional study included 102 transgender men who anonymously completed a 55-ite...

Purpose The aim of our study was to assess dermatological changes in transgender people after the start of gender-affirming hormonal treatment (GAHT) and to investigate whether various hormonal preparations differently affect dermatological changes in trans AFAB (assigned female at birth) people. Methods In a multicenter prospective study, 484 par...

Background Aging and type 2 diabetes (T2DM) are associated with an increased risk of developing sarcopenia which is associated with poor outcomes and may necessitate specific treatment. Diagnosis of sarcopenia often requires the referral of patients to dual-energy X-ray absorptiometry (DXA) in specialized settings. Another available method for asse...

Background Aging and type 2 diabetes (T2DM) are associated with an increased risk of sarcopenia. Diagnosis of sarcopenia is commonly done using dual-energy X-ray absorptiometry (DXA) in specialized settings. Another available method for assessing body composition is direct segmental multi-frequency bioelectrical impedance analysis (DSMF-BIA). Here,...

Introduction: Prediabetes is a risk factor for type 2 diabetes (T2DM). However, it may be reversed via lifestyle changes. Lumen® is a novel handheld device that measures exhaled CO2 producing results in agreement with those of indirect calorimetry when assessing metabolic fuel usage. The aim of this study was to examine the effects of following Lu...

Objective: This extended evaluation (EE) of the SONICS study assessed effects of levoketoconazole for an additional 6 months following open-label, 6-month maintenance treatment in endogenous Cushing's syndrome. Design/methods: SONICS included dose-titration (150-600 mg BID), 6-month maintenance, and 6-month EE phases. Exploratory efficacy assess...

Purpose Prolactin (PRL)-secreting tumors are the most common functional pituitary adenomas. They usually respond to dopamine agonist (DA) treatment, with PRL normalization and adenoma shrinkage. Our aim was to characterize patients with prolactinoma resistant to DA treatment. Methods This retrospective case series included patients diagnosed with...

Gonadotroph cell adenoma is the most common clinically nonfunctioning pituitary adenoma; and is pathologically defined by immunopositivity for SF-1, GATA2 and ER-α. Most tumors also stain for follicle stimulating hormone and luteinizing hormone β-subunits, but are usually hormonally silent and discovered incidentally or due to local mass effects. C...

Literature on the efficacy and safety of gender-affirming hormonal treatment (GAHT) in transgender people is limited. For this reason, in 2010 the European Network for the Investigation of Gender Incongruence (ENIGI) study was born. The aim of this review is to summarize evidence emerging from this prospective multicentric study and to identify fut...

Dear Editor, In their recently published paper “Toward a Lowest Effective Dose of Cyproterone Acetate in Trans Women: Results From the ENIGI Study” (1), Kuijpers et al conclude that a daily dose of 10 mg of cyproterone acetate (CPA) is equally effective in lowering testosterone concentrations in trans women as higher doses, while showing fewer side...

Research question What are the fertility preservation (FP) rates of transgender women and transgender men, and which factors affect their decision making? Design This prospective study included 97 transgender women and 91 transgender men referred to the Gender Clinic of our medical center's Endocrinology Institute and to the Gan Meir Community Hea...

Purpose Results are presented from 2 to 3 trials investigating oral octreotide capsules (OOC) as an alternative to injectable somatostatin receptor ligands (iSRLs) in the treatment of acromegaly. Methods CH-ACM-01 was an open-label trial (N = 155) and CHIASMA OPTIMAL was a double-blind placebo-controlled (DPC) trial (N = 56), both investigating OO...

Context: Aldosterone has been recently characterized as a "stress hormone". Stress per se elicits a sizable rise in aldosterone secretion, which could be replicated by the administration of a low dose (0.03-1ug, IV) of ACTH. Whether or not the aldosterone response to ACTH could be selectively impaired, i.e., in association with intact cortisol resp...

STUDY QUESTION Is the functional ovarian reserve in transgender men affected by testosterone therapy? SUMMARY ANSWER Serum anti-Müllerian Hormone (AMH) levels slightly decrease during testosterone treatment but remain within the normal range, suggesting preserved follicular ovarian reserve. WHAT IS KNOWN ALREADY Few small studies have investigate...

Non-functioning pituitary adenomas (NFPA) usually present with symptoms of mass effect. Thus, the first-line treatment generally consists of transsphenoidal surgery. Since these tumors are usually large and invasive, post-surgical tumor remnants are common. Active surveillance is the follow-up strategy adopted by most pituitary centers, although th...

