Publications by authors named "Sorana Marcovitz"

4 Publications

  • Page 1 of 1

Examination of the Dose-Effect Relationship of Radiation-Induced Hypopituitarism: Results of a Case-Control Study.

Adv Radiat Oncol 2021 Jul-Aug;6(4):100693. Epub 2021 Apr 15.

Department of Radiation Oncology.

Purpose: Previous reports have documented a dose-effect relationship for radiation-induced hypopituitarism in patients receiving therapy near or at the base of the skull. We aimed to characterize this long-term endocrinopathy further by examining the effect of dose on both the incidence and severity of toxicity, as well as exploring a possible dose threshold for this effect.

Methods And Materials: Out of an initial 346 patients who had received radiation therapy to the base of the skull, 53 patients with adequate endocrine evaluation were found. Of these, 19 patients who subsequently developed at least 1 endocrinopathy (cases) as well as 17 patients who did not (controls) were identified, for a total of 36. Patients' charts were reviewed, and endocrinologic laboratory tests recorded. Treatment plans were reviewed and doses to the hypothalamus and pituitary gland were calculated. One-way analysis of variance was used to determine differences between cases and controls, and Pearson's correlation coefficient was used to relate mean pituitary dose to serum free thyroxine, insulin-like growth factor 1, prolactin, cortisol, and luteinizing hormone.

Results: There were 20 men and 16 women, with a median age of 58. Median follow-up was 32 months (range, 18- 85 months). Median total plan dose delivered was 54 Gy (range, 50.4-70 Gy). Independent sample tests as well as univariate analysis showed a significantly greater dose to the hypothalamus and pituitary of the cases compared with the controls, while other factors were not significantly different between the 2 groups. There was a statistically significant negative correlation (Pearson's correlation coefficient = -0.65,  = .001) between the mean dose to the pituitary gland and the serum free thyroxine. No case of endocrine toxicity was observed at a mean dose to the pituitary below 30 Gy.

Conclusions: Our results suggest that late endocrinopathy is a true deterministic effect, with a dose threshold, and with both the incidence and severity of toxicity being related to the dose.
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http://dx.doi.org/10.1016/j.adro.2021.100693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184512PMC
April 2021

Bronchopulmonary carcinoid tumor associated with Cushing syndrome.

Ann Thorac Surg 2008 Nov;86(5):1688-90

Division of Thoracic Surgery, McGill University Health Center, Montreal, Quebec, Canada.

Cushing syndrome due to adrenocorticotropic hormone secretion by a bronchial carcinoid tumor is rare. The present study reports a case of a bronchopulmonary carcinoid presenting with Cushing syndrome in a 24-year old man who was successfully treated with a right middle lobectomy. The pertinent literature is reviewed, and the pathology and clinical presentation are discussed.
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http://dx.doi.org/10.1016/j.athoracsur.2008.04.029DOI Listing
November 2008

Canadian consensus guidelines for the diagnosis and management of acromegaly.

Clin Invest Med 2006 Feb;29(1):29-39

University of Toronto, Toronto, Ontario.

Acromegaly is a chronic condition associated with considerably increased morbidity and mortality if left unchecked. In December 2004, a national meeting was held to discuss the diversity in clinical practice across the country in diagnosing and treating patients with acromegaly, as well as to seek consensus on a number of management principles. The group reviewed recent guidelines and discussed issues of diagnosis, treatment, monitoring and treating comorbidities to seek a Canadian consensus on the management of this rare disorder. Consensus was that diagnosis should include clinical and biochemical findings, but is hinged on establishing GH hypersecretion with IGF-I and OGTT testing. Treatment has traditionally included surgical resection or debulking, along with adjunctive medical therapy (primarily somatostatin analogues), if necessary, to normalize GH levels. The option of primary medical therapy in managing this condition has recently emerged and can be justified for non-surgical candidates or for those in whom surgery is not expected to be curative. Overall, improved screening practices and superior epidemiological data are required, since timely diagnosis and appropriate treatment are crucial for reducing the potentially debilitating effects of this chronic, progressive disease. The current evidence also supports the need for long-term follow-up of disease activity and comorbidities in diagnosed patients. A national meeting was held to discuss the diversity in clinical practice across the country in diagnosing and treating patients with acromegaly, as well as to seek consensus on a number of management principles. After brief reviews of the most recent Canadian guidelines and the 2004 guidelines published by the American Association of Clinical Endocrinologists, the group was asked to specifically examine the issues of diagnosis, treatment, monitoring and treating comorbidities and seek a Canadian consensus on practice. This paper summarizes the working group's findings and the points of consensus that were achieved.
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February 2006

A case of seasonal bipolar disorder exacerbated by Cushing's disease.

Compr Psychiatry 2005 Mar-Apr;46(2):155-8

Department of Psychiatry, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

While depression is common in Cushing's syndrome from whatever cause (pituitary, adrenal, or ectopic adrenocorticotropic hormone-secreting tumor or hyperplasia, or exogenous administration of glucocorticoids) and hypercortisolemia is prevalent in major depression, any association between seasonal affective disorder and Cushing's syndrome is unknown. We present a case of seasonal bipolar disorder, gradually worsening for more than 9 years (1985-1994), accompanied by increasing osteoporosis, mild weight gain, and slight truncal obesity in a middle-aged woman. In January 1991, her seasonal affective disorder was successfully treated with light therapy, but in the following year, bipolar mood swings with a seasonal pattern emerged, which were refractory to light therapy and antidepressants but responsive to lithium. In August 1992, she became depressed despite a 1500-mg lithium daily dosage along with light therapy, and, in 1993, a diagnosis of Cushing's disease (Cushing's syndrome as a result of a pituitary adrenocorticotropic hormone-secreting tumor) was made. The pituitary tumor was removed in February 1994, and pituitary function was fully restored by 1996. While the symptoms of Cushing's syndrome subsided, her bipolar illness continued to require maintenance treatment with low doses of lithium but did not require light therapy.
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http://dx.doi.org/10.1016/j.comppsych.2004.07.029DOI Listing
September 2005
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