RESUMEN
The aim of this retrospective study was to evaluate the results of transsphenoidal surgery in a group of patients with acromegaly who were operated by the same neurosurgeon. Our results were compared to those from a cumulative meta-analysis of 10 series (1,632 patients) published between 1992 and 2005. We followed 28 patients (17M/11F; 44.1 +/- 12.7 yr; 27 with macroadenomas; 86% being invasive) during 21.4 +/- 17.6 months after treatment. Patients were classified according to disease activity as follows: 1) controlled (CD): basal or mean GH < 2.5 ng/ml or nadir GH (OGTT) < 1 ng/ml and normal IGF-1; 2) uncontrolled (UCD): basal or mean GH > 2.5 ng/ml or nadir GH > 1 ng/ml and elevated IGF-1; 3) inadequately controlled (ICD): normal GH and elevated IGF-1 or elevated GH and normal IGF-1. After surgery, GH levels decreased from 61.7 +/- 101.1 ng/ml to 7.2 +/- 13.7 ng/ml (p< 0.001) and mean IGF-1 from 673.1 +/- 257.7 ng/ml to 471.2 +/- 285 ng/ml (p= 0.01). Biochemical remission rate was 57% [10 (35.5%) patients with CD and 6 (21.5%) with ICD], similar to the mean remission rate observed in the meta-analysis of surgical outcome of macroadenomas. Seven of 28 patients were submitted to surgical re-intervention (4 had been previously operated elsewhere and 3 by our neurosurgeon), with CD observed in 5 (71.5%) on follow-up. Cavernous sinuses invasion was more prevalent in UCD and ICD, whereas infundibular stalk deviation occurred only in patients with UCD. Remission rate was significantly higher in series where all surgical procedures were performed by the same surgeon (66% vs. 49%; p< 0.05). Thus, the surgeon's experience significantly improves the surgical outcome in acromegaly, especially in patients harboring large and invasive tumors, and re-intervention performed by an experienced surgeon should be considered in the algorithms for clinical management of this disease.
Asunto(s)
Acromegalia/cirugía , Adenoma/cirugía , Adenoma Hipofisario Secretor de Hormona del Crecimiento/cirugía , Procedimientos Neuroquirúrgicos/normas , Acromegalia/sangre , Acromegalia/patología , Adenoma/sangre , Adenoma/patología , Adulto , Anciano , Biomarcadores/análisis , Métodos Epidemiológicos , Femenino , Prueba de Tolerancia a la Glucosa , Adenoma Hipofisario Secretor de Hormona del Crecimiento/sangre , Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Hormona de Crecimiento Humana/sangre , Hormona de Crecimiento Humana/metabolismo , Humanos , Factor I del Crecimiento Similar a la Insulina/análisis , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Inducción de Remisión , Hueso Esfenoides , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. SUBJECTS AND METHODS: We evaluated 120 patients with benign thyroid nodules. Patients underwent evaluation of serum TSH and free T4, cervical ultrasound, and thyroid scintigraphy (in those with suppressed TSH levels). The application of sterile ethanol 99% was guided by ultrasound, with the injected volume amounting to one-third of the nodule volume. Response was considered complete (reduction of 90%); partial (reduction between 50 and 90%); or none (reduction of < 50%). Autonomous nodules were evaluated for normalization of TSH levels. RESULTS: Among the nodules studied, 30.8% were solid, 56.7% were mixed, 12.5% were cystic, and 21.6% were hyperfunctioning. The initial volume of the treated nodules ranged from 0.9 to 74.8 mL (mean 13.1 ± 12.4 mL). We performed 1-8 sessions of PEI, applying an average of 6.2 mL of ethanol for patient. After 2 years of follow-up, 17% of patients achieved a complete response (94% reduction); 53%, a partial response (70% reduction); and 30%, no response. A reduction in the volume of autonomous nodules was noted in 70% of cases, and 54% had a normalized value of TSH. The main side effect is local pain, lasting less than 24 hours in most cases. CONCLUSION: This study showed that PEI is a safe and effective procedure for treatment of benign, solid or mixed thyroid nodules. Most cases resulted in significant reduction in nodule volume, with normalization of thyroid function.
