Macroprolactinemia in women with hyperprolactinemia: a 10-year follow-up.

OBJECTIVES: To determine the frequency of macroprolactinemia in a cohort of hyperprolactinemic women, describing 1) the association of macroprolactinemia with clinical variables and morphological changes in the pituitary gland and 2) clinical status and prolactin levels after 10 years of follow-up. DESIGN: Blood samples were obtained from 32 patients for hormonal assessment. Treatment with cabergoline or bromocriptine was interrupted 3 months before the determination of serum prolactin and macroprolactin. Macroprolactin was measured using the polyethylene glycol (PEG) precipitation method. Computed tomography was performed in all patients. RESULTS: The frequency of macroprolactinemia was 28.1%. In 19 patients prolactin remained elevated (persistent hyperprolactinemia). In 13, prolactin returned to normal (former hyperprolactinemia). Nine patients with PEG recovery between 40 and 50%, and the only two macroprolactinemic patients with previous hyperprolactinemia were excluded from the analysis of clinical outcomes. Only one of seven macroprolactinemic patients had an abnormal pituitary image (empty sella). None had galactorrhea. MAIN FINDINGS: Classic symptoms of hyperprolactinemia and abnormal imaging findings are not common in patients in whom macroprolactin is the predominant form of PRL. CONCLUSIONS: Women with hyperprolactinemia, especially if asymptomatic, should be routinely screened for macroprolactinemia. Macroprolactinemia remains stable in the long term.

Neuromuscular, hormonal, and metabolic responses to different plyometric training volumes in rugby players.

The purpose of this study was to investigate the effect of different volumes of plyometric exercise (i.e., 100, 200, or 300 hurdle jumps) on acute strength and jump performance and on the acute hormonal and lactate responses in rugby players. Eleven young male elite rugby players (age, 23.5 ± 0.9 years; height, 173 ± 4.8 cm) volunteered for the study. Maximal isometric peak torque (PT), maximal rate of force development (RFD), squat jump (SJ), and drop jump (DJ) performance were assessed before and 5 minutes, 8 hours, and 24 hours after 100, 200, or 300 jumps. In addition, total testosterone (TT), cortisol (COR), and lactate were measured before and after the 3 different plyometric exercise volumes. There were significant decreases in the PT (p < 0.02) and maximal RFD (p < 0.001) 5 minutes, 8 hours, and 24 hours after 100, 200, and 300 jumps, with no differences between the exercise volumes. Additionally, there were significant decreases in the SJ (p < 0.001) and DJ (p < 0.01) performances 24 hours after 100, 200, and 300 jumps, with no differences between the exercise volumes. However, there were significant increases in the TT (p < 0.001), COR (p < 0.05), and lactate (p < 0.001) after 100, 200, and 300 jumps, with no differences between the exercise volumes. All plyometric exercise volumes (100, 200, and 300 jumps) resulted in similar neuromuscular, metabolic, and hormonal responses.

Hormonal responses to concurrent strength and endurance training with different exercise orders.

The purpose of this study was to examine the influence of the intrasession sequencing of concurrent strength and aerobic training on the acute testosterone (TT) and cortisol (COR) responses. Ten recreationally strength-trained young men (23.5 ± 0.9 years) performed 2 exercise interventions: aerobic-strength (AS) and strength-aerobic (SA), which consisted of 30 minutes of aerobic exercise on a cycle ergometer at 75% of maximal heart rate and 3 sets of 8 repetitions at 75% of 1 repetition maximum (1RM) in 4 strength exercises. Maximal heart rate was determined using a maximal incremental test on a cycle ergometer. Blood samples were collected before, between exercise modalities, and immediately after the concurrent training sessions to determine basal and acute total TT and COR concentrations. There were significant increases in TT after the first modality in both exercise orders (p < 0.05). However, the TT level remained significantly higher than the resting levels after the second exercise modality only in the AS (p < 0.05) which resulted in a significant higher relative total change after the complete concurrent training session compared with SA (p < 0.05). Regarding COR, there were significant increases after the first modality in both AS and SA orders (p < 0.05), but the COR returned to resting levels after the second modality in both AS and SA interventions. During AS and SA, the change observed after the first modality performance was greater than that after the second in both hormones. The present results suggest that the TT response is optimized after the AS order, whereas both AS and SA produced similar hormonal levels at all time points. However, it is important to state that the present results should be applied only when short duration and moderate intensity aerobic training is performed.

