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PURPOSE: Reporting the clinical outcomes, patient satisfaction, and complications following an imaging-guided percutaneous screw fixation in the treatment of sacroiliac joint dysfunction and evaluating the safety and effectiveness of this method. METHODS: We performed a retrospective study on a prospectively gathered cohort of patients with physiotherapy-resistant pain due to sacroiliac joint incompetence that underwent percutaneous screw fixation, between 2016 and 2022 in our center. A minimum of two screws were used in all patients to obtain fixation of the sacroiliac joint, using percutaneous screw insertion under CT guidance, coupled with a C-arm fluoroscopy unit. RESULTS: The mean visual analog scale significantly improved at 6 months of follow-up (p < 0.05). One hundred percent of the patients reported significant improvement in pain scores at the final follow-up. None of our patients experienced intraoperative or postoperative complications. CONCLUSION: The use of percutaneous sacroiliac screws provides a safe and effective technique for the treatment of sacroiliac joint dysfunction in patients with chronic resistant pain.
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Fixação Interna de Fraturas , Articulação Sacroilíaca , Humanos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/cirurgia , Resultado do Tratamento , Tomografia Computadorizada por Raios X , DorRESUMO
Lithium, which is widely used in the management of patients with bipolar disorder, may alter the function of some endocrine organs, particularly the thyroid and parathyroid glands, as well as it may reduce the sensitivity of the kidneys to vasopressin. In most lithium-treated patients, endocrine abnormalities are limited to one endocrine organ and are observed only after long-term lithium therapy. The patient reported in this study developed hypothyroidism, hyperparathyroidism and nephrogenic diabetes insipidus. However, the last two disorders were induced by a small increase in plasma lithium levels as a result of the treatment with enalapril and verapamil. This case shows that patients at high risk of thyroid, parathyroid or renal disorders receiving lithium should not be treated with drugs known to interfere with plasma lithium levels.
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OBJECTIVE: Studies assessing the extra-lipid effects of ezetimibe have provided contrasting results. In the present study, we compared the effects of ezetimibe and simvastatin, administered alone or in combination, on the secretory function of human lymphocytes, systemic inflammation and endothelial function in subjects with elevated cholesterol levels. METHODS: A prospective study involving a group of 178 ambulatory patients with isolated hypercholesterolaemia who were randomly assigned in a double-blind fashion to 90days of treatment with ezetimibe (10mg), simvastatin (40mg), ezetimibe (10mg) plus simvastatin (4mg) or placebo. A total of 170 patients completed the study. MAIN OUTCOME MEASURES: Lymphocyte cytokine release and plasma levels of high-sensitivity C-reactive protein (hsCRP) and intercellular adhesion molecule 1 (ICAM-1). RESULTS: Although both drugs reduced lymphocyte release of tumour necrosis factor-α, interferon-γ and interleukin-2 in a lipid-independent manner, only the effect of simvastatin was statistically significant (P<0.001). This lymphocyte-suppressing effect, which was accompanied by a decrease in plasma levels of hsCRP and ICAM-1 (P<0.001), was strongest in patients receiving both simvastatin and ezetimibe. There were no differences in lymphocyte-suppressing, systemic anti-inflammatory and endothelial protective effects of simvastatin between insulin-resistant and insulin-sensitive subjects, whereas the effects of ezetimibe and the combined treatment were greater in the former group of patients (P<0.01 and P<0.001, respectively). CONCLUSIONS: The results of this study indicate that simvastatin is superior to ezetimibe in producing lymphocyte-suppressing, systemic anti-inflammatory and endothelial protective effects in patients with elevated cholesterol levels. Hypercholesterolaemic patients with high cardiovascular risk may receive the greatest benefits from concomitant treatment with a statin and ezetimibe.
