nach oben

Erschienen in:

17.09.2021 | Original Article

Vitamin D deficiency and tumor aggressiveness in gastroenteropancreatic neuroendocrine tumors

verfasst von: Barbara Altieri, Luigi Barrea, Roberta Modica, Filomena Bottiglieri, Federica de Cicco, Giovanna Muscogiuri, Luisa Circelli, Giovanni Savarese, Carolina Di Somma, Silvia Savastano, Annamaria Colao, Antongiulio Faggiano

Erschienen in: Endocrine | Ausgabe 2/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Data regarding vitamin D status in patients affected by gastroenteropancreatic (GEP) neuroendocrine tumor (NET) are limited and often showing contrasting results. The aim of the study was to evaluate the incidence of vitamin D deficiency (<20 ng/mL) in GEP-NET patients and compare the 25-hydroxyvitamin D (25(OH)D) levels with clinicopathological parameters and clinical outcome.

Methods

A retrospective cross-sectional study including 75 low grade (G1-G2) GEP-NETs and 123 healthy controls matched for age, sex, and body mass index, was performed.

Results

GEP-NET patients had significantly lower 25(OH)D levels compared to controls (17.9 ± 7.8 vs 24.2 ± 7.7 ng/mL, p < 0.0001). Ileal NETs were associated to lower 25(OH)D levels compared to other primary tumor sites (p = 0.049) and small bowel resection posed a significant increased risk of severe vitamin D deficiency (OR = 2.81, 95% CI = 1.25–3.37, p = 0.018). No correlation with somatostatin analogs treatment was found. 25(OH)D levels were significantly lower in G2 compared to G1 GEP-NETs (15.6 ± 7.8 vs 19.9 ± 7.4 ng/mL, p = 0.016) and in patients with progressive disease (12.6 ± 5.7 ng/mL) compared to those with stable disease (mean 21.5 ± 8.2 ng/mL, p = 0.001) or tumor free after surgery (19.6 ± 7.3 ng/mL, p = 0.002). Patients with vitamin D deficiency and insufficiency had shorter progression-free survival compared to those with sufficiency (p = 0.014), whereas no correlation was found with disease-specific survival.

Conclusions

Vitamin D deficiency is highly prevalent among GEP-NETs and could be associated with high tumor grade and disease progression. Therefore, the monitoring of 25(OH)D levels is relevant in these patients and vitamin D supplementation should be considered in the management of GEP-NET patients with vitamin D deficiency or insufficiency.

D.D. Bikle, Extraskeletal actions of vitamin D. Ann. N. Y Acad. Sci. 1376(1), 29–52 (2016). https://doi.org/10.1111/nyas.13219CrossRefPubMedPubMedCentral

R. Bouillon, C. Marcocci, G. Carmeliet, D. Bikle, J.H. White, B. Dawson-Hughes, P. Lips, C.F. Munns, M. Lazaretti-Castro, A. Giustina, J. Bilezikian, Skeletal and extraskeletal actions of vitamin D: current evidence and outstanding questions. Endocr. Rev. 40(4), 1109–1151 (2019). https://doi.org/10.1210/er.2018-00126CrossRefPubMed

G. Muscogiuri, L. Barrea, B. Altieri, C. Di Somma, H.P. Bhattoa, D. Laudisio, G.T. Duval, G. Pugliese, C. Annweiler, F. Orio, H. Fakhouri, S. Savastano, A. Colao, Calcium and vitamin D supplementation. myths and realities with regard to cardiovascular risk. Curr. Vasc. Pharmacol. 17(6), 610–617 (2019). https://doi.org/10.2174/1570161117666190408165805CrossRefPubMed

D. Feldman, A.V. Krishnan, S. Swami, E. Giovannucci, B.J. Feldman, The role of vitamin D in reducing cancer risk and progression. Nat. Rev. Cancer 14(5), 342–357 (2014). https://doi.org/10.1038/nrc3691CrossRefPubMed

G. Muscogiuri, B. Altieri, M. Penna-Martinez, K. Badenhoop, Focus on vitamin D and the adrenal gland. Horm. Metab. Res. 47(4), 239–246 (2015). https://doi.org/10.1055/s-0034-1396893CrossRefPubMed

N. Keum, D.H. Lee, D.C. Greenwood, J.E. Manson, E. Giovannucci, Vitamin D supplementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials. Ann. Oncol. 30(5), 733–743 (2019). https://doi.org/10.1093/annonc/mdz059CrossRefPubMedPubMedCentral

