On the possibility of using temperature to aid in thyroid nodule investigation.

Thyroid nodules are common, and their investigation is very important to exclude the possibility of cancer. The increase in blood vessels of malignant tumours may be related to local temperature augmentation detectable on the skin surface. The objective of this paper is to evaluate the feasibility of Infrared Thermography for cancer identification. For this purpose, two studies were performed. One used numerical modelling to simulate regional metabolic temperature propagation to evaluate whether a nodule is perceptible on the skin surface. A second study considered thyroid nodule identification by using convolutional neural networks (CNNs). First, variations in nodular size and fat thickness were investigated, showing that the fat layer has an important role in regional heat transfer. In the second study, the training process achieved accuracy of 96% for in-sample and 95% for validation. In the testing phase, 92% accuracy, 100% precision and 80% recall were achieved. Thus, the presented studies suggest the feasibility of using Infrared Thermography with the CNN Artificial Intelligence technique as additional information in the investigation of thyroid nodules for patients without a very thick subcutaneous fat layer.

Low risk of coronary artery disease in patients with acromegaly.

The aims of this study are to determine the prevalence of coronary atherosclerosis in acromegalic patients and to investigate the relationship between the coronary artery calcium score (CS) and acromegaly status and clinical parameters [Framingham risk score (FRS)]. Fifty-six acromegalic patients and paired non-acromegalic volunteers were stratified according to the FRS into low-, intermediate-, and high-risk groups. CS was assessed using multidetector computed tomography. The patients were considered to have controlled or active acromegaly at the time they were submitted to evaluation. Sixty-six percent of acromegalic patients exhibited arterial hypertension, 36 % had diabetes mellitus, and 34 % had hypercholesterolemia. The median FRS and the median risk for cardiovascular event within the next 10 years were similar in the acromegalics and the controls. The median total CS and CS >75th percentile didn't differ significantly between these groups. In patients with controlled acromegaly, a low, intermediate, or high FRS risk was observed in 86, 14, and 0 %, respectively. In patients with active disease, a low, intermediate, or high FRS risk was verified in 94, 3, and 3 %, respectively, and differences between the controlled and active groups were not significant. Seventy-two percent of the patients had total CS = 0, and there were no differences between the controlled and active groups. The risk of coronary artery disease in acromegalic patients, determined according to FRS and CS, is low despite the high prevalence of metabolic abnormalities.

Effects of GH-IGF-I excess and gonadal status on bone mineral density and body composition in patients with acromegaly.

SUMMARY: Studies on body composition and bone mineral density in acromegaly have conflicting results. Our data point to an increase in lean mass, a decrease in adipose tissue, and that the anabolic effect of GH on bone is partially dependent on modifications in body composition. INTRODUCTION: The effects of growth hormone (GH) and insulin-like growth factor I (IGF-I) excess and gonadal status on bone mineral density (BMD) and body composition (BC) in acromegalic patients are uncertain. METHODS: Bone mineral density and BC were evaluated by dual-energy X-ray absorptiometry (Prodigy-GE) in 75 patients (22 men and 53 women) with acromegaly, mean age 48.9 ± 14.5 years. Acromegaly was considered "controlled" when serum IGF-I was within the specific age-adjusted reference range, and serum GH was lower than 2.5 ng/mL. Comparisons between groups were performed using unpaired t test or Mann-Whitney U test. Categorical variables were analyzed by chi-square (x (2)) test. In order to compare data of different subgroups stratified by disease activity and gonadal status, one-way analysis of variance (ANOVA) and Bonferroni post hoc analysis were performed. To evaluate the correlation between GH and IGF-I and densitometric parameters, Pearson and Spearman rank order correlation were performed, as appropriate. RESULTS: There were no differences in BMD when considering disease activity and gonadal status. Active disease and eugonadism were positively correlated to an increase in lean mass and a decrease in fat mass. After multiple linear regression, there were positive correlations between GH and Z-score at lumbar spine and between lean mass and BMD at proximal femur. CONCLUSION: Our data support that GH-IGF-I excess and eugonadism have great influence on BC modifications and that the anabolic effects of GH-IGF-I on bone are, at least in part, dependent on these alterations in body composition.

Osteosarcoma and acromegaly: a case report and review of the literature.

A 72-yr-old acromegalic man, who presented with pain in the left femur, was found to have a metastatic osteosarcoma. Only three cases describing the coexistence of acromegaly and osteosarcoma have been reported by the literature. As the patient didn't have other risk factors for osteosarcoma, the hypothesis that accelerated rate of bone turnover caused by long-term exposure to high GH and IGF-I could act as a predisposing factor in the development of this malignant bone tumor is discussed.