Multidisciplinary Team Care in Pituitary Tumours.

The optimal care for patients with pituitary tumours is best provided in a multidisciplinary and collaborative environment, which requires the contribution of multiple medical specialties working together. The benefits and advantages of the pituitary multidisciplinary team (MDT) are broad, and all relevant international consensus and guidelines in the field recommend that patients with pituitary tumours should always be managed in a MDT. Endocrinologists and neurosurgeons are normally the leading specialties within the pituitary MDT, supported by many other specialties with significant contributions to the diagnosis and management of pituitary tumours, including neuropathology, neuroradiology, neuro-ophthalmology, and otorhinolaryngology, among others. Here, we review the literature concerning the concepts of Pituitary MDT/Pituitary Tumour Centre of Excellence (PTCOE) in terms of their mission, goals, benefits, structure, proposed models of function, and barriers, and we also provide the views of different specialists involved in our Pituitary MDT.

Pseudoacromegaly-A challenging entity in the endocrine clinic: A systematic review.

OBJECTIVE: Pseudoacromegaly encompasses conditions with features of acromegaly/gigantism, but no growth hormone (GH) or insulin-like growth factor-1 (IGF-1) excess. We aimed to review published pseudoacromegaly cases evaluated due to clinical suspicion of acromegaly. DESIGN/PATIENTS: PubMed/Medline search was conducted to identify reported pseudoacromegaly cases, which were systematically reviewed to ensure they met eligibility criteria: (1) presentation suggestive of acromegaly; (2) acromegaly excluded based on normal GH, IGF-1 and/or GH suppression on oral glucose tolerance test (OGTT-GH); (3) diagnosis of the pseudoacromegaly condition was established. Data were retrieved from each case and analysed collectively. RESULTS: Of 76 cases, 47 were males, mean ages at presentation and at first acromegaloid symptoms were 28 ± 16 and 17 ± 10 years, respectively. Most common conditions were pachydermoperiostosis (47%) and insulin-mediated pseudoacromegaly (IMP) (24%). Acromegaloid facies (75%) and acral enlargement (80%) were the most common features. Measurement of random GH was reported in 65%, IGF-1 in 79%, OGTT-GH in 51%. GH excess was more frequently excluded based on two tests (53%). Magnetic resonance imaging (MRI) was performed in 30 patients, with pituitary adenoma or hyperplasia being reported in eight and three patients, respectively. Investigations differed between cases managed by endocrine and non-endocrine specialists, the former requesting more often IGF-1, OGTT-GH and pituitary MRI. CONCLUSIONS: Pseudoacromegaly is a challenging entity that may be encountered by endocrinologists. Pachydermoperiostosis and IMP are the conditions most often mimicking acromegaly. Adequate assessment of GH/IGF-1 is crucial to exclude acromegaly, which may be better performed by endocrinologists. Pituitary incidentalomas are common and require careful judgement to prevent unnecessary pituitary surgery.

Essential Trace Elements Status in Portuguese Pregnant Women and Their Association with Maternal and Neonatal Outcomes: A Prospective Study from the IoMum Cohort.

Cobalt (Co), copper (Cu), manganese (Mn), molybdenum (Mo), and zinc (Zn) are essential trace elements (ETEs) and important cofactors for intermediary metabolism or redox balance. These ETEs are crucial during pregnancy, their role on specific pregnancy outcomes is largely unknown. This prospective study (#NCT04010708) aimed to assess urinary levels of these ETEs in pregnancy and to evaluate their association with pregnancy outcomes. First trimester pregnant women of Porto and Lisbon provided a random spot urine sample, and sociodemographic and lifestyle data. Clinical data were obtained from clinical records. Urinary ETEs were quantified by inductively coupled plasma mass spectrometry (ICP-MS). A total of 635 mother:child pairs were included. Having urinary Zn levels above the 50th percentile (P50) was an independent risk factor for pre-eclampsia (PE) (aOR [95% CI]: 5.350 [1.044-27.423], p = 0.044). Urinary Zn levels above the P50 decreased the risk of small for gestational age (SGA) birth head circumference (aOR [95% CI]: 0.315 [0.113-0.883], p = 0.028), but it increased the risk SGA length (aOR [95% CI]: 2.531 [1.057-6.062], p = 0.037). This study may provide valuable information for public health policies related to prenatal nutrition, while informing future efforts to de-fine urinary reference intervals for ETEs in pregnant women.

[Cyto-histological correlation of malignant thyroid nodules: clinical factors as predictors of malignancy]. / Correlação cito-histológica de nódulos da tiróide: características clínicas de malignidade.

INTRODUCTION: Fine-needle aspiration (FNA) is routinely used to distinguish benign from malignant tumors in thyroid nodules. Most benign or malignant diagnosis are confirmed by histology, but for suspected malignancies (Follicular neoplasm and Hürthle-cell neoplasm histology is always required. Some clinical factors have been identified as predictors of malignancy in the suspicious cases with eventual interest for treatment options. AIM: To determine the correlation between FNA and histological diagnosis in malignant tumors at Hospital de Egas Moniz. Identify factors that may influence the risk of malignancy in patients with suspected malignancies (Tumor size, gender and age group). METHODS: Retrospective study of patients with malignant or suspected malignant tumors diagnosed by FNA in the institution. All patients were subsequently diagnosed by histology and age, sex and tumor dimension were also recorded. RESULTS: From 2685 FNA performed between October 1996 and June 2005, 68 patients were considered for analysis, which have been diagnosed as malignant (34 patients) or suspicious of malignancy (34 patients). Only in one case didn't the histology confirm the cytological diagnosis of malignancy. Among the suspicious FNA 25 were benign (23 female and 2 male, mean age of 54,3 +/-17 yo and mean nodule size of 2,8 +/- 1,8 cm) and nine (26,5%) were malignant (all female, mean age 68,3 +/- 13 yo and mean nodule size 2,67 +/- 1,5 cm). Nodules with 2 cm or more were malignant in 37% (vs 8% when < 2 cm; P=0,033) and patients with 50 yo or more revealed to be malignant in 33% (vs 10% when < 50 yo; P=0,019), therefore nodule size and age were identified as independent predictors for malignancy. CONCLUSIONS: There was a strong correlation between cytological and histological diagnoses. Age and tumor size were strong predictors of malignancy in patients with suspected malignancies. This and other factors may be useful to identify patients who may benefit from a total thyroidectomy as the first intervention.