W.B. Grant, F. Al Anouti, M. Moukayed, Targeted 25-hydroxyvitamin D concentration measurements and vitamin D3 supplementation can have important patient and public health benefits. Eur. J. Clin. Nutr. 74(3), 366–376 (2020). https://doi.org/10.1038/s41430-020-0564-0CrossRefPubMed

S. Chiloiro, F. Lanza, A. Bianchi, G. Schinzari, M.G. Brizi, A. Giampietro, V. Rufini, F. Inzani, A. Giordano, G. Rindi, A. Pontecorvi, L. De Marinis, Pancreatic neuroendocrine tumors in MEN1 disease: a mono-centric longitudinal and prognostic study. Endocrine 60(2), 362–367 (2018). https://doi.org/10.1007/s12020-017-1327-0CrossRefPubMed

B. Altieri, C. Di Dato, C. Martini, C. Sciammarella, A. Di Sarno, A. Colao, A. Faggiano, N. Group: Bone metastases in neuroendocrine neoplasms: from pathogenesis to clinical management. Cancers 11(9) (2019). https://doi.org/10.3390/cancers11091332

10.

J. Hofland, G. Kaltsas, W.W. de Herder, Advances in the diagnosis and management of well-differentiated neuroendocrine neoplasms. Endocr. Rev. 41(2) (2020). https://doi.org/10.1210/endrev/bnz004

11.

G.P. Hess, C.C. Chen, Z. Liu, J.C. Yao, A.T. Phan, J.W. Hill, Clinical burden of illness in patients with neuroendocrine tumors. Pancreas 41(7), 1058–1062 (2012). https://doi.org/10.1097/MPA.0b013e318249d8f7CrossRefPubMed

12.

G. Muscogiuri, B. Altieri, M. Albertelli, A. Dotto, R. Modica, L. Barrea, G. Fanciulli, T. Feola, R. Baldelli, R.M. Ruggeri, M. Gallo, V. Guarnotta, P. Malandrino, E. Messina, M.A. Venneri, E. Giannetta, D. Ferone, A. Colao, A. Faggiano, N. Group, Epidemiology of pancreatic neuroendocrine neoplasms: a gender perspective. Endocrine (2020). https://doi.org/10.1007/s12020-020-02331-3

13.

B. Altieri, C. Di Dato, R. Modica, F. Bottiglieri, A. Di Sarno, J.F.H. Pittaway, C. Martini, A. Faggiano, A. Colao, Bone metabolism and vitamin D implication in gastroenteropancreatic neuroendocrine tumors. Nutrients 12(4) (2020). https://doi.org/10.3390/nu12041021

14.

H.B. Fiebrich, G. Van Den Berg, I.P. Kema, T.P. Links, J.H. Kleibeuker, A.P. Van Beek, A.M. Walenkamp, W.J. Sluiter, E.G. De Vries, Deficiencies in fat-soluble vitamins in long-term users of somatostatin analogue. Aliment Pharm. Ther. 32(11-12), 1398–1404 (2010). https://doi.org/10.1111/j.1365-2036.2010.04479.xCrossRef

15.

A. Lind, B. Wangberg, L: Ellegard, Vitamin D and vitamin B12 deficiencies are common in patients with midgut carcinoid (SI-NET). Eur. J. Clin. Nutr. 70(9), 990–994 (2016). https://doi.org/10.1038/ejcn.2016.40CrossRefPubMed

16.

S. Massironi, A. Zilli, S. Bernasconi, I. Fanetti, F. Cavalcoli, C. Ciafardini, I. Felicetta, D. Conte, Impact of vitamin D on the clinical outcome of gastro-entero-pancreatic neuroendocrine neoplasms: report on a series from a single institute. Neuroendocrinology 105(4), 403–411 (2017). https://doi.org/10.1159/000456619CrossRefPubMed

17.

H.L. Robbins, M. Symington, B. Mosterman, J. Goodby, L. Davies, G.K. Dimitriadis, G. Kaltsas, H.S. Randeva, M.O. Weickert, Supplementation of vitamin D deficiency in patients with neuroendocrine tumors using over-the-counter vitamin D3 PReparations. Nutr. Cancer 70(5), 748–754 (2018). https://doi.org/10.1080/01635581.2018.1470650CrossRefPubMed

18.

