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Dottorato in Fisiopatologia Medica

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Dott.ssa Chiara Bima

Tesi di dottorato

Title of doctoral thesis

“Role of copeptin and salivary cortisol as potential markers of biochemical monitoring in primary adrenal insufficiency”

Background and objectives

In the development of my research issue, I analysed the available scientific literature concerning the homeostatic mechanisms in the maintenance of hydro-electrolyte metabolism and cardiovascular regulation. I focalized on the role of copeptin, the C-terminal part of the precursor pre-provasopressin (CT-proAVP), acting as a stable and easy-to-measure surrogate marker of arginine vasopressin (AVP). Several studies have underlined the advantages of copeptin as diagnostic and prognostic marker in cardio-cerebrovascular diseases, as well as in some electrolyte disorders, such as in the differential diagnosis of hyponatremia and in polyuria‐polydipsia syndrome. Primary adrenal insufficiency (PAI) is an endocrine fluid and electrolyte disease characterized by secretory deficit of glucocorticoid (GC) and mineralocorticoid (MR). Until now, monitoring and management of replacement therapy is primarily based on clinical signs and symptoms of over- and undertreatment, due to the lack of objective assessment hormonal markers, although the evaluation of salivary cortisol has been proposed as a tool to manage GC replacement. Based on these assumptions, my research project is aimed to determine the utility of copeptin, in relation to salivary cortisol profile, in the biochemical monitoring of replacement therapy in patients affected by PAI.

Study design

We designed a monocentric, prospective, cohort, cross sectional clinical study, that was approved by the local ethics committee of “City of Health and Science University Hospital” of Turin. We enrolled 19 patients, aged between 18 and 65 years, affected by PAI, in replacement therapy with GC (hydrocortisone/modified release hydrocortisone) and MR (fludrocortisone) at stable dosage for at least three months. Before receiving their replacement therapy, subjects were evaluated for: 1) clinical and anthropometric data; 2) health-related quality of life through filling in a specific 30-item questionnaire (AddiQoL); 3) biochemical and hormonal parameters (plasma renin, ACTH, copeptin levels, serum electrolytes, serum creatinine, fasting glucose, glycated hemoglobin, serum lipids, plasmatic and urinary osmolarity, spot urinary sodium and potassium); 4) body composition by performing bioelectric impedance vector analysis (BIVA). Moreover, plasma renin, ACTH, and copeptin levels were measured in the morning 120 minutes after taking GC and MC replacement therapy. Bone mineral density was taken in consideration for patients who performed a dual-energy X-ray absorptiometry (DXA) scan during the period of the study. These parameters were measured at baseline (T0), after 6 (T1) and 12 (T2) months of follow-up, during stable replacement therapy. The week before every evaluation time, patients performed multiple daily saliva collection for the assessment of salivary cortisol and cortisone profile in 6 different times: a) F0, on awakening/before therapy; b) F1, 90 minutes after therapy; F2, 6 hours after therapy/before lunch; F3, 8 hours and 30 minutes after therapy; F4, 12 hours after therapy/before dinner; F5 before sleeping.

Aim of the project and clinical impact

Primary purpose of the study was the correlation of copepetin and salivary cortisol profile for assessing therapeutic adequacy in PAI. The therapeutic management of PAI is extremely important, because both a condition of under-treatment and over-treatment could lead patients to serious consequences. This finding could help to establish personalized dosages in single patient (“target therapy”) and to provide an objective parameter of replacement quality.

Attività di ricerca

Research project Role of hormones, neurohormones and molecules endowed with endocrine actions in the control of fluid and electrolyte metabolism

Main project Role of copeptin and salivary cortisol as potential markers of biochemical monitoring in primary adrenal insufficiency

Other projects Asymmetric dimethylarginine and symmetric dimethylarginine as markers of endothelial dysfunction in cerebrovascular disease: a prospective case-control study

  1. Asymmetric dimethylarginine and symmetric dimethylarginine as markers of endothelial dysfunction in cerebrovascular disease: a prospective case-control study. Chiara Bima, Mirko Parasiliti-Caprino, Francesca Rumbolo, Federico Ponzetto, Iacopo Gesmundo, Antonello Nonnato, Paolo Fornengo, Giovanna Vaula, Ezio Ghigo, Giulio Mengozzi, Fabio Settanni. Nutrition, Metabolism and Cardiovascular Diseases. Submitted under review

 

