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Introducción: El papel estimulante de los estrógenos sobre la secreción de prolactina y sobre la proliferación de los lactotropos está bien establecido. Hay escasa literatura sobre los efectos de la menopausia en pacientes con prolactinomas. Objetivos: Evaluar la evolución del tamaño del tumor y de los niveles plasmáticos de prolactina (PRL) en pacientes con microprolactinomas diagnosticados y tratados con agonistas dopaminérgicos (AD) durante su edad fértil y los efectos de la suspensión del tratamiento después de la menopausia. Materiales y métodos: Estudio retrospectivo, multicéntrico. Veintiún pacientes con microprolactinomas diagnosticados durante su edad fértil fueron estudiados en la menopausia. La edad media ± SD de la menopausia fue de 49 ± 3,6 años. En todas las pacientes se suspendió el tratamiento en la menopausia. Resultados: El nivel de PRL pretratamiento fue de 120 ± 58 ng/ml (media±SD) durante la menopausia, al suspender el tratamiento antes de los 12 meses de 23 ± 14 ng/ml y después de 12 meses o más de 1 año de 16 ± 6 ng / ml. Durante la menopausia y al suspender el tratamiento, el tumor desapareció en 9/21 y disminuyó en 12/21 pacientes; un año o más de un año después de la suspensión del tratamiento, el tumor desapareció en 9 /12 y se mantuvo sin cambios en 3/12. La duración promedio del tratamiento fue de 135 ± 74 meses. Dos pacientes reiniciaron el tratamiento debido a que los niveles de PRL aumentaron. Conclusiones: En la mayoría de las pacientes estudiadas se normalizaron los niveles plasmáticos de prolactina y se observó una disminución o desaparición de los microprolactinomas. Los AD podrían suspenderse después de la menopausia en pacientes microprolactinomas. Rev Argent Endocrinol Metab 51:136-141, 2014 Los autores declaran no poseer conflictos de interés.
Introduction: The stimulatory role of estrogens on prolactin secretionn and on proliferation of lactotropic cells is well-established. There is scarce literature about the effects of menopause in patients with prolactinomas. Objectives: To assess the evolution of tumor size and prolactin (PRL) levels in patients with microprolactinomas diagnosed and treated with dopamine agonists bromocriptine (BEC)/cabergoline (CAB) during their fertile age and the effects of discontinuation of those drugs after menopause. Material and methods: retrospective, multicenter study. Twenty-one patients diagnosed with microprolactinomas during their fertile age were studied in their menopause. Mean ± SD age at menopause was 49±3.6 years. In all patients, treatment was stopped when they reached menopause. Results: Mean ± SD pre-treatment PRL level was 120 ± 58 ng/ml and during menopause after stopping treatment, it was 23 ± 14 ng/ml before 12 months, and 16 ± 6 ng/ml after 12 months. During menopause and when stopping treatment, the tumor disappeared in 9/21 and the tumor size decreased in 12/21 patients; a year or more after treatment discontinuation, the tumor disappeared in 9/12 and was unchanged in 3/12. The mean ± SD treatment duration was 135 ± 74 months. Two patients were restarted on treatment because PRL levels increased. Conclusions: Normal PRL levels and sustained reduction or resolution of adenomas were achieved in most patients studied. Only two out of 21 restarted treatment because of hyperprolactinemia. Dopamine agonists might be safely stopped after menopause in patients with microprolactinomas. Rev Argent Endocrinol Metab 51:136-141, 2014 No financial conflicts of interest exist.