Asunto(s)
Etanol/administración & dosificación , Bocio Nodular/tratamiento farmacológico , Nódulo Tiroideo/tratamiento farmacológico , Etanol/efectos adversos , Femenino , Estudios de Seguimiento , Bocio Nodular/diagnóstico por imagen , Bocio Nodular/patología , Humanos , Hipertiroidismo/diagnóstico por imagen , Inyecciones Intralesiones/efectos adversos , Inyecciones Intralesiones/métodos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Cintigrafía , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Tirotropina/sangre , Tiroxina/sangre , Resultado del Tratamiento , UltrasonografíaRESUMEN
OBJECTIVE: To evaluate the associations between leptinemia and the components of metabolic syndrome (MetS). METHODS: Fifty-one obese adults (9 men; 36.7 +/- 10.0 years; body mass index (BMI) 46.2 +/- 10.0 kg/m(2)) were submitted to clinical examination, determinations of body fat mass (BF, bioimpedance) and resting energy expenditure (REE, indirect calorimetry), and to hormonal and biochemical analysis. Patients were categorized into three groups, according to the number of criteria for MetS: Group I: none or 1; Group II: 2; and Group III: 3 or 4 criteria. RESULTS: Absolute leptinemia (LepA; 37.5 +/- 16.9 ng/mL) was directly correlated with BMI (r = 0.48; p = 0.0004), waist circumference (r = 0.31; p = 0.028) and BF (r = 0.52; p = 0.0001). Leptinemia adjusted for BF (LepBF) was inversely correlated with weight (r = -0.41; p=0.027), REE (r = -0.34; p = 0.01) and number of MetS criteria (r = -0.32; p = 0.02). There was no difference in LepA among the groups. LepBF in Group III (0.58 +/- 0.27 ng/mL/kg) was significantly lower compared to Group I (0.81 +/- 0.22 ng/mL/kg; p = 0.03) and Group II (0.79 +/- 0.30 ng/mL/kg; p = 0.02). CONCLUSIONS: Leptin production by the adipose tissue is decreased in obese subjects fulfilling three or more criteria of MetS, suggesting a state of relative leptin deficiency in obesity associated with advanced stages of MetS.
Asunto(s)
Tejido Adiposo/metabolismo , Leptina/biosíntesis , Síndrome Metabólico/metabolismo , Obesidad/metabolismo , Adulto , Índice de Masa Corporal , Peso Corporal/fisiología , Metabolismo Energético/fisiología , Métodos Epidemiológicos , Femenino , Humanos , Leptina/sangre , Masculino , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/etiología , Factores de Riesgo , Circunferencia de la Cintura/fisiologíaRESUMEN
Objective The objective of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. Subjects and methods We evaluated 120 patients with benign thyroid nodules. Patients underwent evaluation of serum TSH and free T4, cervical ultrasound, and thyroid scintigraphy (in those with suppressed TSH levels). The application of sterile ethanol 99% was guided by ultrasound, with the injected volume amounting to one-third of the nodule volume. Response was considered complete (reduction of 90%); partial (reduction between 50 and 90%); or none (reduction of < 50%). Autonomous nodules were evaluated for normalization of TSH levels. Results Among the nodules studied, 30.8% were solid, 56.7% were mixed, 12.5% were cystic, and 21.6% were hyperfunctioning. The initial volume of the treated nodules ranged from 0.9 to 74.8 mL (mean 13.1 ± 12.4 mL). We performed 1-8 sessions of PEI, applying an average of 6.2 mL of ethanol for patient. After 2 years of follow-up, 17% of patients achieved a complete response (94% reduction); 53%, a partial response (70% reduction); and 30%, no response. A reduction in the volume of autonomous nodules was noted in 70% of cases, and 54% had a normalized value of TSH. The main side effect is local pain, lasting less than 24 hours in most cases. Conclusion This study showed that PEI is a safe and effective procedure for treatment of benign, solid or mixed thyroid nodules. Most cases resulted in significant reduction in nodule volume, with normalization of thyroid function. Arq Bras Endocrinol Metab. 2014;58(9):912-7 .