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Anticolesterolemiantes/administração & dosagem , Azetidinas/administração & dosagem , Citocinas/metabolismo , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/imunologia , Linfócitos/efeitos dos fármacos , Linfócitos/metabolismo , Sinvastatina/administração & dosagem , Método Duplo-Cego , Quimioterapia Combinada , Ezetimiba , Feminino , Humanos , Hipercolesterolemia/complicações , Inflamação/etiologia , Inflamação/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
INTRODUCTION: Abetalipoproteinemia is a rare inherited disorder characterized by very low plasma levels of cholesterol and triglycerides, secondary to a dramatic decrease in apolipoprotein B-containing lipoproteins, which is induced by a mutation in the microsomal triglyceride transfer protein gene. CASE: In our paper, we describe an atypical clinical manifestation of this condition in a young man, which included the presence of hypogonadism and chronic adrenal failure. We connect the development of both endocrine disorders with very low plasma levels of cholesterol, which is uptaken by the gonads and adrenal cortex and used as a substrate for steroidogenesis, accentuated by carbamazepine treatment. Testosterone treatment and administration of hydrocortisone, fludrocortisone and dehydroepiandrosterone resulted in a significant improvement in a patient's condition. CONCLUSIONS: This case shows that untreated or inaccurately managed long-lasting abetalipoproteinemia may impair the production of steroid hormones and lead to the development of some endocrine disorders.
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Abetalipoproteinemia/complicações , Insuficiência Adrenal/etiologia , Hipogonadismo/etiologia , Abetalipoproteinemia/sangue , Hormônio Adrenocorticotrópico/sangue , Adulto , LDL-Colesterol/sangue , Doença Crônica , Humanos , MasculinoRESUMO
INTRODUCTION: Elevated plasma calcium level in patients diagnosed with primary hypoparathyroidism is a rare finding, resulting in most cases from the treatment with excessive doses of either vitamin D or its derivatives, or calcium salts. CASE: We report a case of a woman who developed severe hypercalcemia due to metastatic lung cancer, describing diagnostics strategies undertaken in this patient. Pamidronate treatment with subsequent chemotherapy resulted in a transient normalization of plasma calcium levels. CONCLUSION: Our report shows that the presence of malignancy should always be taken into consideration in hypoparathyroid patients in whom plasma calcium levels increase and that the assessment of plasma levels of parathyroid hormone related peptide may be helpful in the differential diagnosis of hypercalcemia.
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Hipercalcemia/etiologia , Hipoparatireoidismo/complicações , Neoplasias Pulmonares/complicações , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Hipercalcemia/diagnóstico , Proteína Relacionada ao Hormônio Paratireóideo/sangueRESUMO
Glucocorticoid hypersensitivity syndrome has been reported to date only in several patients. This article describes a unique case of this syndrome in a 24-year old female admitted to hospital because of arterial hypertension and obesity. Although her clinical picture suggested Cushing's syndrome, she had low adrenocorticotropic hormone (ACTH) and cortisol levels with a poor response to corticotrophin-releasing hormone and Synacthen. In turn, an overnight dexamethasone suppression test with 0.25 mg of dexamethasone led to a dramatic decrease in morning cortisol. A diagnosis of glucocorticoid hypersensitivity was made and the patient started treatment with ketoconazole and cabergoline, which resulted in some clinical improvement. This case illustrates the need for clinical awareness of glucocorticoid hypersensitivity in patients suspected of Cushing's syndrome.
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Glucocorticoides/efeitos adversos , Hipersensibilidade/diagnóstico , Hipersensibilidade/etiologia , Inibidores de 14-alfa Desmetilase/uso terapêutico , Adulto , Cabergolina , Agonistas de Dopamina/uso terapêutico , Quimioterapia Combinada , Ergolinas/uso terapêutico , Feminino , Humanos , Hipersensibilidade/tratamento farmacológico , Cetoconazol/uso terapêuticoRESUMO
We report for the first time the case of a young man who developed both glucocorticoid resistance and resistance to parathyroid hormone. Treatment with high doses of dexamethasone together with administration of calcium and calcitriol resulted in a significant improvement in the patients condition. In this paper, we discuss in detail diagnostic and treatment strategies used on the patient and the impact on the course and outcome of both disorders. We associate the development of both these disorders with a possible inherited defect in the signal pathways common to glucocorticoid and parathyroid hormone receptors.