C. Chung, Management of neuroendocrine tumors. Am. J. Health Syst. Pharm. 73(21), 1729–1744 (2016). https://doi.org/10.2146/ajhp150373CrossRefPubMed

19.

B. Altieri, L. Barrea, R. Modica, G. Muscogiuri, S. Savastano, A. Colao, A. Faggiano, Nutrition and neuroendocrine tumors: An update of the literature. Rev. Endocr. Metab. Disord. 19(2), 159–167 (2018). https://doi.org/10.1007/s11154-018-9466-zCrossRefPubMed

20.

V.M. Sagar, S.C. Cooper, J. Johnson, S. Shetty, T. Shah, Gastrointestinal manifestations of neuroendocrine tumours: their investigation and management. Postgrad. Med J. 93(1102), 494–497 (2017). https://doi.org/10.1136/postgradmedj-2017-134847CrossRefPubMed

21.

E. Motylewska, J. Gawronska, A. Niedziela, G. Melen-Mucha, H. Lawnicka, J. Komorowski, J. Swietoslawski, H. Stepien, Somatostatin analogs and tumor localization do not influence vitamin D Concentration in patients with neuroendocrine tumors. Nutr. Cancer 68(3), 428–434 (2016). https://doi.org/10.1080/01635581.2016.1152387CrossRefPubMed

22.

M.D. Walker, J.P. Bilezikian, Vitamin D and primary hyperparathyroidism: more insights into a complex relationship. Endocrine 55(1), 3–5 (2017). https://doi.org/10.1007/s12020-016-1169-1CrossRefPubMed

23.

V. Carnevale, S. Modoni, M. Pileri, A. Di Giorgio, I. Chiodini, S. Minisola, R. Vieth, A. Scillitani, Longitudinal evaluation of vitamin D status in healthy subjects from southern Italy: seasonal and gender differences. Osteoporos. Int. 12(12), 1026–1030 (2001). https://doi.org/10.1007/s001980170012CrossRefPubMed

24.

L. Barrea, G. Muscogiuri, D. Laudisio, G. Pugliese, G. de Alteriis, A. Colao, S. Savastano, Influence of the Mediterranean diet on 25- hydroxyvitamin D levels in adults. Nutrients 12(5) (2020). https://doi.org/10.3390/nu12051439

25.

A. Faggiano, R. Modica, F. Lo Calzo, L. Camera, V. Napolitano, B. Altieri, F. de Cicco, F. Bottiglieri, F. Sesti, G. Badalamenti, A.M. Isidori, A. Colao, Lanreotide therapy vs active surveillance in MEN1-related pancreatic neuroendocrine tumors <2 centimeters. J. Clin. Endocrinol. Metab. 105(1) (2020). https://doi.org/10.1210/clinem/dgz007

26.

G. Rindi, R. Arnold, C. Capella, D.S. Klimstra, G. Klöppel, P. Komminoth, E. Solcia, in World Health Organization Classification of Tumours, Pathology and Genetics of Tumours of the Digestive System. ed. by F. Bosman (IARC, Lyon, 2010)

27.

L. Barrea, B. Altieri, G. Muscogiuri, D. Laudisio, G. Annunziata, A. Colao, A. Faggiano, S. Savastano, Impact of nutritional status on gastroenteropancreatic neuroendocrine tumors (GEP-NET) aggressiveness. Nutrients 10(12) (2018). https://doi.org/10.3390/nu10121854

28.

G. Muscogiuri, L. Barrea, C. Di Somma, B. Altieri, M. Vecchiarini, F. Orio, T. Spinosa, A. Colao, S. Savastano, Patient empowerment and the Mediterranean diet as a possible tool to tackle prediabetes associated with overweight or obesity: a pilot study. Hormones (Athens) 18(1), 75–84 (2019). https://doi.org/10.1007/s42000-018-0090-9CrossRef

29.

L. Barrea, G. Muscogiuri, R. Modica, B. Altieri, G. Pugliese, R. Minotta, A. Faggiano, A. Colao, S. Savastano, Cardio-metabolic indices and metabolic syndrome as predictors of clinical severity of gastroenteropancreatic neuroendocrine tumors. Front Endocrinol. 12, 649496 (2021). https://doi.org/10.3389/fendo.2021.649496CrossRef

30.

WHO, Body mass index - BMI. http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. Accessed 7 June 2020

31.