Neuromuscular economy, strength, and endurance in healthy elderly men.

Declines in muscular strength resulting from reduced neural activity may influence the reduction in aerobic capacity in older men. However, there has been little investigation into the relationship between muscular strength and economy of movement during aerobic exercise in elderly subjects. Thus, the purpose of this study was to investigate the possible relationship between strength, aerobic performance, and neuromuscular economy in older men. Twenty-eight aged men (65 ± 4 years old) were evaluated in dynamic (1 repetition maximum test), isometric strength (maximal voluntary contraction), and rate of force development. Peak oxygen uptake, maximal workload, and ventilatory threshold were determined during a ramp protocol on a cycle ergometer. Throughout the same protocol, the neuromuscular economy (electromyographic signal) of the vastus lateralis was measured. Significant correlations were found between muscular strength, cardiorespiratory fitness, and neuromuscular economy (r = 0.43-0.64, p < 0.05). Our results suggest that cardiorespiratory capacity and economy of movement are associated with muscular strength during aging.

Salivary hormonal responses to different water-based exercise protocols in young and elderly men.

Although adaptations to water-based resistance exercise and conventional water-based exercise have been investigated, little is known regarding acute anabolic and catabolic hormonal responses to these 2 types of exercise. The purpose of this study was to investigate the acute responses of salivary testosterone and cortisol to 2 water-based exercise protocols in which the different intensities were determined using Borg's perceived exertion scale. Ten young (24 +/- 2.7 yr) and 7 elderly men (65 +/- 5.5 yr) who were familiar with exercise in water were subjects of the study. Salivary samples were collected at rest and 5 minutes after the 2 water-based exercise protocols. One session involved intermittent water resistance training at a Borg-scale intensity of 19 (W19), whereas the other involved continuous water aerobic training at an intensity of 13 (W13). The samples were used to determine salivary levels of free testosterone and cortisol. There was a significant increase on salivary testosterone in both groups after the W19 protocol (p < 0.05), but no such alteration was observed after W13. The testosterone response to the W19 protocol was significantly higher in young than in elderly men (p < 0.05). Although no modification on salivary cortisol was observed after either protocol, in young men, the cortisol response to W19 was higher than in elderly men (p < 0.05). Water-based exercise with emphasis on strength development was found to stimulate a more acute increase on salivary testosterone than water-based aerobic exercise, probably as a result of the higher intensity used in that training protocol. Given the known relationship between acute hormonal responses and chronic neuromuscular adaptations, the testosterone response after W19 should be considered when prescribing water-based exercise, especially to older populations.

Relationship between endogenous testosterone and cardiovascular risk in early postmenopausal women.

Cardiovascular disease (CVD) is the leading cause of death among postmenopausal women. Changes in endothelial function play an important role in the pathophysiology of atherosclerosis, and evidence suggests that interventions to improve endothelial function could modify the rates of progression and the risk of cardiovascular events. In addition, a positive association between markers of endothelial dysfunction and androgenicity has been described in women with polycystic ovary syndrome, suggesting a correlation with the early-onset endothelial dysfunction found in these patients. We performed a cross-sectional study to verify whether endogenous testosterone levels are correlated with markers of inflammation and endothelial function and with anthropometric and metabolic profile in 53 postmenopausal women. Serum testosterone, sex hormone-binding globulin, C-reactive protein (CRP), fibrinogen, and plasma endothelin-1 (ET-1) were determined. Patients were stratified into 2 groups (higher or lower than the mean testosterone levels of the studied sample). Mean age was 55 years (+/-5), and median time since menopause was 5.5 years (interquartile range, 3-8 years). Body mass index and waist circumference were significantly higher in the group with testosterone levels >or=0.49 ng/mL. Median CRP levels were greater in the group with higher testosterone levels (1.17 [0.17-2.36] vs 0.17 [0.17-0.61] mg/L, P = .039). Median ET-1 levels were also higher in women with greater testosterone levels (0.84 [0.81-0.97] vs 0.81 [0.74-0.84] pg/mL, P = .023). An association of testosterone with CRP (r = 0.416, P = .004) and ET-1 (r = 0.323, P = .031) was observed. This association was dependent on homeostasis model assessment index for ET-1 but not CRP. Testosterone was also associated with waist circumference and blood pressure (P = .001). These data suggest that endogenous testosterone levels in recently postmenopausal women may be part of a proatherogenic profile. Longitudinal studies are needed to assess if androgenicity represents a risk factor for cardiovascular disease and the clinical relevance of its association with ET-1 and CRP in this population.