  1. Pathophysiology and Management of Glycemic Alterations before and after Surgery for Pheochromocytoma and Paraganglioma. Chiara Lopez*, Chiara Bima*, Martina Bollati, Fabio Bioletto, Matteo Procopio, Stefano Arata, Daniele Giuseppe Candela, Guglielmo Beccuti, Ezio Ghigo, Mauro Maccario and Mirko Parasiliti-Caprino. International Journal of Molecular Sciences. 2023 Mar 8;24(6):5153. doi: 10.3390/ijms24065153 (* contributed equally)

 

  1. Resistance to Somatostatin Analogs in Italian Acromegaly Patients: The MISS Study. Alessandro Maria Berton, Nunzia Prencipe, Luca Bertero, Marco Baldi, Chiara Bima, Marina Corsico, Antonio Bianchi, Giovanna Mantovani, Francesco Ferraù, Paola Sartorato, Irene Gagliardi, Ezio Ghigo and Silvia Grottoli. Journal of Clinical Medicine. 2022 Dec 20;12(1):25. doi: 10.3390/jcm12010025

 

  1. Clinical and Pathological Tools for Predicting Recurrence and/or Metastasis in Patients with Pheochromocytoma and Paraganglioma. Chiara Bima, Fabio Bioletto, Chiara Lopez, Martina Bollati, Stefano Arata, Matteo Procopio, Iacopo Gesmundo, Ezio Ghigo, Mauro Maccario and Mirko Parasiliti-Caprino. Biomedicines. 2022 Jul 28;10(8):1813. doi: 10.3390/biomedicines10081813

 

  1. Galectin-3 and Estrogen Receptor Alpha as Prognostic Markers in Prolactinoma: Preliminary Results From a Pilot Study. Chiara Bima*, Sabrina Chiloiro*, Antonella Giampietro, Marco Gessi, Pier Paolo Mattogno, Liverana Lauretti, Carmelo Anile, Guido Rindi, Alfredo Pontecorvi, Laura De Marinis and Antonio Bianchi. Front Endocrinol (Lausanne). 2021 Jul; 12:684055. doi: 10.3389/fendo.2021.684055 (* contributed equally)

 

  1. Association of Urine Metanephrine Levels with CardiometaBolic Risk: An Observational Retrospective Study. Mirko Parasiliti-Caprino, Chiara Obert, Chiara Lopez, Martina Bollati, Fabio Bioletto, Chiara Bima, Filippo Egalini, Alessandro Maria Berton, Nunzia Prencipe, Fabio Settanni, Valentina Gasco, Giulio Mengozzi, Ezio Ghigo and Mauro Maccario. Journal of Clinical Medicine. 2021 May; 10(9):1967. doi: 10.3390/jcm10091967

 

  1. Morning Serum Cortisol Level Predicts Central Adrenal Insufficiency Diagnosed by Insulin Tolerance Test. Valentina Gasco, Chiara Bima, Alice Geranzani, Jacopo Giannelli, Lorenzo Marinelli, Chiara Bona, Valeria Cambria, Alessandro Maria Berton, Nunzia Prencipe, Ezio Ghigo, Mauro Maccario, Silvia Grottoli. Neuroendocrinology. 2021 Jan. doi: 10.1159/000514216

  1. Precision medicine: new perspectives for the treatment of GH-secreting tumors - the miss study. Alessandro Maria Berton, Nunzia Prencipe, Luca Bertero, Marina Corsico, Daniela Cuboni, Marco Baldi, Chiara Bima, Antonio Bianchi, Giovanna Mantovani, Francesco Ferrau`, Paola Sartorato, Irene Gagliardi & Silvia Grottoli. ECE Congress 2022. 21-24 May 2022

 

  1. Diabete transitorio da stress: una nuova entità nosografica. Descrizione di un caso clinico. Bima C., Samperi I., Radaelli P., Steffanini M., Ponziani M.C. XXXIII Congresso Nazionale AMD. 27-30 October 2021

 

  1. Acromegalia: fattori predittivi di risposta alla terapia con analoghi della somatostatina. Studio multicentrico italiano (MISS). Cuboni D., Baldi M., Prencipe N., Bertero L., Corsico M., Bima C., Mantovani G., Farraù F., Sartorato P., Gagliardi I., Berton A.M., Grottoli S. SIE 2021. Abstract for SIE Congress. July 2021.