M.I. Khan, S.G. Waguespack, M.I. Hu, Medical management of postsurgical hypoparathyroidism. Endocr. Pract. 17(Suppl 1), 18–25 (2011). https://doi.org/10.4158/EP10302.RACrossRefPubMed

32.

M.C. Savanelli, E. Scarano, G. Muscogiuri, L. Barrea, L. Vuolo, M. Rubino, S. Savastano, A. Colao, C. Di Somma, Cardiovascular risk in adult hypopituitaric patients with growth hormone deficiency: is there a role for vitamin D? Endocrine 52(1), 111–119 (2016). https://doi.org/10.1007/s12020-015-0779-3CrossRefPubMed

33.

B. Altieri, E. Cavalier, H.P. Bhattoa, F.R. Perez-Lopez, M.T. Lopez-Baena, G.R. Perez-Roncero, P. Chedraui, C. Annweiler, S. Della Casa, S. Zelzer, M. Herrmann, A. Faggiano, A. Colao, M.F. Holick, Vitamin D testing: advantages and limits of the current assays. Eur. J. Clin. Nutr. 74(2), 231–247 (2020). https://doi.org/10.1038/s41430-019-0553-3CrossRefPubMed

34.

M.F. Holick, N.C. Binkley, H.A. Bischoff-Ferrari, C.M. Gordon, D.A. Hanley, R.P. Heaney, M.H. Murad, C.M. Weaver, S. Endocrine, Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96(7), 1911–1930 (2011). https://doi.org/10.1210/jc.2011-0385CrossRefPubMed

35.

M.F. Holick, The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention. Rev. Endocr. Metab. Disord. 18(2), 153–165 (2017). https://doi.org/10.1007/s11154-017-9424-1CrossRefPubMed

36.

G. Tirabassi, G. Salvio, B. Altieri, C.L. Ronchi, S. Della Casa, A. Pontecorvi, G. Balercia, Adrenal disorders: is there any role for vitamin D? Rev. Endocr. Metab. Disord. 18(3), 355–362 (2017). https://doi.org/10.1007/s11154-016-9391-yCrossRefPubMed

37.

G. Sarno, R. Nappi, B. Altieri, G. Tirabassi, E. Muscogiuri, G. Salvio, S.A. Paschou, A. Ferrara, E. Russo, D. Vicedomini, C. Vincenzo, A. Vryonidou, S. Della Casa, G. Balercia, F. Orio, P. De Rosa, Current evidence on vitamin D deficiency and kidney transplant: What’s new? Rev. Endocr. Metab. Disord. 18(3), 323–334 (2017). https://doi.org/10.1007/s11154-017-9418-zCrossRefPubMed

38.

K.C. Chiang, C.N. Yeh, J.H. Pang, J.T. Hsu, T.S. Yeh, L.W. Chen, S.F. Kuo, P.J. Hsieh, Y.C. Pan, M. Takano, T.C. Chen, T.H. Feng, A. Kittaka, H.H. Juang, 1alpha,25(OH)2D3 analog, MART-10, inhibits neuroendocrine tumor cell growth through induction of G0/G1 cell-cycle arrest and apoptosis. Anticancer Res. 36(7), 3307–3313 (2016)PubMed

39.

K.C. Chiang, C.N. Yeh, J.S. Pang, J.T. Hsu, T.S. Yeh, L.W. Chen, S.F. Kuo, M. Takano, T.C. Chen, A. Kittaka, P.J. Hsieh, H.H. Juang, 1alpha,25(OH)2D3 analog, MART-10, inhibits neuroendocrine tumor cell metastasis after VEGF-A stimulation. Anticancer Res. 37(11), 6215–6221 (2017). https://doi.org/10.21873/anticanres.12072CrossRefPubMed

40.

R. Ross, I.J. Neeland, S. Yamashita, I. Shai, J. Seidell, P. Magni, R.D. Santos, B. Arsenault, A. Cuevas, F.B. Hu, B.A. Griffin, A. Zambon, P. Barter, J.C. Fruchart, R.H. Eckel, Y. Matsuzawa, J.P. Despres, Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR Working Group on visceral obesity. Nat. Rev. Endocrinol. 16(3), 177–189 (2020). https://doi.org/10.1038/s41574-019-0310-7CrossRefPubMedPubMedCentral

41.