Objetivo O objetivo deste estudo foi avaliar a eficácia e segurança da injeção percutânea de etanol (IPE) no tratamento de nódulos tireoidianos benignos. Sujeitos e métodos Foram avaliados 120 pacientes com nódulos benignos de tireoide. Todos realizaram dosagens de TSH, T4 livre, ecografia cervical (US) e cintilografia de tireoide (em pacientes com TSH suprimido). A aplicação de etanol estéril a 99% foi guiada por US e o volume de etanol injetado correspondeu a um terço do volume nodular calculado. A resposta foi considerada completa (redução de 90%); parcial (redução entre 50 e 90%) ou ausência de resposta (redução menor que 50%). Nos nódulos autônomos, foi avaliada a normalização do TSH. Resultados Entre os nódulos estudados, 30,8% eram sólidos, 56,7% eram mistos, 12,5% eram císticos e 21,6%, nódulos hiperfuncionantes. O volume inicial dos nódulos tratados variou de 0,9 a 74,8 mL (média 13,1 ± 12,4 mL). Foram realizadas de 1 a 8 sessões de IPE (média 2,8), com aplicação média de 6,2 mL de etanol por paciente. Após dois anos de seguimento, 17% dos pacientes obtiveram resposta completa (redução de 94%), 53% obtiveram resposta parcial (redução de 70%) e 30% não responderam. Houve redução de volume nos nódulos autônomos em 70% dos casos, e 54% normalizaram o valor do TSH. Os efeitos colaterais registrados foram decorrentes apenas do desconforto no local de aplicação. Conclusão Este trabalho mostrou que a IPE é um procedimento seguro e eficaz para tratamento de nódulos benignos, sólidos ou mistos de tireoide. ...
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Etanol/administración & dosificación , Bocio Nodular/tratamiento farmacológico , Nódulo Tiroideo/tratamiento farmacológico , Etanol/efectos adversos , Estudios de Seguimiento , Bocio Nodular/patología , Bocio Nodular , Hipertiroidismo , Inyecciones Intralesiones/efectos adversos , Inyecciones Intralesiones/métodos , Dimensión del Dolor , Resultado del Tratamiento , Nódulo Tiroideo/patología , Nódulo Tiroideo , Tirotropina/sangre , Tiroxina/sangreRESUMEN
OBJECTIVE: To evaluate the associations between leptinemia and the components of metabolic syndrome (MetS). METHODS: Fifty-one obese adults (9 men; 36.7 ± 10.0 years; body mass index (BMI) 46.2 ± 10.0 kg/m²) were submitted to clinical examination, determinations of body fat mass (BF, bioimpedance) and resting energy expenditure (REE, indirect calorimetry), and to hormonal and biochemical analysis. Patients were categorized into three groups, according to the number of criteria for MetS: Group I: none or 1; Group II: 2; and Group III: 3 or 4 criteria. RESULTS: Absolute leptinemia (LepA; 37.5 ± 16.9 ng/mL) was directly correlated with BMI (r = 0.48; p = 0.0004), waist circumference (r = 0.31; p = 0.028) and BF (r = 0.52; p = 0.0001). Leptinemia adjusted for BF (LepBF) was inversely correlated with weight (r = -0.41; p=0.027), REE (r = -0.34; p = 0.01) and number of MetS criteria (r = -0.32; p = 0.02). There was no difference in LepA among the groups. LepBF in Group III (0.58 ± 0.27 ng/mL/kg) was significantly lower compared to Group I (0.81 ± 0.22 ng/mL/kg; p = 0.03) and Group II (0.79 ± 0.30 ng/mL/kg; p = 0.02). CONCLUSIONS: Leptin production by the adipose tissue is decreased in obese subjects fulfilling three or more criteria of MetS, suggesting a state of relative leptin deficiency in obesity associated with advanced stages of MetS.
