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1.
Clin Endocrinol (Oxf) ; 72(5): 668-77, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-19769624

RESUMO

BACKGROUND: Only six women who were treated with somatostatin analogues (SSAs) throughout their pregnancies have been described so far. The influence of SSAs on the course of pregnancy and newborn outcomes remains largely unknown. Many aspects of SSAs pharmacokinetics in mother and foetus have not yet been defined. METHODS AND FINDINGS: We report a case study on the effects of octreotide on uterine artery blood flow, octreotide concentrations in biological fluids of mother and newborn, and somatostatin (SST) receptor expression and binding at the level of the maternal-foetal barrier tissues in an acromegalic woman treated with short-acting octreotide throughout her pregnancy. An acute decrease in uterine artery blood flow was observed after octreotide injections, without affecting the pregnancy course, delivery, or foetal development. Octreotide concentrations were high in maternal serum and colostrum and lower in umbilical cord serum, amniotic fluid, and newborn serum. All SST receptor subtypes can be expressed in placental tissue but their binding profile was weak both in the placenta and umbilical cord. The child was healthy and developed normally up to age 6 from an anthropometric, metabolic, and endocrine point of view. We reviewed all published reports on pregnancy SSA exposure and outcomes were compared to a time-matched group of acromegalic women not exposed to SSA. No significant effect on the mother or foetus was observed. CONCLUSIONS: Short-acting octreotide appears not to affect the function of the maternal-foetal barrier or foetal development, except for the occurrence of acute, reversible, and clinically irrelevant haemodynamic changes. These data support the feasibility and safety of treatment with short-acting octreotide in acromegalic women during pregnancy and excludes major matters of concern about the effects of this medication on pregnancy itself and its outcome.


Assuntos
Acromegalia/tratamento farmacológico , Octreotida/uso terapêutico , Complicações na Gravidez/tratamento farmacológico , Acromegalia/metabolismo , Adulto , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Feminino , Sangue Fetal/química , Desenvolvimento Fetal/efeitos dos fármacos , Hormônio do Crescimento Humano/metabolismo , Humanos , Recém-Nascido , Troca Materno-Fetal , Octreotida/sangue , Placenta/metabolismo , Gravidez , Resultado da Gravidez , Receptores de Somatostatina/metabolismo , Cordão Umbilical/metabolismo , Artéria Uterina/fisiologia
2.
Int J Cardiol ; 104(2): 197-203, 2005 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-16168814

RESUMO

BACKGROUND: Sudden death and increased prevalence of ventricular arrhythmias have already been described in acromegaly. Although late potentials (LPs) have been proved to be a new technique in detecting patients at risk for ventricular tachyarrhythmias its use in acromegaly is still unknown. METHODS: We studied 70 acromegalic patients [32 males, 38 females; age 49+/-12 years (mean+/-S.D.)] and 70 control subjects age- and sex-matched [(35 males and 35 females; 46+/-12 years (mean+/-S.D.)]. Besides hormonal tests, we performed the following cardiovascular investigations: ECG, 24-h ECG Holter monitoring, echocardiography, and signal-averaged ECG (SAECG) time-domain analysis. RESULTS: LPs occurrence was significantly higher in acromegalic patients as compared to the control group (22.9% vs. 2.9%; p=0.001). A greater duration of disease in patients with positive LPs compared to negative ones was pointed out (18 vs. 12 years; p=0.024). In the group of acromegalic patients with positive LPs we observed a significant association with premature ventricular complexes (PVCs) detected by means of 24-h Holter ECG recording (13 out of 15 patients: 86.7%; p=0.024). The positivity or negativity of LPs proved to be significantly associated with Lown scale PVC trends recorded by 24-h Holter ECG (p=0.014). In the group of patients with left ventricular hypertrophy a significant and pathological worsening of SAECG signals (QRS, LAS, RMS) was documented. CONCLUSIONS: We observed a higher prevalence of LPs in acromegaly which significantly correlated with Lown scale of PVCs.


Assuntos
Acromegalia/fisiopatologia , Potenciais de Ação , Taquicardia Ventricular/fisiopatologia , Acromegalia/sangue , Acromegalia/diagnóstico , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Morte Súbita Cardíaca/etiologia , Ecocardiografia , Eletrocardiografia Ambulatorial , Feminino , Hormônio do Crescimento Humano/metabolismo , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade , Processamento de Sinais Assistido por Computador , Síncope/fisiopatologia , Taquicardia Ventricular/sangue , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Fatores de Tempo , Complexos Ventriculares Prematuros/fisiopatologia
3.
Heart Vessels ; 23(1): 71-4, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18273550

RESUMO

Acromegaly, when left untreated, is associated with premature mortality which is chiefly related to cardiovascular complications. We report on a 50-year-old acromegalic woman, resistant to therapy, who died suddenly because of thoracic aortic rupture and massive bleeding into the left pleural space. The postmortem examination disclosed, nearby the point of rupture, a pulmonary abscess as well as extensive intrinsic alteration of arteries originating from the aortic arch and aorta itself, which featured microscopic cystic medial necrosis. We discussed how these aspects could be related to long-term exposition to growth hormone excess. In particular, this case gives further evidence of vascular system frailty in acromegaly.


Assuntos
Acromegalia/complicações , Aneurisma da Aorta Torácica/complicações , Ruptura Aórtica/complicações , Morte Súbita Cardíaca/etiologia , Aneurisma da Aorta Torácica/diagnóstico , Ruptura Aórtica/diagnóstico , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia Torácica , Fatores de Risco
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