W. Shen, M. Punyanitya, J. Chen, D. Gallagher, J. Albu, X. Pi-Sunyer, C.E. Lewis, C. Grunfeld, S. Heshka, S.B. Heymsfield, Waist circumference correlates with metabolic syndrome indicators better than percentage fat. Obesity 14(4), 727–736 (2006). https://doi.org/10.1038/oby.2006.83CrossRefPubMed

42.

S. Maasberg, B. Knappe-Drzikova, D. Vonderbeck, H. Jann, K.H. Weylandt, C. Grieser, A. Pascher, J.C. Schefold, M. Pavel, B. Wiedenmann, A. Sturm, U.F. Pape, Malnutrition predicts clinical outcome in patients with neuroendocrine neoplasia. Neuroendocrinology 104(1), 11–25 (2017). https://doi.org/10.1159/000442983CrossRefPubMed

43.

N. Keum, D.H. Lee, R. Kim, D.C. Greenwood, E.L. Giovannucci, Visceral adiposity and colorectal adenomas: dose-response meta-analysis of observational studies. Ann. Oncol. 26(6), 1101–1109 (2015). https://doi.org/10.1093/annonc/mdu563CrossRefPubMed

44.

B. Altieri, G. Tirabassi, S. Della Casa, C.L. Ronchi, G. Balercia, F. Orio, A. Pontecorvi, A. Colao, G. Muscogiuri, Adrenocortical tumors and insulin resistance: what is the first step? Int. J. Cancer 138(12), 2785–2794 (2016). https://doi.org/10.1002/ijc.29950CrossRefPubMed

45.

G. Bellastella, L. Scappaticcio, K. Esposito, D. Giugliano, M.I. Maiorino, Metabolic syndrome and cancer: “The common soil hypothesis”. Diabetes Res Clin. Pract. 143, 389–397 (2018). https://doi.org/10.1016/j.diabres.2018.05.024CrossRefPubMed

46.

J.L.D.L. Shaker, in Calcium and Phosphate Homeostasis. ed. by K. R. Feingold, B. Anawalt, A. Boyce, et al. (Endotext, South Dartmouth (MA), 2018)

47.

K.A. Tappenden, Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy. J. Parenter. Enter. Nutr. 38(1 Suppl), 14S–22S (2014). https://doi.org/10.1177/0148607113520005CrossRef

48.

D. Sgambato, F. Gimigliano, C. De Musis, A. Moretti, G. Toro, E. Ferrante, A. Miranda, D. De Mauro, L. Romano, G. Iolascon, M. Romano, Bone alterations in inflammatory bowel diseases. World J. Clin. Cases 7(15), 1908–1925 (2019). https://doi.org/10.12998/wjcc.v7.i15.1908CrossRefPubMedPubMedCentral

49.

P.R. Kiela, F.K. Ghishan, Physiology of intestinal absorption and secretion. Best. Pract. Res Clin. Gastroenterol. 30(2), 145–159 (2016). https://doi.org/10.1016/j.bpg.2016.02.007CrossRefPubMedPubMedCentral

50.

E. Reboul, Intestinal absorption of vitamin D: from the meal to the enterocyte. Food Funct. 6(2), 356–362 (2015). https://doi.org/10.1039/c4fo00579aCrossRefPubMed

51.

V.K. Maurya, M. Aggarwal, Factors influencing the absorption of vitamin D in GIT: an overview. J. Food Sci. Technol. 54(12), 3753–3765 (2017). https://doi.org/10.1007/s13197-017-2840-0CrossRefPubMedPubMedCentral

52.

I. Holmberg, L. Aksnes, T. Berlin, B. Lindback, J. Zemgals, B. Lindeke, Absorption of a pharmacological dose of vitamin D3 from two different lipid vehicles in man: comparison of peanut oil and a medium chain triglyceride. Biopharm. Drug Dispos. 11(9), 807–815 (1990). https://doi.org/10.1002/bdd.2510110908CrossRefPubMed

53.

E. Reboul, A. Goncalves, C. Comera, R. Bott, M. Nowicki, J.F. Landrier, D. Jourdheuil-Rahmani, C. Dufour, X. Collet, P. Borel, Vitamin D intestinal absorption is not a simple passive diffusion: evidences for involvement of cholesterol transporters. Mol. Nutr. Food Res. 55(5), 691–702 (2011). https://doi.org/10.1002/mnfr.201000553CrossRefPubMed

54.