  1. XII Corso di aggiornamento SIE in Endocrinologia Clinica Sez. Piemonte-Valle d’Aosta. Cuneo, 29-30 September 2023

 

  1. 12° Clinical Update in Endocrinologia e Metabolismo. Turin, 6-7 July 2023

 

  1. SID – Panorama diabete forum multidisciplinare e multidimensionale. Riccione. 21-24 May 2023

 

  1. 25th Annual European Congress of Endocrinology ECE 2023. Online attendance, 13-16 May 2023

 

  1. Congresso AME regionale 2023: “Update di terapia endocrinometabolica: farmaci, tecnologia ed interventistica”. Turin, 18 February 2023

 

  1. 29° Congresso Nazionale SID (Società Italiana di Diabetologia). Rimini, 26-29 October 2022

 

  1. 24th Annual European Congress of Endocrinology ECE 2022. Milan, 21-21 May 2022

 

  1. Convegno Macroregionale 8° AME Day. Online congress, 14 May 2022

 

  1. XIV Incontro Piemontese in Endocrinologia, Diabetologia e Metabolismo. Orta San Giulio (NO) 25-26 March 2022

 

  1. Congresso Interregionale SIIA Piemonte – Liguria – Valle d’Aosta. Turin, 9 October 2021

 

  1. X Corso di aggiornamento SIE in Endocrinologia Clinica Sez. Piemonte-Valle d’Aosta. Turin, 18 September 2021

 

  1. Convegno Macroregionale AME Day VII Edizione. FAD Webinair. 1463–316130. 15 June 2021

 

  1. VII Annual Meeting on Pituitary Tumors. The biological and molecular mechanisms in PITNET and their relationship with personalized therapy: last year update. FAD Webinair. 26-27 November 2020

 

  1. Congresso Interregionale SIIA Piemonte-Liguria-Valle d’Aosta. Turin, 10 October 2020

 

  1. IX Corso di aggiornamento SIE in Endocrinologia Clinica Sez. Piemonte-Valle d'Aosta. FAD Webinair. 2-3 October 2020

  1. “Progetto LEQ’s go un moderno approccio al paziente cardiovascolare con dislipidemie: share experience dalla real life”. Novara, 16 September 2023

 

  1. GLP1RA revolution Il punto sulla semaglutide orale. Pollenzo (CN), 16-17 June 2023

 

  1. Trial clinici: metodologie, lettura e applicazioni cliniche in diabetologia. Novara, 27 May 2023

 

  1. Archipelago D – Living the experience. Copenhagen, 27-28 April 2023

 

  1. Diademy Nozioni di statistica avanzata. Online course, 2 April 2023

 

  1. Obesity, let’s take care. Online course, 26 February 2023

 

  1. Monitoraggio in continuo della glicemia e microinfusori per l’erogazione dell’insulina nella gestione del paziente diabetico. Online course, 15 March-31 December 2022

 

  1. CGM therapy: la nuova frontiera nel compenso glicemico. Online course, 1 November 2022

 

  1. Archipelago D – Deep into excellence. Naples, 28 September-1 October 2022

 

  1. “Cambiare le foglie e conservare le radici 4 anni dopo: innovazioni terapeutiche (INNOVATE) in diabetologia. Novara, 10 June 2022

 

  1. Archipelago D – Beyond barriers. Rome, 29-30 April 2022

 

  1. Congresso congiunto SID-AMD-SIEDP-ANIED-OSDI Liguria Piemonte Valle d’Aosta Webinair L’ultima connessione…e quindi uscimmo a riveder le stelle. Online congress, 22-23 October 2021

 

  1. Project LIP-NET “Piemonte – Liguria – Valla d’Aosta”. Turin, 7 October 2021

 

  1. “A new story” raccontiamo la storia del DMT1. Online course, 7 June – 13 September 2021

 

  1. Corso teorico avanzato di ecografia diagnostica ed operativa del collo endocrino. Online course, 6 July 2021

 

  1. Clinical practise in Diabetology. Online course, 30 June 2021

 

  1. Progetto V-DIAB virtual meeting in diabetes. Online course, 5 June 2021

 

  1. Innovation in the management of the Pituitary: Adrenal Disorders and their comorbilities. FAD Webinair 1463-307541, 18 December 2020

 

  1. Diabete e dintorni ai tempi del Covid-19. FAD webinair. 1 October – 31 December 2020

 

  1. Tiroide, tumori e dintorni. FAD webinair. 1 October – 31 December 2020

 

  1. 8 June 2023, In presence lecture- Prof. De Ferrari: Cardiac electric physiopathological properties

 

  1. 6 June 2023, In presence lecture – Prof.ssa Costa: Biology and Diagnosis of SARSCov2

 

  1. 31 May 2023, Online Lecture – Prof. De Rosa: Alteration of intestinal microbioma as organ insufficiency: practical implications

 

  1. 7 December 2022, E-learning training course – University of Turin: OPEN SCIENCE A to Z – a.y. 2022-2023 – Certificate of attendance

 

  1. 7 December 2022, E-learning training course – University of Turin: FAIR DATA - a.y 2022-2023 – Certificate of attendance