Effects of Marapuama in the chronic mild stress model: further indication of antidepressant properties.

ETHNOPHARMACOLOGY RELEVANCE: Ptychopetalum olacoides Bentham (PO) (Olacaceae), known as Marapuama, is regarded as a "nerve tonic" in the Amazon. Traditional uses include states of lassitude with noticeable lack of desire/motivation, and to manage particularly stressful (physical and/or psychological) circumstances. Suggestive of antidepressant activity, we have established that a specific PO ethanol extract (POEE) significantly decreases immobility in the tail suspension and forced swimming tests. AIM OF THE STUDY: The aim of this study was to verify the effects of POEE in the unpredictable chronic mild stress (UCMS) depression model in mice, given the construct and face values of the UCMS as an experimental model of depression and the traditional use of this species. MATERIALS AND METHODS: Over 6 weeks BALB/c mice were subjected to the UCMS protocol. The effects of POEE (50, 100, 300mg/kg, p.o.) and imipramine (20mg/kg, i.p.) were evaluated in relation to coat state, splash-test grooming, and corticosterone levels. RESULTS: The coat state degradation, decreased grooming and increased serum corticosterone induced by UCMS were prevented by POEE and imipramine treatments. CONCLUSION: In addition to supporting traditional claims and previously reported antidepressant properties for POEE, this study shows that POEE prevents stress-induced HPA hyperactivity.

Hormonal responses to resistance exercise in long-term trained and untrained middle-aged men.

This cross-sectional study compared hormonal responses to resistance exercise between trained and untrained men to investigate the adaptations of the endocrine system to long-term strength training in middle-aged men. Twenty-one middle-aged men were recruited for this study and matched into a strength-trained group (SG) (n = 10) and an untrained group (UG) (n = 11). In the SG, the individuals had practiced strength training for hypertrophy for at least 3 years. Upper- and lower-body muscle strength was measured with a 1 repetition maximum (1RM) test. Blood samples were collected at rest and after multiple sets of a superset strength training protocol (SSTP), with an intensity of 75% of 1RM values. With these blood samples, the levels of total testosterone (TT), free testosterone (FT), dehydroepiandrosterone (DHEA), cortisol, and sex hormone-binding globulin (SHBG) were determined. In addition, the TT-to-cortisol ratio and TT-to-SHBG ratio were calculated. There was no difference at rest between groups in hormonal values for TT, FT, DHEA, cortisol, the TT-to-SHBG ratio, and the TT-to-cortisol ratio. There were increases after SSTP in the levels of TT, FT, DHEA, and cortisol and the TT-to-SHBG ratio in the UG, but only FT increased in the SG. The SG demonstrated lower values in the TT-to-SHBG ratio after the training session. These results suggest the presence of alterations in anabolic and catabolic hormonal responses to resistance exercise in long-term trained middle-aged men, with the trained subjects demonstrating lower responsiveness in the hormone values. Long-term trained men seem to require a higher volume of training, at least similar to their daily workout, to stimulate greater hormone responses.

Changes in S100B cerebrospinal fluid levels of rats subjected to predator stress.

Predator stress is a type of psychogenic stress induced by an innate recognition of threat. S100B, a calcium-binding protein secreted by astrocytes, has been associated with neurotrophic or neurotoxic action in several neuropsychiatric disorders. It has been recently demonstrated that serum S100B levels in rats are increased after stress by immobilization [S. Scaccianoce, P. Del Bianco, G. Pannitteri, F. Passarelli, Relationship between stress and circulating levels of S100B protein, Brain Res. 1004 (2004) 208-11]. This study aimed to measure cerebrospinal fluid (CSF) S100B in rats after an acute stress situation, which is induced by exposure to a predator. S100B was measured in CSF and in hippocampal and cortical slices by ELISA. Forty-three male Wistar rats, aged 70 days, were randomly assigned to handled (control) or stressed groups (exposed to a cat for 5 min). CSF and brain tissue were removed 1 or 24 h after the procedures. Rats exposed to the cat demonstrated a biphasic change in CSF S100B levels. An increase was observed at 1 h after cat exposure, and a decrease was observed 24 h later, although this was not accompanied by changes in S100B content in hippocampus or cerebral cortex. The effectiveness of the stressor used was confirmed by increased freezing response (during cat exposure) and increased anxiety in the plus maze test (1 h after cat exposure). These results indicate that CSF S100B is changed by stress, reinforcing the possibility that this protein is involved in the adaptive response to stress and/or in secondary neuropsychiatric disorders.