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Erros Inatos do Metabolismo/genética , Hormônio Paratireóideo/administração & dosagem , Pseudo-Hipoparatireoidismo/diagnóstico , Adulto , Calcitriol/administração & dosagem , Carbonato de Cálcio/administração & dosagem , Criança , Dexametasona/administração & dosagem , Diagnóstico Diferencial , Resistência a Medicamentos , Quimioterapia Combinada , Humanos , Masculino , Fenótipo , Pseudo-Hipoparatireoidismo/tratamento farmacológico , Pseudo-Hipoparatireoidismo/genética , Receptores de Glucocorticoides/deficiência , Receptores de Glucocorticoides/genética , Pseudo-HipoparatireoidismoRESUMO
BACKGROUND: Very little is known about extra-lipid effects of statins in prediabetic subjects. AIM: Our study has assessed the effect of simvastatin on coagulation and fibrinolysis in patients with impaired glucose tolerance (IGT), comparing this effect with that exhibited by simvastatin in isolated hypercholesterolaemia. METHODS: Lipid profile, fasting and 2-h post-glucose challenge plasma glucose levels, the homeostatic model assessment (HOMA) ratio, glycated haemoglobin, the prothrombin and partial thromboplastin time, plasma fibrinogen, plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF), factor X levels and factor VII coagulant activity were assessed at baseline, and after 30 and 90 days of simvastatin treatment (20 mg daily) in 28 patients with IGT and 28 subjects with primary isolated hypercholesterolaemia. The control group included 26 age-, sex- and weight-matched dyslipidaemia-free individuals with normal glucose tolerance. The experiments comply with the current law of Poland. RESULTS: Compared to the control subjects, hypercholesterolaemic and IGT patients exhibited increased baseline plasma levels of fibrinogen, PAI-1 and vWF, and increased factor VII activity, with no difference between the two groups of patients. All these haemostatic abnormalities were alleviated or normalized after simvastatin treatment, which was accompanied by a prolongation of the prothrombin and partial thromboplastin time. In both treatment groups simvastatin reduced total and low-density lipoprotein (LDL)-cholesterol, oxidized LDL and apoprotein B but did not affect glucose metabolism marker levels. CONCLUSIONS: Our study shows that haemostasis is disturbed to a similar degree in IGT and isolated hypercholesterolaemia. Simvastatin exhibits a multidirectional, lipid-independent favourable action on coagulation and fibrinolysis in IGT patients, which may play a role in the prevention of initiation and progression of atherosclerosis in this prediabetic state.
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Glicemia/metabolismo , Intolerância à Glucose/sangue , Hemostasia/efeitos dos fármacos , Hipercolesterolemia/sangue , Sinvastatina/uso terapêutico , Adulto , Idoso , Glicemia/efeitos dos fármacos , Feminino , Intolerância à Glucose/tratamento farmacológico , Teste de Tolerância a Glucose/métodos , Hemostasia/fisiologia , Humanos , Hipercolesterolemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Sinvastatina/farmacologiaRESUMO
Background: Metformin decreases serum levels of monomeric prolactin. No previous study has investigated the effect of metformin on macroprolactin content in patients with macroprolactinemia. Methods: We studied three age-, sex- and weight-matched groups of patients: 15 women with monomeric prolactin, 12 women with macroprolactin, as well as 15 women with normal prolactin levels. Because of coexisting 2 diabetes or prediabetes all patients were treated with metformin (1.7-3 g daily). Plasma lipids, glucose homeostasis markers, as well as serum levels of prolactin and macroprolactin were assessed at baseline and after 4 months of metformin treatment. Results: As expected, metformin reduced plasma glucose and triglycerides, as well as improved insulin sensitivity in all treatment groups. Moreover, the drug reduced post-polyethylene glycol prolactin levels and tended to reduce pre-polyethylene glycol prolactin levels in women with monomeric prolactin but not in women with macroprolactinemia and women with normal prolactin levels. Conclusion: The obtained results indicate that metformin has a negligible effect on macroprolactin levels.