OBJETIVO: Avaliar as associações entre leptinemia e os componentes da síndrome metabólica (MetS). MÉTODOS: Cinquenta e um adultos obesos (9 homens, 36,7 ± 10,0 anos, índice de massa corpórea, IMC, 46,2 ± 10,0 kg/m²) foram submetidos à avaliação clínica, a determinações da massa adiposa (BF, bioimpedância) e do gasto energético basal (REE, calorimetria indireta) e a análises hormonais e bioquímicas. Os pacientes foram divididos em três grupos, de acordo com o numero de critérios para MetS: Grupo I, nenhum ou 1; Grupo II: 2; e Grupo III: 3 ou 4 critérios. RESULTADOS: A leptinemia absoluta (LepA; 37,5 ± 16,9 ng/mL) se correlacionou diretamente a IMC (r = 0,48; p = 0,0004), circunferência abdominal (r = 0,31; p = 0,028) e BF (r = 0,52; p = 0,0001). A leptinemia ajustada por BF (LepBF) se correlacionou inversamente ao peso (r = -0,41; p = 0,027), ao REE (r = -0,34; p = 0,01) e ao número de critérios para MetS (r = -0,32; p = 0,02). Não houve diferença de LepA entre os grupos. LepBF no Grupo III (0,58 ± 0,27 ng/mL/kg) foi significativamente menor que no Grupo I (0,81 ± 0,22 ng/mL/kg; p = 0,03) e II (0,79 ± 0,30 ng/mL/kg; p = 0,02). CONCLUSÕES: A produção de leptina pelo tecido adiposo está diminuída em pacientes obesos que preenchem três ou mais critérios para MetS, sugerindo um estado de deficiência relativa de leptina na obesidade associada a estágios avançados de MetS.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Tejido Adiposo/metabolismo , Leptina/biosíntesis , Síndrome Metabólico/metabolismo , Obesidad/metabolismo , Índice de Masa Corporal , Peso Corporal/fisiología , Métodos Epidemiológicos , Metabolismo Energético/fisiología , Leptina/sangre , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/etiología , Factores de Riesgo , Circunferencia de la Cintura/fisiologíaRESUMEN
Avaliamos retrospectivamente os resultados da cirurgia transesfenoidal num grupo de acromegálicos operados por um único neurocirurgião, comparando-os com uma meta-análise cumulativa de 10 séries (1.632 pacientes) publicadas entre 1992-2005. Estudamos 28 pacientes (17M/11F; 44,1 ± 12,7 anos; 27 com macroadenomas, sendo 86 por cento invasivos), acompanhados por 21,4 ± 17,6 meses após a cirurgia; eles foram classificados de acordo com a atividade da acromegalia em: 1) doença controlada (DC): GH basal ou médio < 2,5 ng/ml ou GH nadir no TTOG < 1ng/ml e IGF-1 normal; 2) não controlada (DNC): GH basal ou médio > 2,5 ng/ml ou nadir no TTOG > 1 ng/ml e IGF-1 elevado; 3) inadequadamente controlada (DIC): GH normal e IGF-1 elevado ou GH elevado e IGF-1 normal. Após a cirurgia, os níveis de GH reduziram de 61,7 ± 101,1 ng/ml para 7,2 ± 13,7 ng/ml (p< 0,001), e os de IGF-1 de 673,1 ± 257,7 ng/ml para 471,2 ± 285 ng/ml (p= 0,01). A taxa de remissão bioquímica foi de 57 por cento [10 pacientes (35,5 por cento) com DC e 6 (21,5 por cento) com DIC], similar àquela obtida na meta-análise de cirurgias de macroadenomas. Sete dos 28 pacientes foram submetidos à re-intervenção (4 operados em outro hospital e 3 pelo nosso neurocirurgião), sendo 5 (71,5 por cento) classificados como DC no pós-operatório. Invasão de seio cavernoso foi mais prevalente nos DNC e DIC, e desvio de haste hipofisária no grupo DNC. A taxa de remissão foi maior nas séries em que apenas um único cirurgião realizou os procedimentos (66 por cento vs. 49 por cento; p< 0,05). Em conclusão, esses dados comprovam que a experiência do neurocirurgião pode aumentar significativamente as taxas de remissão do tratamento cirúrgico da acromegalia, especialmente em tumores maiores e mais invasivos, e que a re-intervenção realizada por cirurgião experiente deve ser considerada nos algoritmos de abordagem terapêutica desta doença.