Effects of a highly palatable diet on lipid and glucose parameters, nitric oxide, and ectonucleotidases activity.

Obesity has reached epidemic proportions worldwide and is stimulated by the ready availability of food rich in fat and sugar (highly palatable diet). This type of diet increases the risks of obesity-associated pathologies, such as insulin resistance and cardiovascular disease. Nitric oxide, a potent endogenous vasodilator, is decreased in these pathologies, mostly as a result of insulin resistance. Ectonucleotidases are ecto and soluble enzymes that regulate the availability of the nucleotides ATP, ADP, and AMP and the nucleoside adenosine in the vascular system, thereby affecting vasoconstriction, vasodilatation, and platelet aggregation homeostasis. The aim of this study was to evaluate the effects of a highly palatable diet on serum lipid and glucose parameters, nitric oxide, and ectonucleotidase activity. Forty male Wistar rats were fed 1 of 2 diets for either 45 days or 4 months: standard chow (SC, n = 10) or a highly palatable diet enriched with sucrose (HP, n = 10). Body mass, visceral fat mass, glucose tolerance, cholesterol (total, high-density lipoprotein (HDL) and non-HDL), serum triacylglycerol, liver triacylglycerol, and free glycerol were increased in the HP group after 45 days and after 4 months, whereas insulin levels were not different between the groups at either time. Furthermore, levels of nitric oxide metabolites and ATP, ADP, and AMP hydrolysis were significantly lower in the HP group (p < 0.05) after 4 months. In conclusion, the consumption of the HP diet for 4 months induced overall corporal and metabolic changes, and decreased nitric oxide metabolites and ectonucleotidase activity, thereby promoting an appropriate environment for the development of cardiovascular diseases, without apparent changes in insulin levels.

Effects of nonoral estradiol-micronized progesterone or low-dose oral estradiol-drospirenone therapy on metabolic variables and markers of endothelial function in early postmenopause.

OBJECTIVE: To evaluate the effects of low-dose oral hormone therapy and nonoral hormone therapy on endothelial function markers and on anthropometric, metabolic, and hormonal variables in early postmenopausal women. DESIGN: Cross-over, randomized clinical trial. SETTING: Gynecological Endocrinology Unit. PATIENT(S): Healthy postmenopausal women. INTERVENTION(S): Twenty patients received oral E(2) 1 mg plus drospirenone 2 mg/d for 2 months. Another group of 20 patients received 3 mg/d 17beta intranasal E(2), and then 200 mg/d vaginal micronized P for 14 days during two 28-day cycles. At the end of this period, the patients were crossed over for another 2 months. MAIN OUTCOME MEASURE(S): Endothelial function markers and anthropometric, metabolic, and hormonal variables before and after hormone therapy. RESULT(S): Mean age was 51.2 +/- 2.7 years. Mean time since menopause was 23.1 +/- 10 months. After low-dose treatment, a reduction in waist circumference, waist-to-hip ratio, and high-density-lipoprotein cholesterol was observed. Triglycerides and von Willebrand factor levels decreased significantly with nonoral treatment. Fasting glucose and insulin levels did not change. In both groups, total and non-high-density-lipoprotein cholesterol levels decreased below basal levels, and endothelin-1, fibrinogen, and C-reactive protein levels remained unchanged. CONCLUSION(S): Neither treatment induced deleterious effects in the short term on variables related to cardiovascular risk in early postmenopausal women.

Antidepressant-like effects of melatonin in the mouse chronic mild stress model.

Melatonin is a hormone primarily synthesized by the pineal gland and has been shown to govern seasonal and circadian rhythms, as well as the immune system, certain behaviours, and responses to stress. Chronic exposure to stress is involved in the etiology of human depression, and depressed patients present changes in circadian and seasonal rhythms. This study investigated the effects of daily exogenous melatonin (1 and 10 mg/kg, p.o.) and imipramine (20 mg/kg, i.p.) on the changes in the coat state, grooming behaviour and corticosterone levels induced by the unpredictable chronic mild stress model of depression in mice. As expected, the 5 weeks of unpredictable chronic mild stress schedule induced significant degradation of the coat state, decreased grooming and increased serum corticosterone levels. All of these unpredictable chronic mild stress-induced changes were counteracted by melatonin (P<0.05) and imipramine (P<0.01). Especially in view of the relevance of stress as a major contributing factor in depression, as well as the alleged importance of normalizing a hyperfunctioning HPA axis and resynchronizing circadian rhythms for a successful treatment of depression, this study reassesses the potential of melatonin as an antidepressant.