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El tirotropinoma es el adenoma hipofisario menos frecuente (< 2 %). Debido a su infrecuencia, describimos 5 casos. Caso 1: Varón de 23 años, presentó fibrilación auricular aguda. El perfil tiroideo mostró: TSH: 4,2 uUI/ml (0,3-4), T4: 14,8 ug/dl (4,5-12,5), T4L: 2,2 ng/dl (0,8-1,9),T3: 170 ng/dl (80-180), T3L: 7,8 pg/ml (1,8-4,6) y test de TRH-TSH plano. La resonancia nuclear magnética (RNM) de cerebro reveló un macroadenoma. Se inició tratamiento con metimazol sin lograr respuesta apropiada. Luego comenzó tratamiento con octreótido-Lar logrando el eutiroidismo. Fue intervenido por vía transesfenoidal (TE), confirmándose por inmunohistoquímica (IHQ) adenoma (+) para TSH. A los 7 días luego de la cirugía la TSH se constató suprimida. Cinco años después se encuentra en remisión. Caso 2: Mujer de 41 años, consultó por hipertiroidismo bioquímico e hipertensión arterial (HTA). La evaluación hormonal mostró: TSH: 3,21 uUI/ml (0,4-4), T4: 16,9 ug/dl (4,5-10,9), T4L: 2,2 ng/dl (0,8-1,5), T3: 245 ng/dl (60-180) y test de TRH-TSH plano. La RNM evidenció un microadenoma de 2 mm. La terapia con cabergolina no modificó las hormonas tiroideas. El tumor mostró crecimiento progresivo (10,8 mm a los 2 años). Se operó por vía TE y el tumor fue (+) en la IHQ para TSH y GH. Luego de la cirugía presentó TSH suprimida por 15 días. Actualmente lleva un año y medio libre de enfermedad. Caso 3: Hombre de 53 años consultó por disminución de la libido, impotencia sexual y aumento de peso. El laboratorio reveló: TSH: 9,1 uUI/ml, T4L: 1,79 ng/dl (0,9-1,8), T3: 164 ng/dl (40-181). En la RNM se halló un macroadenoma. Se realizó cirugía TE, el adenoma fue (+) para TSH y GH en la IHQ. Evolucionó con hipotiroidismo primario. Caso 4: Mujer de 36 años consultó por hipertiroidismo. El perfil tiroideo reveló: TSH: 3,76 uUI/ml (0,4-4), T4: 13,2 ug/dl (4-12), T4L: 2,3 ng/dl (0,9-1,7), T3: 247 ng/dl (70-200) y test TRH-TSH plano. La RNM evidenció un adenoma de 10 mm. Se intervino ...
Thyrotropinomas are the less frequent adenomas (< 2 %). Because of their infrequency, we report 5 cases. Case 1: 23-year-old man, with sudden atrial fibrillation. The hormonal profile showed: TSH: 4.2 uIU/ml (0.3-4), T4: 14.8 ug/dl (4.5-12.5), FT4: 2.2 ng/dl (0.8-1.9), T3: 170 ng/dl (80-180), FT3: 7.8 pg/ml (1.8-4.6) and flat TRH test. MRI revealed a macroadenoma. Therapy with metimazol was initiated, without response. Subsequently, treatment with octreotide-Lar was started and euthyroidism was reached. He underwent transsphenoidal surgery. Immunohistochemistry was positive for TSH. One week after surgery, TSH was suppressed. He has been free of disease for the last 5 years. Case 2: 41-year-old woman with biochemical hyperthyroidism and hypertension. Labs showed: TSH: 3.21 uIU/ml (0.4-4), T4: 16.9 ug/dl (4.5-10.9), FT4: 2.2 ng/dl (0.8-1.5), T3: 245 ng/dl (60-180) and flat TRH test. On MRI a microadenoma of 2 mm was diagnosed. Therapy with cabergoline did not normalize thyroid hormones. The tumor grew to 10.8 mm after 2 years. Transsphenoidal surgery was performed. Immunohistochemical staining was positive for TSH and GH. She evolved with suppressed TSH for 15 days. She has been free of disease for the last 18 months. Case 3: 53-year-old man, with loss of libido, sexual impotence and weight gain. Laboratory tests revealed: TSH: 9.1 uIU/ml, FT4: 1.79 ng/dl (0.9-1.8), T3: 164 ng/dl (40-181). MRI showed a macroadenoma. Transsphenoidal surgery was performed, the adenoma was positive for TSH and GH. The patient evolved with primary hypothyroidism. Case 4: 36-year-old woman who presented with hyperthyroidism. The thyroid profile revealed: TSH: 3.76 uIU/ml (0.4-4), T4: 13.2 ug/dl (4-12), FT4: 2.3 ng/dl (0.9-1.7), T3: 247 ng/dl (70-200) and TRH test was flat. MRI showed an adenoma of 10 mm. She underwent transsphenoidal surgery. Immunohistochemical staining was positive for TSH and GH. She evolved with suppressed TSH for 15 days. She has been free of disease for the last 8 years. Case 5: 49-year-old man, with decreased libido and occasional headaches. The hormonal evaluation revealed: TSH: 14.4 uIU/ml (0.3-4.9), T4: 14.8 ug/dl (4.5-12), T4L: 4.1 ng/dl (0.8-1.5). On MRI an invasive macroadenoma was found. Therapy with octreotide-Lar was started and he was lost to follow-up. Conclusions: We report these cases because of their low prevalence. We emphasize that clinical presentation was variable. We can speculate on the secretion of a less biologically active TSH for cases with no symptoms of hyperthyroidism. Five out of five (5/5) showed non-suppressed TSH, 3/5 presented a macrodenoma at initial diagnosis, 3/5 showed TSH suppression one week after surgery, which might be considered as a criteria of cure. Four out of four patients operated on were cured. Rev Argent Endocrinol Metab 51:141-150, 2014 No financial conflicts of interest exist.
