Capsulite Libroia

CAPSULITE E
PATOLOGIE
ENDOCRINE: UNO
STRETTO
COLLEGAMENTO?
DOTT. MATTEO LIBROIA

GRAZIE
PAPA’…
ALFONSO LIBROIA
MEDICO CHIRURGO SPECIALISTA ENDOCRINOLOGO

PRIMARIO EMERITO U.O. OSP. NIGUARDA MILANO
CURRICULUM PROFESSIONALE
Laureato a Milano il 18 novembre 1966
Iscritto all’Albo Professionale dei Medici di Milano dal 10 maggio 1967
Specializzato in Endocrinologia presso l’università di Torino l’11 luglio 1969
Dal luglio 1967 al novembre 2003 ha prestato servizio presso l’Ente Ospedaliero Niguarda Cà-Granda di
Milano in qualità di assistente, aiuto ed infine primario della divisione di endocrinologia
Dal 2005 al 2006 è stato responsabile del Centro di Endocrinologia del Policlinico di Monza.
Socio da molti anni delle Società Italiane di Endocrinologia e Obesità
Dal 1970 al 1992 ha diretto l’ambulatorio specialistico di endocrinologia dell’U.S.S.L. 75/1 di Milano
Ha sempre svolto attività di ricerca e partecipato a molti congressi in qualità di relatore
CAPSULITE E
PATOLOGIE
ENDOCRINE: UNO
STRETTO
COLLEGAMENTO?
NO…
O FORSE SI’?
JSES 2001 JBJS 1949
ANN R COLL SURG ENGL 1997
JBJS 1949
JBJS 1949
DISORDINI TIROIDEI, IN
PARTICOLARE
IPOTIROIDISMO,
SONO FATTORE DI RISCHIO
PER CAPSULITE
(2,69 VOLTE IN PIU’), MA
NON PER ALTRE
PATOLOGIE DELLA SPALLA
FORSE QUI COMINCIA A
ESSERCI UNA
SPIEGAZIONE…
• NGF 75
• MMP
• VIMENTINA
• TGF B 1
• LOW GRADE
INFLAMMATION
(DIABETE E TIROIDITI)
• LDL
FORSE QUI COMINCIA A
ESSERCI UNA
SPIEGAZIONE…
• IPERGLICEMIA, DIABETE
• AGEs (ADVANCED
GLICATION ENDS
PRODUCTS)
What triggers the onset of a FS?
As with many diseases, it is still unclear what triggers the onset of the disease. Microtrauma has been suggested as a trigger, although
this is hard to support with evidence [103]. With the identification of predisposing factors we do get a better understanding of the
etiology.
An increasing amount of evidence supports a chronic state of low-grade inflammation as an important predisposing factor for the
development of FS [46, 48, 79, 81, 104]. Markers of chronic inflammation (ICAM-1, TIMP) are elevated in FS patients, and
pro-inflammatory lipo-proteins are significant risk factors for FS, similar to patients with cardiovascular disease or metabolic syndrome
[48, 82]. The incidence of FS is so much higher in patients with DM and thyroid disorders, since these conditions are associated with a
chronic state of inflammation [20, 83]. Even depressive personality traits are sometimes linked to FS, and depression is also associated
with enhanced inflammatory cytokine levels [105]. It seems plausible that female hormones might be related in this context, since the
peak incidence of FS is in perimeno-pausal women. However, a clear explanation, or a direct relationship between female hormones and
FS was not found in the current literature.
Calcitonin was more or less accidentally discovered as
a treatment agent for FS when postmenopausal women
with FS were treated with calcitonin for osteoporosis
[33]. Their FS symptoms improved significantly after the
use of a nasal calcitonin spray. Calcitonin is a hormone,
secreted by the thyroid, known to inhibit osteoclast ac-

tivity and lowering the kidney excretion of calcium. The
presence of abundant calcitonin receptors in fibroblasts
of the shoulder synovium and capsule could be con-

firmed with immunohistochemistry. Cultured fibroblast
from FS patient stimulated with salmon calcitonin
showed a significant decrease in the production of colla-

gen type I and III. Synthesis of TGF-beta1 mRNA was
suppressed by salmon calcitonin, and the adhesion abil-

ity of the fibroblasts decreased with if treated with sal-
mon calcitonin. Apoptosis of the cultured fibroblasts
could even be induced with high levels of salmon calci-

tonin. The efficacy of nasal calcitonin spray was demon-
strated in a placebo controlled double blind randomized
trial [115]. This might also explain why patients with

thyroid disorders have an increased risk of FS, since
hypothyroidism and auto-immune thyroiditis can be ac-

companied by calcitonin deficiency [116, 117].
MAI SENTITO
PARLARE DI PNEI?
ENZO SORESI
PRIMARIO EMERITO U.O.
PNEUMOTISILIOGIA
OPSEDALE NIGUARDA
MILANO
MAI SENTITO
PARLARE DI PNEI?
PSICO
NEURO
ENDOCRINO
IMMUNOLOGIA
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CAPSULITE E

DOTT. MATTEO LIBROIA

MEDICO CHIRURGO SPECIALISTA ENDOCRINOLOGO

ANN R COLL SURG ENGL 1997

secreted by the thyroid, known to inhibit osteoclast ac-

presence of abundant calcitonin receptors in ﬁbroblasts

of the shoulder synovium and capsule could be con-

from FS patient stimulated with salmon calcitonin

showed a signiﬁcant decrease in the production of colla-

suppressed by salmon calcitonin, and the adhesion abil-

could even be induced with high levels of salmon calci-

trial [115]. This might also explain why patients with

hypothyroidism and auto-immune thyroiditis can be ac-

Luogo, luogo, luogo

CONFIDENTIAL AND PROPRIETARY

1 Testo di prova, inserire testo corretto.

2 Testo di prova, inserire testo corretto.

3 Testo di prova, inserire testo corretto.

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