Correlations between serum and salivary hormonal concentrations in response to resistance exercise.

The aim of present study was to examine the relationships between serum and salivary values of free testosterone, dehydroepiandrosterone, and cortisol before and after a session of resistance exercise. Twenty-eight healthy men (mean age 40 years, s = 4) participated in the present study. Serum and salivary samples were collected at rest and after a multiple-sets resistance exercise protocol, of approximately 25 minutes duration. Concentrations of free testosterone, dehydroepiandrosterone, and cortisol were measured using radioimmunoassay kits. No significant correlation was observed between serum free testosterone and salivary testosterone (r = 0.22 to 0.26, P > 0.05). Serum cortisol was significantly correlated with salivary cortisol before (r = 0.52, P = 0.005) and after (r = 0.62, P = 0.001) the exercise protocol. Serum and salivary concentrations of dehydroepiandrosterone were significantly correlated before (r = 0.68, P < 0.001) and after (r = 0.7, P < 0.001) exercise. The results of the present study suggest that even under exercise conditions, the salivary values of cortisol and dehydroepiandrosterone can reflect the behaviour of these hormones in blood. However, further studies are necessary to verify if salivary testosterone reflects the behaviour of serum free testosterone during resistance exercise.

Effect of DHEA glutamate release from synaptosomes of rats at different ages.

Dehydroepiandrosterone (DHEA) exerts multiple effects in the central nervous system. Most of them seem to be mediated through their nongenomic actions on neurotransmitter receptors, and these actions occur within seconds or milliseconds. DHEA increases neuronal excitability, enhances neuronal plasticity, and has neuroprotective properties. By investigating glutamate release from synaptosomes of rats at different ages (from 17 days to 12 months), we observed that (i) there is an increase in basal and K(+)-stimulated L-[3H] glutamate release in rats at 12 months old, when compared to other ages; and (ii) there is an inhibitory effect of DHEA on basal L-[3H] glutamate release in 12 months old. This inhibitory effect of DHEA could be related to its reported protective role against excitotoxicity caused by overstimulation of the glutamatergic system and ageing.

Fatores relacionados com as respostas da testosterona e do cortisol ao treinamento de força / Factors concerned with the testosterone and cortisol response to strength training

Esse artigo visa revisar os resultados encontrados na literatura a respeito dos diversos fatores relacionados com a resposta hormonal aguda e crônica ao treinamento de força. Foi observado que existe uma estreita relação entre a treinabilidade de indivíduos submetidos ao treinamento de força e os níveis circulantes de testosterona nesses sujeitos. Além disso, outros parâmetros hormonais, tais como as razões entre a testosterona e sua proteína carreadora e entre a testosterona com o cortisol, também foram relacionados com a capacidade de aumento de força. Diversos fatores ligados à sessão de treino, além das características da população investigada, influenciam a resposta hormonal aguda e crônica ao treinamento. Entre esses fatores, o volume e a intensidade são as principais variáveis ligadas à magnitude dessa resposta. A determinação de quais fatores possam estar estreitamente relacionados com a resposta hormonal ao treinamento de força pode ser importante para o estabelecimento de uma sessão de treino e uma periodização que otimizem o ambiente anabólico determinado pelas concentrações de testosterona e cortisol, e, dessa forma, maximizar os ajustes neuromusculares decorrentes desse tipo de treinamento.

This study aims to review the results found in the literature concerning a variety of factors related to the acute and chronic hormonal response to strength training. It has been observed that there is a close relationship between the trainability of individuals submitted to strength training and the circulating testosterone levels in these subjects. Moreover, other hormonal parameters, such as the ratios between testosterone and its binding protein and between testosterone and cortisol, were also related to the ability to increase strength. Besides the characteristics of the population investigated, several factors associated with the training session affect the acute and chronic hormonal response to training. Among them, volume and intensity are the main variables associated with the magnitude of this response. Determining which factors might be closely related to the hormonal response to strength training may be important to establish a training session and a periodization that optimize the anabolic environment determined by the testosterone and cortisol concentrations, and thus enhance the neuromuscular adaptations resulting from this type of training.