Elevated low-density lipoprotein (LDL) cholesterol is one of the leading causes of cardiovascular disease. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduce LDL cholesterol levels with subsequent reductions in cardiovascular morbidity. Elevated aldosterone levels are also associated with a greater risk of cardiovascular morbid...

Background: Transgender women with intact gonads receive lifelong hormonal treatment to suppress physiologic androgen production, the optimal efficacious and safe cyproterone acetate (CPA) dose has not been established. Aim: To assess the effectiveness and safety of low-dose (10-20 mg/day) compared with high-dose (50-100 mg/day) CPA treatment....

Background: Hyponatremia is the most common electrolyte-abnormality in hospitalized-patients, it increases likelihood of hospital death up-to 50% when serum Na<120mEq/L. Syndrome of inappropriate ADH secretion (SIADH) is the most common cause of hyponatremia in hospital inpatients. Clinical Case: 29 years-old woman, hospitalized several times due t...

Background: Intravenous levothyroxine (IVT4) is FDA-approved for the treatment of myxedema coma (ME). ATA guidelines also acknowledge other rare situations, mostly such where oral/enteral access is compromised for prolonged periods, in which IVT4 may be appropriate. We noticed that at our hospital, IVT4 is administered more frequently than expected...

Background: Transgender individuals feel an incongruity between the assigned gender at birth and their gender identity. Because the prevalence of cardiovascular risk factors and morbidity associated with cross-sex hormonal therapy is not well established, particularly in the older transgender population, we set out to compare it to that of the gene...

Measuring resting metabolic rate (RMR) is time-consuming and expensive, and thus various equations for estimating RMR have been developed. This study’s objective was to compare five equations in elderly people with type 2 diabetes (T2DM). RMR was measured in 90 older adults (≥65 years) with T2DM (mean body mass index (BMI) of 31.5 kg/m2), using ind...

Background Cushing’s syndrome (CS) is associated with numerous comorbidities, including diabetes mellitus (DM). Levoketoconazole, an orally administered ketoconazole stereoisomer, is in clinical trials for the treatment of CS. Methods SONICS, a prospective, open-label, phase 3 study in adults with confirmed CS and mean 24-h urinary free cortisol (...

The WHO Classification of Endocrine Tumours designates pituitary neoplasms as adenomas. A proposed nomenclature change to neuroendocrine tumors (PitNETs) has been met with concern by some stakeholder groups. The Pituitary Society coordinated the Pituitary Neoplasm Nomenclature (PANOMEN) Workshop to address the topic. Experts in pituitary developmen...

Objective Guidelines recommend initiating testing for Cushing's syndrome (CS) on the basis of a “strong clinical suspicion”. Our experience suggests classical stigmata are absent in the majority of patients with CS diagnosed in recent years. We aimed to confirm this premise by revisiting the clinical features of this syndrome in a modern series of...

Objectives: As members of a gender minority, transgender individuals face many challenges. Many experience distress, depression, anxiety and suicidal ideation related to gender non-conformity and transphobia. Stress and trauma may contribute to the development of fibromyalgia (FM) syndrome, characterised by widespread pain and fatigue. The prevale...

NFPAs are clinically silent tumors that develop from different pituitary lineages. Their classification landscape has changed with the recognition that even in the absence of evidence of hormone production based on immunohistochemistry, they can be assigned to specific lineages based on staining for transcription factors. Early evidence suggests th...

Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) level with a normal serum-free thyroxine (FT4) level. SCH has been associated with an increased risk of adverse cardiovascular outcomes. We investigated possible associations of unknown SCH with in-hospital outcomes and short- and long-term all-cause...

Introduction Less attention has been given to the detection and nutritional status and needs of obese frail/sarcopenic older subjects. The aim of this study was to characterize the nutritional composition in older (≥65 years), frail-prone, obese subjects (defined by either waist circumference [WC] or body mass index [BMI]). Methods A cross-section...

Objective: Suppression of testosterone secretion and/or action in transgender women using cyproterone acetate (CPA), spironolactone, or gonadotropin-releasing hormone analogues (GA) is achieved through various mechanisms. Our objective was to characterize possible differential effects of these compounds on metabolic and endocrine variables. Methods...

Objective: Suppression of testosterone secretion and/or action in transgender women using cyproterone acetate (CPA), spironolactone, or gonadotropin-releasing hormone analogues (GA) is achieved through various mechanisms. Our objective was to characterize possible differential effects of these compounds on metabolic and endocrine variables. Method...