S.A. Qureshi, N. Burch, M. Druce, J.G. Hattersley, S. Khan, K. Gopalakrishnan, C. Darby, J.L. Wong, L. Davies, S. Fletcher, W. Shatwell, S. Sothi, H.S. Randeva, G.K. Dimitriadis, M.O. Weickert, Screening for malnutrition in patients with gastro-entero-pancreatic neuroendocrine tumours: a cross-sectional study. BMJ Open 6(5), e010765 (2016). https://doi.org/10.1136/bmjopen-2015-010765CrossRefPubMedPubMedCentral

55.

B.G. Naraev, M. Halland, D.M. Halperin, A.J. Purvis, T.M. O’Dorisio, T.R. Halfdanarson, Management of diarrhea in patients with carcinoid syndrome. Pancreas 48(8), 961–972 (2019). https://doi.org/10.1097/MPA.0000000000001384CrossRefPubMedPubMedCentral

56.

S. Fang, D. Sui, Y. Wang, H. Liu, Y.J. Chiang, M.I. Ross, J.E. Gershenwald, J.N. Cormier, R.E. Royal, A. Lucci, J. Wargo, M.I. Hu, J.M. Gardner, J.D. Reveille, R.L. Bassett, Q. Wei, C.I. Amos, J.E. Lee, Association of vitamin D levels with outcome in patients with melanoma after adjustment for C-reactive protein. J. Clin. Oncol. 34(15), 1741–1747 (2016). https://doi.org/10.1200/JCO.2015.64.1357CrossRefPubMedPubMedCentral

57.

G. Janbabai, R. Shekarriz, H. Hassanzadeh, M. Aarabi, S.S. Borhani, A survey on the relationship between serum 25-hydroxy vitamin D level and tumor characteristics in patients with breast cancer. Int. J. Hematol. Oncol. Stem Cell Res. 10(1), 30–36 (2016)PubMedPubMedCentral

58.

M. Pavel, K. Oberg, M. Falconi, E.P. Krenning, A. Sundin, A. Perren, A. Berruti, Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 31(7), 844–860 (2020). https://doi.org/10.1016/j.annonc.2020.03.304.CrossRefPubMed

59.

L.D. de Hosson, J. Stelwagen, G. Bouma, B. Sijtema, S. Huitema, H.J.R. van Faassen, G.H. de Bock, D.J.A. de Groot, M.J.E. Campmans-Kuijpers, I.P. Kema, E.G.E. de Vries, A.M.E. Walenkamp, Towards optimal personalized diet and vitamin supplementation in NET patients. Endocr. Relat. Cancer 25(3), L23–L26 (2018). https://doi.org/10.1530/ERC-17-0549CrossRefPubMed

Titel: Vitamin D deficiency and tumor aggressiveness in gastroenteropancreatic neuroendocrine tumors
verfasst von: Barbara Altieri
Luigi Barrea
Roberta Modica
Filomena Bottiglieri
Federica de Cicco
Giovanna Muscogiuri
Luisa Circelli
Giovanni Savarese
Carolina Di Somma
Silvia Savastano
Annamaria Colao
Antongiulio Faggiano
Publikationsdatum: 17.09.2021
Verlag: Springer US
Erschienen in: Endocrine / Ausgabe 2/2022
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-021-02869-w

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

24.04.2024 | DGIM 2024 | Kongressbericht | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Vitamin D deficiency and tumor aggressiveness in gastroenteropancreatic neuroendocrine tumors

Abstract

Purpose

Methods

Results

Conclusions

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Metformin rückt in den Hintergrund

Myokarditis nach Infekt – richtig schwierig wird es bei Profisportlern

Thrombophiliescreening – Wenn, dann richtig und nur bei therapeutischer Konsequenz

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Update Innere Medizin

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2022

Identification of evodiamine as a suppressor of prostate cancer progression by reducing AR transcriptional activity via targeting Src

Imaging medullary thyroid cancer patients with detectable serum markers: state of the art and future perspectives

Correction: Hypercalcemia during pregnancy: management and outcomes for mother and child

Core needle biopsy and ultrasonography are superior to fine needle aspiration in the management of follicular variant papillary thyroid carcinomas

Long-term outcomes and prognostic factors in papillary thyroid microcarcinoma patients with distant metastases

Pediatric and adult obesity concerns in female health: a Mendelian randomization study

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Metformin rückt in den Hintergrund

Myokarditis nach Infekt – richtig schwierig wird es bei Profisportlern

Thrombophiliescreening – Wenn, dann richtig und nur bei therapeutischer Konsequenz

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Update Innere Medizin