Influência do uso continuado de fluoxetina nas dosagens séricas de prolactina em mulheres / Influence of the continous use of fluoxetin in the measurement of serum prolactin in women

A importância da dosagem de prolactina reside principalmente no fato de sua utilização diagnóstica em alterações da hipófise anterior. Alguns medicamentos, como a fluoxetina, podem alterar a secreção da prolactina. Assim, o foco deste trabalho foi ode avaliar a real importância de se considerar o uso da fluoxetina, um inibidor seletivo da recaptação da serotonina (ISRS), como um interferente na interpretação dos valores de dosagens laboratoriais da prolactina em mulheres. Foram analisados dados de 95 mulheres, com idade entre 15 e 70 anos, que realizaram dosagens séricas de prolactina. As mulheres em tratamento com a fluoxetina apresentaram um aumento significativo de prolactina. Este aumento foi maior em mulheres com até 29 anos, onde chegou a níveis considerados patológicos, diminuindo de uma maneira inversamente proporcional com o aumento da faixa etária. Acima dos 45 anos, onde a maioria das mulheres encontra-se na menopausa, os valores de prolactina não se alteram com o uso da fluoxetina.

Low-dose adrenocorticotropin test in patients with the Acquired Immunodeficiency Syndrome

Adrenocortical insufficiency is a serious complication of AIDS. Usually, integrity of the hypothalamo-pituitary-adrenal (HPA) axis in AIDS patients is assessed by measuring basal cortisol levels and cortisol response to 250 µg of ACTH. Recent studies suggest that a lower ACTH dose increases the sensitivity of the procedure. In the present study, we investigated the prevalence of adrenal hypofunction in AIDS patients using a low-dose ACTH test (1 µg), evaluated the clinical characteristics that might suggeest this diagnosis, and the diseases and/or drugs that could be associated with it. We prospectively evaluated 63 very ill AIDS patients and 16 normal controls. A standard examination assessed the presence of signs and symptoms of adrenal insufficiency. Blood samples were colleted before and 30 and 40 minutes after an injection of 1 µg 1-24 ACTH. No opportunistic disease, signs, symptoms or drugs were associated with an abnormal cortisol response to ACTH. The lowest stimulated cortisol level in the contol group was 18.5 µg/dL; cortisol level (greather or equal) 18 µg/dL were taken to indicate a normal HPA axis. Test results revealed that 12/63 AIDS patients (19 percent) had an abnormal HPA axis. With these data in mind, we suggest a prospective adrenal function evaluation of all severely ill AIDS patients.

Diagnóstico e prevalência da hiperplasia adrenal congênita forma näo clássica em uma amostra de 122 pacientes hirsutas / Diagnosis and prevalence of nonclassical congenital adrenal hyperplasia in 122 hirsute patients

OBJETIVOS: Estabelecer o diagnóstico de HAC-NC e a prevalência desta patologia no nosso meio, em pacientes consultando por hirsutismo. PACIENTES E MÉTODOS: Foram avaliadas do ponto de vista clínico e hormonal 122 pacientes hirsutas. A avaliaçao hormonal incluiu a realizaçao sistemática do teste do ACTH em todas as pacientes. Os dados foram comparados com um grupo controle constituído por 13 mulheres normais, nao hirsutas e com um grupo de 5 heterozigóticas obrigatórias para a deficiência da P45Oc21, maes das pacientes. RESULTADOS: Nove pacientes tiveram o diagnóstico de HAC-NC por déficit na P45O-c21 e 1 por deficiência na P45O-c11. O perfil clínico e hormonal apresentou grande variabilidade entre as 9 pacientes, incluindo os níveis basais de 17-hidroxiprogesterona, que foram normais em 2 delas. A paciente com deficiência na P45O-c11 era normotensa, com acne severa e moderadamente hirsuta, sem outros sinais de virilizaçao. Esta paciente apresentou níveis moderadamente elevados de 17-hidroxiprogesterona em resposta ao ACTH e o diagnóstico foi confirmado pela resposta aumentada do 11 deoxi-cortisol ao estímulo corticotrófico. Na amostra estudada de 122 pacientes hirsutas, a prevalência encontrada para a HAC-NC por deficiência da P45O-c21 foi de 7,4 por cento.