Introduction : Transgender women with intact gonads receive lifelong hormonal treatment in order to suppress physiologic androgen production. Cyproterone acetate (CA) is the most comon antiandrogenic drug prescribed for this indication in Europe, with a dose range between 25-100 mg/day. Aim: To assess the effectiveness and safety of low dose (<20 m...

Introduction Factors influencing development and course of ophthalmopathy, the most common extrathyroidal manifestation of Graves’ disease, remain poorly defined. Clinical Case A 46 year old healthy, non-smoking, medical secretary, presented with Graves’ disease. Laboratory investigation showed thyrotoxicosis with high thyroid stimulation immunoglo...

BACKGROUND: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with poor prognosis. The aim of this study was to characterize patients diagnosed with ACC at a single center between 2014-2019. METHODS: We retrospectively reviewed data regarding demographics, tumor characteristics and functionality, treatment and survival. RESULTS: The stu...

Background: Treatment of hemodynamic instability in patients with PPGL in the intra-and postoperative periods is challenging. Persistent postoperative hypotension is a common and serious complication, reportedly occurring in 30-60% of PPGL patients. This phenomenon reflects 1) high doses of pre-operative antihypertensive drugs; 2) low intravascular...

Research question What is the fertility preservation (FP) rate among transgender women who received professional fertility counseling compared to transgender men? Design This retrospective cohort study included 56 transgender women and 56 transgender men referred to comprehensive fertility counseling at the Gender Clinic of the medical center's Fe...

Purpose Treatment goals in prolactinomas are to correct hypogonadism, restore fertility and control tumor mass in case of macroadenomas. According to current guidelines, medical treatment of asymptomatic postmenopausal women is not indicated. The purpose of this study was to review the current literature pertaining to biological behavior of prolact...

Background: Levoketoconazole is a ketoconazole stereoisomer in development for treatment of Cushing's syndrome and has not been assessed previously in a clinical trial in patients with Cushing's syndrome. We aimed to investigate the efficacy and safety of levoketoconazole in patients with endogenous Cushing's syndrome. Methods: SONICS is a phase...

In the current era of effective antiretroviral therapies (ARTs), human immunodeficiency virus (HIV) infection became a chronic disorder that requires long term follow-up. Among other medical issues, these patients may develop endocrine problems, specific to HIV infection and its treatment. The purpose of this review is to give an overview of common...

Background: Cushing’s syndrome (CS) has numerous comorbidities, including diabetes mellitus (DM).¹ Levoketoconazole is a ketoconazole stereoisomer in clinical trials for the treatment of CS. Methods: SONICS is a prospective, open-label, phase 3 maintenance-of-benefit study in adults with confirmed CS and mean urinary free cortisol (mUFC) of ≥1.5x u...

Background: Although successful pregnancies carried by transgender men have been reported, long-term effects of testosterone therapy on fertility remain unknown. Aims: To study markers of ovarian reserve during testosterone therapy. Methods: Prospective open-label study of transgender men prior and during treatment with testosterone. Sampling was c...

Background and aim of study: Although gender dysphoria is no longer considered a mental illness, transgender people are at risk for psychopathologic morbidities. Endocrinologists play a central role in the gender-affirming process that transgender people chose to undergo, and may be ill-prepared to recognize and manage psychologic difficulties alre...

Thyrotropin (TSH)-secreting pituitary tumors are the rarest functioning pituitary tumors. Nonetheless, they are not infrequently plurihormonal, as they may express/secrete hormones made by other pituitary cells derived from the Pit-1 lineage such as growth hormone (GH), prolactin (PRL), and α-subunit (αSU). However, adrenocorticotropin (ACTH) or go...

Purpose Aminobisphosphonates may cause orbital/ocular inflammation. Awareness of the clinical presentation and disease course is crucial. The purpose of this study was to analyse demographics, clinical presentation, disease course and treatment of aminobisphosphonate‐associated orbital/ocular inflammation in a large series of patients. Methods A r...

Introduction: Pasireotide, a multi-somatostatin receptor (SSTR)-ligand with high affinity for SSTR5 was recently approved for acromegaly treatment. Patients and methods: A retrospective multicenter study investigating the efficacy and safety of long-acting (LAR) pasireotide treatment in 35 patients (20 males) with active acromegaly (28 macroaden...