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Introducción: La determinación de IGF-I en suero o plasma es una herramienta esencial en el diagnóstico y seguimiento de la acromegalia. Sin embargo, se deben tener presentes algunos inconvenientes en su medición por diferentes inmunoensayos. Objetivos: Evaluar dos inmunoensayos para la determinación de IGF-I y su correlación con el nadir de GH en el TTOG en pacientes acromegalicos. Materiales y métodos: Se analizaron 37 pacientes acromegálicos, 20 mujeres y 17 hombres. IGF-I fue determinada por Immulite 1000, (IMM) y por IRMA (DSL). Se realizó el TTOG y se determinó glucosa y GH en todos los tiempos (basal, 30, 60, 90 y 120min). Se consideró respuesta normal un nadir de GH <1ng/ml. Nueve pacientes se encontraban bajo tratamiento y 28 sin tratamiento. Análisis estadístico: se utilizaron el test de Wilcoxon, de Bland y Altman y curvas ROC. Se consideró significativa una p<0,05. Resultados: Las concentraciones basales de glucosa fueron 97,86±10,91 mg/dl, de GH 2,8 (1,59-14,4) ng/ml, de IGF-I por IMM 602±318 ng/ml y por DSL 1006±596 ng/ml. IGF-I por IMM y DSL mostró una diferencia significativa con p <0,01 y un bias de - 403,2 ng/ml con valores menores por IMM. IGF-I elevada por IMM y DSL, se encontró en el 84% y en el 97% respectivamente. IGF-I elevada con nadir de GH >1ng/ml se encontró en el 70%, con nadir de GH normal en el 13,5%. IGF-I normal con nadir >1ng/ml en el 2,7% y con nadir de GH normal en el 13,5%. El área bajo las curvas ROC no mostró diferencias significativas. Conclusiones: Los niveles de IGF-I determinados por IMM y DSL fueron significativamente diferentes mostrando un bias negativo para IMM. La mayoría de los valores del nadir de GH fueron consistentes con los niveles de IGF-I observándose una discrepancia en el 30% de los pacientes, estuvieran o no bajo tratamiento.