Uso clínico e nefrotoxicidade da gentamicina em um hospital geral: estudo prospectivo em 83 pacientes / And clinical use of gentamicin nephrotoxicity in a general hospital: prospective study in 83 patients

A gentamicina, principal antibiótico do grupo dos aminoglicosídios, é utilizada muito frequentemente em pacientes hospitalizados, portadores de infecções graves. Apresenta boa atividade no combate a infecções causadas por bactérias gram-negativas, principalmente Escherichia coli, Proteus e as do grupo Pseudomas, podendo ser ativa também contra algumas cepas de bactérias gram-positivas. É comumente associada a outros antibióticos, principalmente do grupo das penicilinas. A maior preocupação com o uso desse antibiótico refere-se ao seu potencial tóxico, especialmente em relação ao rim, podendo provocar IRA. Com o objetivo de verificar a incidência deste efeito adverso no nosso meio, desenvolvemos estudo prospectivo em 83 pacientes hospitalizados submetidos ao tratamento regular com gentamicina. Encontramos incidência de IRA em 6% dos casos estudados; destes, 60% eram do tipo não oligúrico. A insuficiência renal aguda esteve associada a níveis séricos elevados de gentamicina, principalmente quando o nível mínimo foi superior a 2 microgramas por milímetro. Concluímos, portanto, que quando a gentamicina for utilizada, deve ser realizada uma cuidadosa avaliação da função renal. Sugerimos também que a monitorização da concentração sérica do antibiótico deve ser efetuada rotineiramente, no nosso meio.

Gentamicin, an antibiotic of the main aminoglycosides, is used very frequently in hospitalized patients, patients with serious infections. Shows good activity in combating infections caused by gram-negative bacteria, especially Escherichia coli, Proteus and Pseudomonas group, may also be active against some strains of gram-positive bacteria. It is commonly associated with other antibiotics, mainly penicillin group of drugs. The biggest concern with the use of this antibiotic refers to its potential toxicity, especially in relation to the kidney and may cause ARF. In order to check the incidence of this adverse effect on our environment, we developed a prospective study in 83 hospitalized patients undergoing regular treatment with gentamicin. We found the incidence of ARF in 6% of cases and of these, 60% were non-oliguric type. Acute renal failure was associated with elevated serum levels of gentamicin, particularly when the minimum level was greater than 2 micrograms per milliliter. We therefore conclude that when gentamicin is used, should be performed a careful assessment of renal function. We also suggest that monitoring of serum concentration of antibiotic should be performed routinely in our midst.

Avaliaçäo do método imunoturbidimétrico para medida de excreçäo urinária de albumina em pacientes com diabete melito / Evaluation of the immunoturbidimetry method for measure albumin excretion in patients with diabetes mellitus

O objetivo deste estudo foi verificar se a imunoturbidimetria (ITM) é um método acurado para avaliar a excreçäo urinária de albumina (EUA) de pacientes com diferentes graus de comprometimento renal pelo diabete melito (DM). A EUA foi medida por radioimunoensaio (RIE, Diagnostic Product Corporation) e por ITM (Microalb, Ames) em 64 amostras de urina de 24h de 55 pacientes com DM. De acordo com as medidas por RIE, as amostras foram divididas em: normoalbuminúricas (EUA < 20 ncg/min; n=30), microalbuminúricas (EUA > 20 e < 200 mcg/min; mcg/min; n=18) e proteinúricas (EUA > 200 mcg/min; n=16). O coeficiente de variaçäo (CV) intra-ensaio médio da ITM foi calculado a partir de 9 amostras (3 normoalbuminúricas, 3 microalbuminúricas, e proteinúricas) sendo realizadas 10 medidas de cada amostra. Para o CV intersaio médio foram usadas 7 amostras (2 normoalbuminúricas, 3 microalbuminúricas, 2 proteinúricas), sendo realizadas 3 medidas de cada uma em 3 diferentes "Kits". O coeficiente de correlaçäo de Spearman das dosagens por ITM e RIE foi 0,97 e nas amostras normoalbuminúricas = 0,81; microalbuminúricas = 0,72 e proteinúricas = 0,95 (P<0,0001). O CV intra-ensaio médio da ITM foi = 4,7 por cento e nas amostras normoalbuminúricas = 3 por cento e proteinúricas = 3,6 por cento. O CV interensaio médio foi = 5,5 por cento. Conclui-se que a determinaçäo da EUA por ITM é uma técnica exata e precisa e pode ser utilizada para avaliaçäo de pacientes com DM em diferentes estágios de nefropatiadiabética