Objective: Hyperprolactinemia is common in acromegaly and in these patients, insulin-like growth factor (IGF)-1 level may decrease with dopamine agonist. We report a series of patients with prolactinoma and a paradoxical increase of IGF-1 levels during cabergoline treatment. Methods: Clinical characteristics and response to treatment of patients...

Dopamine agonists (DA) are well established as first-line therapy for prolactinomas. These tumors express high levels of dopamine 2 receptors (D2R), leading to the strong efficacy of DA in reducing tumor size and hormonal secretion. Other pituitary tumor subtypes express D2R to varying degrees, leading to an extensive body of research into potentia...

Introduction: Non-functioning pituitary adenomas (NFPAs) are in general large tumors that present with symptoms secondary to local pressure on adjacent structures. Transsphenoidal surgery is the first line of treatment but residual tumor mass is often detected post-operatively. Medical therapy, in any stage of tumor management, is not well establi...

Thyrotrophin-secreting adenomas are the least prevalent among pituitary tumors. Patients present with signs and symptoms of thyrotoxicosis associated with high serum levels of thyroid hormones and elevated or inappropriately normal TSH levels. Most tumors are macroadenomas, therefore clinical manifestations related to compression of neighboring str...

Ghrelin plasma concentration increases in parallel to cortisol after a standardized psychological stress in humans, but the physiological basis of this interaction is unknown. We aimed to elucidate this question by studying the ghrelin response to pharmacological manipulation of the hypothalamo-pituitary-adrenal (HPA) axis. Six lean, healthy male v...

Introduction With the goal of generate uniform criteria among centers dealing with pituitary tumors and to enhance patient care, the Pituitary Society decided to generate criteria for developing Pituitary Tumors Centers of Excellence (PTCOE). Methods To develop that task, a group of ten experts served as a Task Force and through two years of iterat...

In contrast to the clear indication for surgical treatment in symptomatic patients with clinically nonfunctioning pituitary adenomas (NFPA), there are no randomized controlled studies comparing therapeutic strategies such as watchful waiting, irradiation, or medical therapy for the management of NFPA after surgery. Further, no medical therapy is cu...

PurposePasireotide is the only pituitary targeted medication registered for the treatment of Cushing’s disease. Drug efficacy data are largely based on a major prospective study in which the vast majority of patients had microadenomas. The purpose of this study was to summarize results of pasireotide treatment of ACTH secreting macroadenomas from o...

Purpose Because only the free fraction of serum cortisol can readily access glucocorticoid receptors, we investigated whether or not a gender-related difference in serum free cortisol (FC) exists in the basal and ACTH-stimulated state. Methods Serum total and FC were measured in 323 subjects (M/F 175/148). Additionally, the low-dose 1-μg ACTH te...

Objectives: Prolactin (PRL)-secreting macroadenomas usually measure between 10 and 40 mm. Giant (adenoma size ≥40 mm) PRL-tumors are not common, and larger prolactinomas (maximal diameter ≥60 mm) are rare, and their management outcomes have not been well characterized. Methods: We have identified 18 subjects (16 men, 2 females) with giant PRL-ad...

Purpose: Acromegaly is associated with increased cardiovascular morbidity and mortality when inadequately treated, which may be secondary to associated comorbidities or to direct IGF-1 effects on the cardiovascular system. By using a control group carefully matched for traditional cardiovascular risk factors, we aimed to assess the direct contribu...

Objective: Clinically nonfunctioning pituitary adenoma (NFPA), remain the only pituitary tumor subtype for which no effective medical therapy is available or recommended. We evaluated dopamine agonist (DA) therapy for preventing growth of post-surgical pituitary tumor remnants. Design: Historical cohort analysis of clinical results at two pituit...

Abstract Objective: To improve the preoperative assessment of pancreatic incidentalomas (PI) by analysis of one index case and characterization of the published features of intrapancreatic accessory spleen (IPAS) compared to pancreatic neuroendocrine tumor (PNET). Methods: A search of the literature using the online database MEDLINE Results: In all...

Transsphenoidal surgery is the treatment of choice for large non-functioning pituitary adenomas (NFPA) and symptomatic patients. The therapeutic strategies for the management of NFPA after surgery, i.e., watchful waiting, irradiation, or medical therapy have not been compared by randomized controlled trials. Slow re-growth is common, but the natura...

As optimal postoperative management of patients with clinically nonfunctioning pituitary adenomas (NFPA) is a matter of debate, the role of dopamine agonist (DA) therapy in this clinical setting was evaluated. Methods: Retrospective analysis of prospectively collected data was conducted at two pituitary referral centrer with different standard prac...