Introduction: IGF-I determination in serum or plasma is an essential tool in the diagnosis and follow-up of acromegaly. Hepatic production of IGF-I is regulated by GH and circulates bound to several IGF-I binding proteins which extends its half life. IGF-I is not released in a pulsatile pattern and has no significant variability in 24 h. Objective: To evaluate two different methodologies in IGF-I levels determination and their correlation with GH nadir in OGTT in acromegalic patients. Material and methods: We analyzed 37 acromegalic patients, 20 women and 17 men, mean age was 45±12 years. IGF-I levels were assayed by Immulite 1000, DPC (IMM) and DSL-5600 ACTIVE® IGF-I Coated-Tube IRMA (DSL) and OGTTs (at baseline and at 30, 60, 90 and 120 minutes) were performed by measuring plasma glucose and GH assay by immunochemiluminometric assay (Access); we considered a nadir <1ng/ml as normal response. Nine patients were under medical treatment (cabergoline: 4, octeotride: 4, and cabergoline plus octeotrite: 1) and 28 without treatment. Statistical analysis: Wilcoxon and, Bland and Altman tests and ROC curves. Differences were considered significant at p< 0.05. Results: Basal glucose levels were 97.86±10.91 mg/dl and mean GH was 2.8 (1.59-14.4) ng/ml. Mean IGF-I levels performed by IMM were 602±318 ng/ml and 1006±596 ng/ml by DSL. There was a statistically significant difference between both methodologies (p<0.01). Bland and Altman test showed a bias of - 403.2 ng/ml with lower values by IMM. We observed elevated IGF-I levels in 84% by IMM and in 97% by DSL, and only one patient had normal levels with both methodologies. Elevated IGF-I levels and GH nadir >1ng/ml were observed in 70% of the patients, increased IGF-I with normal GH nadir in 13.5%, normal IGF-I with GH nadir >1ng/ml in 2.7% and normal IGF-I with normal GH nadir in 13.5%. Patients under treatment: 3 showed normal GH nadir with elevated IGF-I levels, in 2 of them by both methodologies, and in the other one it was normal by IMM and elevated by DSL; the other 6 showed GH nadir > 1ng/ml, 5 of them presented elevated IGF-I by both methodologies and the other one showed discrepancy in IGF-I levels. The under ROC curve area and confidence interval (CI) of 95% for IGF-I IMM and DSL were 0.96 (0.90-1.00) and 0.91 (0.82-1.00) respectively. Differences between the ROC curves areas were not significant Conclusions: IGF-I levels determined by IMM and DSL were statistically significantly different. IGF-I levels showed a negative bias by IMM. Most of the results of GH nadir were consistent with IGF-I levels but we observed discrepancy in 30% of the patients, regardless of whether they were under treatment or not.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Acromegalia/sangue , Fator de Crescimento Insulin-Like I/análise , Teste de Tolerância a Glucose/estatística & dados numéricos , Imunoensaio/métodos , Interpretação Estatística de Dados , Hormônio do Crescimento Humano/análiseRESUMO
Objetivos: Estimar la frecuencia de complicaciones maternofetales en mujeres que se embarazaron durante el tratamiento con cabergolina (CAB). Estimar la frecuencia de patología detectada posnacimiento en los niños producto de dichos embarazos. Material y métodos: Estudio retrospectivo y multicéntrico de 86 embarazos en 78 mujeres con hiperprolactinemia idiopática (7) o tumoral (44 micro y 27 macro), en tratamiento con CAB en el momento de la concepción. Edad: 20 a 45 años; PRL inicial: 30 a 1429 ng/ml; duración del tratamiento previo al embarazo 1 a 120 meses; dosis: 0.125 a 4 mg/semana. El rango de exposición embriofetal a la CAB fue de 3 a 27 semanas, el 96.39% de las pacientes la recibió durante el primer trimestre y el 3.61% hasta el segundo. Resultados: No hubo complicaciones mayores durante el embarazo. Se registraron 7 abortos espontáneos (8.1%) y 75 partos, de los cuales 49 fueron vaginales y 26 cesáreas. Se registraron 69 recién nacidos, 63 fueron a término y 6 pretérmino (8.8%), ninguno bajo peso para la edad gestacional. En 3 (5.2%) recién nacidos se observó: 1 malformación mayor (Síndrome de Down) y 2 menores (hernia umbilical e inguinal). Se obtuvo seguimiento de 42 recién nacidos; se diagnosticó epilepsia refractaria en uno y un trastorno generalizado del desarrollo en otro. No se halló una mayor frecuencia de complicaciones en los embarazos ni en los recién nacidos expuestos a CAB que en la población normal. Sería necesario mayor número de pacientes para concluir sobre la seguridad de CAB durante el embarazo.