 

  1. 25 October 2022, PhD student’s scientific presentations

 

  1. 20 September 2022, Online Lecture – Prof.ssa Arvat/Dott. Felicetti: Cancer survivors: pathophysiology of late-effects and challenges in their management

 

  1. 14 September 2022, Online Lecture – Prof. Trusolino: Clinical trials in oncology: Failures and successes

 

  1. 1 September 2022, Online Lecture – Prof.ssa Gruden/Dott.ssa Barutta: Diabetic nephropathy

 

  1. 24 August 2022, E-learning training course – University of Turin: Open Science and F.A.I.R. Data - Certificate of attendance

 

  1. 22 August 2022, E-learning training course – University of Turin: The Research Ecosystem and Its Evaluation - Certificate of attendance

 

  1. 14 June 2022, In presence Lecture – Prof. Mulatero: Monogenic forms of hypertension

 

  1. 7 May 2022, Online training course - University of Turin: Corso di formazione in materia di Igiene e Sicurezza – Rischio alto in area sanitaria -Settore Ateco 2007 Q 86 (D. Lgs. 81/97 s.m.i)- Certificate of attendance and profit

 

  1. Lectures organized by the doctoral school of Medical Physiopathology (first PhD year)

 

  1. 3 – 7 May 2021, Online training course – University of Turin: Causal questions and principled answers: an introduction to causal inference in medical research – Certificate of attendance

 

  1. 22 February – 21 March 2021, E-learning training course – University of Turin: Bibliography and bibliometrics like pros. Stay up to date and Develop Literature Syntheses in the Biomedical Domain - Certificate of attendance

 

  1. 19 March 2021, PhD students’ scientific presentations

 

  1. 1 February 2021, E-learning training course – University of Turin: Basics of project writing - Certificate of attendance

 

  1. 30 January 2021, E-learning training course – University of Turin: How to make the most out of your scientific paper - Certificate of attendance

 

  1. 27 January 2021, E-learning training course – University of Turin: How to write a scientific paper - Certificate of attendance

 

  1. 16 January 2021, Online training course - University of Turin: Corso di Formazione Generale alla Salute e Sicurezza per i lavoratori (art. 37 del D.Lgs. 81/08)- Certificate of attendance and profit

 

  • 1 April 2021-ongoing: Specialist in Endocrinology at Division of Diabetology Borgomanero Hospital; A.S.L. NO

 

  • 1 October 2020-ongoing: Ph.D. Student in Medical Physiopathology; Department of Medical Sciences; University of Turin

 

  • 1 May-30 September 2020: Research fellow at Division of Endocrinology, Diabetes and Metabolism; Department of Medical Sciences; University of Turin

 

  • 21 October 2019: Specialist in Endocrinology and Metabolic Diseases; Catholic University of the Sacred Heart, Rome. Thesis “Valutazione dell’espressione del recettore estrogenico α, della galectina 3 e del sottotipo 2 del recettore della somatostatina negli adenomi ipofisari PRL-secernenti: correlazione con i fattori prognostici di aggressività tumorale”. Final score: 50/50 cum laude

 

  • 19 March 2015: M.D. Degree; University of Turin, San Luigi Gonzaga. Thesis “Feocromocitoma surrenalico ed extrasurrenalico: analisi della casistica dell’ultimo decennio dell’Azienda Ospedaliera “Città della Salute” di Torino e studio dei predittori clinici e istopatologici di comportamento aggressivo”. Final score: 110/110 cum laude

 

Invited Speaker

“SGLT2-I and GLP-1 RA: novità 2022-2023”. XII Corso di aggiornamento SIE in Endocrinologia Clinica. Sez Piemonte/Valle d’Aosta. Cuneo, 30 settembre 2023

Certificates

Diploma nazionale SIUMB di competenza in ecografia tiroide, paratiroidi e patologie carrelate del collo

Membership

  1. ESE (European Society of Endocrinology)
  2. AME (Associazione Medici Endocrinologi)
  3. SIE (Società Italiana di Endocrinologia)
  4. AMD (Associazione Medici Diabetologi)
  5. SIUMB (Società Italiana di Ultrasonologia in Medicina e Biologia)

  6. GdS Tiroide e Ghiandole Endocrine – Rete Oncologica Piemonte e Valle d’Aosta 2022-2023. Member of working group in drafting “Percorso di Salute Diagnostico Terapeutico Assistenziale (PSDTA) Tumori della Tiroide Ed. 2022”

 

Ultimo aggiornamento: 07/10/2023 09:44
Location: https://dott-fisiopatologia.campusnet.unito.it/robots.html
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