The aim of this retrospective study was to evaluate the results of transsphenoidal surgery in a group of patients with acromegaly who were operated by the same neurosurgeon. Our results were compared to those from a cumulative meta-analysis of 10 series (1,632 patients) published between 19922005. We followed 28 patients (17M/11F; 44.1 ± 12.7 yr; 27 with macroadenomas; 86 percent being invasive) during 21.4 ± 17.6 months after treatment. Patients were classified according to disease activity as follows: 1) controlled (CD): basal or mean GH < 2.5 ng/ml or nadir GH (OGTT) < 1 ng/ml and normal IGF-1; 2) uncontrolled (UCD): basal or mean GH > 2.5 ng/ml or nadir GH > 1 ng/ml and elevated IGF-1; 3) inadequately controlled (ICD): normal GH and elevated IGF-1 or elevated GH and normal IGF-1. After surgery, GH levels decreased from 61.7 ± 101.1 ng/ml to 7.2 ± 13.7 ng/ml (p< 0.001) and mean IGF-1 from 673.1 ± 257.7 ng/ml to 471.2 ± 285 ng/ml (p= 0.01). Biochemical remission rate was 57 percent [10 (35.5 percent) patients with CD and 6 (21.5 percent) with ICD], similar to the mean remission rate observed in the meta-analysis of surgical outcome of macroadenomas. Seven of 28 patients were submitted to surgical re-intervention (4 had been previously operated elsewhere and 3 by our neurosurgeon), with CD observed in 5 (71.5 percent) on follow-up. Cavernous sinuses invasion was more prevalent in UCD and ICD, whereas infundibular stalk deviation occurred only in patients with UCD. Remission rate was significantly higher in series where all surgical procedures were performed by the same surgeon (66 percent vs. 49 percent; p< 0.05). Thus, the surgeon's experience significantly improves the surgical outcome in acromegaly, especially in patients harboring large and invasive tumors, and re-intervention performed by an experienced surgeon should be considered in the algorithms for clinical management of this disease.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Acromegalia/cirugía , Adenoma/cirugía , Adenoma Hipofisario Secretor de Hormona del Crecimiento/cirugía , Procedimientos Neuroquirúrgicos/normas , Acromegalia/sangre , Acromegalia/patología , Adenoma/sangre , Adenoma/patología , Biomarcadores/análisis , Métodos Epidemiológicos , Prueba de Tolerancia a la Glucosa , Adenoma Hipofisario Secretor de Hormona del Crecimiento/sangre , Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Hormona de Crecimiento Humana/sangre , Hormona de Crecimiento Humana , Factor I del Crecimiento Similar a la Insulina/análogos & derivados , Invasividad Neoplásica/patología , Inducción de Remisión , Hueso Esfenoides , Resultado del TratamientoRESUMEN
O fato de a arterite de Takayasu ser um protótipo de doença de grandes vasos pode fazer com que as manifestações cutâneas, atribuídas ao acometimento de pequenos vasos, passem despercebidas. Descrevemos um caso de arterite de Takayasu associada a manifestações cutâneas decorrentes de vasculite necrotizante. Neste caso, correlacionamos os achados clínicos e laboratoriais com os da biópsia cutânea, estabelecendo o diagnóstico. A paciente respondeu prontamente ao regime terapêutico de prednisona e metotrexate.
Asunto(s)
Humanos , Femenino , Adulto , Prednisona , Arteritis de Takayasu , VasculitisRESUMEN
A esclerose difusa adquirida é uma entidade em que se observa neoformação óssea. Foram observados casos de osteoesclerose em usuários de drogas endovenosas e portadores do vírus da hepatite C, o que permite que este vírus seja apontado como o provável fator etiológico. existe considerável aumento da densidade óssea, sendo o osso neoformado estruturalmente normal e não-suscetível a fraturas patológicas. Tal achado indica que o entendimento da fisiopatologia da osteoesclerose pode fornecer novas alternativas para o tratamento da osteoporose. Um caso de osteoesclerose em um homem de 36 anos com vírus da hepatite C adquirido pelo uso de drogas endovenosas é descrito