Objectives: To assess the rate of any potential adverse effects on pregnancy and embryo-fetal development in women who became pregnant under treatment with cabergoline (CAB). To follow up medical data of children who were born from mothers exposed to Cab in early weeks of gestation. Material and methods: Observational, retrospective and multicenter study on 86 pregnancies in 78 women with idiopathic or tumoral hyperprolactinemia. All patients were under Cab at conception. The average age was 29 (range: 20-45). Pituitary images at diagnosis showed 44 microadenomas, 27 macroadenomas and 7 were normal. Serum PRL at baseline was between 30 and 1429 ng/ml. Duration of therapy before pregnancy ranged from 1 to 120 months. Maternal and fetal exposure to cabergoline and doses ranged from 0.125 to 4 mg/week. The mean serum PRL level under which patients achieved pregnancy was 17 ng/ml. Fetal exposure ranged from 3 to 27 weeks; 96.39% of patients received CAB during the first trimester of pregnancy and 3.61% until the second one. Results: No significant complications during pregnancy were found. Seven women (8.1%) had spontaneous abortions. Term deliveries were recorded in 63/69, preterm in six (8.8%), none of them with low weight for gestational age. Neonatal abnormalities were observed in 3 (5.2%): 1 major (Down syndrome) and 2 minor malformations (umbilical and inguinal hernia). Two out of 42, developed abnormalities during the follow- up, one of them was a refractory epilepsy during the second month of life, the other presented a Pervasive Developmental Disorder diagnosed in the third year of life. Conclusion: No significantly higher frequency of complications was found in pregnancies and/or offspring exposed to CAB than in normal population. Larger series of patients are needed to asses the safety.
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Humanos , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Complicações na Gravidez/etiologia , Ergolinas/efeitos adversos , Anormalidades Congênitas/prevenção & controle , Gravidez/efeitos dos fármacos , Desenvolvimento Embrionário e Fetal/efeitos dos fármacosRESUMO
OBJECTIVES: The aim of this study was to determine the incidence, sociodemographic parameters, and outcome of surgical repairs of obstetric fistula in our center. METHODS: Case files of patients managed for genital tract fistula over a 10-year period (January 1, 1997 to December 31, 2006) were retrieved and analyzed. RESULTS: Fifty-five patients with of genital tract fistula were managed in the period under review, constituting 1.17% of total gynecological admissions. Obstetric fistula accounted for 51 (93%) of genital fistula, and 92.7% of cases were caused by prolonged obstructed labor. The most common form of fistula was the midvaginal type, and 89% of affected women were married with primiparous women mostly affected (43.6%). Menstrual function was lost in 51% of the patients, while obstetric palsy complicated 18.2% of the cases. Half of the women (51%) were abandoned by their spouses, and surgical repair was successful in only 32% of the cases. CONCLUSION: Obstetric fistula continues to show the deficiency in women's general health status occasioned by poor childbirth attendance in developing countries. Affected women suffer double jeopardy as a result of dearth of appropriate experts in fistula repair.
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Obstetrícia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Complicações na Gravidez/cirurgia , Fístula Vesicovaginal/cirurgia , Adolescente , Adulto , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Estudos Retrospectivos , Fatores Socioeconômicos , Inquéritos e Questionários , Resultado do Tratamento , Estados Unidos , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/etiologia , Adulto JovemRESUMO
BACKGROUND: The incidence of adrenal hemorrhagic pseudocyst is very low. A total of 613 adrenal cysts and 85 hemorrhagic pseudocysts have been reported. A laparoscopically diagnosed and resolved case is presented here, together with the current diagnostic and therapeutic procedures. METHODS: A 40-year-old woman was admitted because of an asymptomatic nonfunctional right adrenal tumor. Right laparoscopic adrenalectomy was performed, 8-cm cyst which found an with thick walls and organized hematic content. The postoperative course was uneventful. Follow-up was 14 months. The pathology was an adrenal hemorrhagic pseudocyst. DISCUSSION: A total of 56% of adrenal cysts are pseudocysts. One third of them have hematic content. They may present as an asymptomatic finding with nonspecific symptoms or as a hormone secreting or complicated tumor. Their vascular etiology is not yet totally accepted. There is a tendency for intracystic bleeding. it is advisable to evaluate the hormonal profile and morphologic characteristics in all cases. Treatment options include needle aspiration, percutaneous drainage, and cyst or gland resection. Laparoscopic excision should be evaluated.