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Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperprolactinemia/tratamento farmacológico , Metformina/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Estado Pré-Diabético/tratamento farmacológico , Prolactina/sangue , Prolactinoma/tratamento farmacológico , Adulto , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Hiperprolactinemia/sangue , Hiperprolactinemia/etiologia , Metformina/farmacologia , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/complicações , Estado Pré-Diabético/sangue , Estado Pré-Diabético/complicações , Prolactinoma/sangue , Prolactinoma/complicações , Adulto JovemRESUMO
Background: Intensive statin therapy was found to reduce thyroid autoimmunity in women with Hashimoto's thyroiditis. No similar data are available for other hypolipidemic agents. Methods: The participants of the study were 16 women with Hashimoto's thyroiditis and coronary artery disease. On the basis of statin tolerance, they were divided into 2 groups. 8 patients who did not tolerate high-dose statin therapy were treated with a statin, the dose of which was reduced by half, together with ezetimibe. The remaining 8 patients tolerating the treatment continued high-dose statin therapy. Plasma lipids, serum levels of thyrotropin, free thyroxine and free triiodothyronine, as well as titers of thyroid peroxidase and thyroglobulin antibodies were measured at the beginning of the study and 6 months later. Results: Replacing high-dose statin therapy with ezetimibe/statin combination therapy increased serum titers of thyroid peroxidase as well as led to an insignificant increase in serum titers of thyroglobulin antibodies. At the end of the study, thyroid peroxidase and thyroglobulin antibody titers were higher in patients receiving the combination therapy than in those treated only with high-dose statin. Conclusions: Our study shows that high-dose statin therapy produces a stronger effect on thyroid autoimmunity than ezetimibe/statin combination therapy.
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Anticolesterolemiantes/farmacologia , Doença da Artéria Coronariana/tratamento farmacológico , Ezetimiba/farmacologia , Doença de Hashimoto/tratamento farmacológico , Adulto , Idoso , Anticolesterolemiantes/administração & dosagem , Comorbidade , Quimioterapia Combinada , Ezetimiba/administração & dosagem , Feminino , Doença de Hashimoto/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Pessoa de Meia-Idade , Projetos PilotoRESUMO
The study included 38 non-lactating l-thyroxine-treated women with postpartum thyroiditis (PPT) and 21 matched healthy postpartum women. Women with vitamin D deficiency were treated with oral vitamin D (4000 IU daily), whereas women with vitamin D insufficiency and women with normal 25-hydroxy vitamin levels were either treated with vitamin D (2000 IU daily) or left untreated. Serum hormone levels and thyroid antibody titers were measured at the beginning of the study and 3 months later. 25-hydroxy vitamin D levels were lower in women with PPT than in healthy women. Thyroid peroxidase and thyroglobulin antibody titers inversely correlated with vitamin D status. Apart from increasing serum levels of 25-hydroxy vitamin D and decreasing serum levels of parathyroid hormone, vitamin D reduced titers of thyroid peroxidase antibodies and this effect was stronger in women with vitamin D deficiency. The study's results suggest that vitamin D supplementation may bring benefits to l-thyroxine-treated women with PPT.
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Autoanticorpos/sangue , Tireoidite Pós-Parto/imunologia , Deficiência de Vitamina D/imunologia , Vitamina D/imunologia , Vitaminas/imunologia , Adulto , Autoanticorpos/imunologia , Estudos de Casos e Controles , Suplementos Nutricionais , Feminino , Humanos , Iodeto Peroxidase/imunologia , Hormônio Paratireóideo/sangue , Tireoidite Pós-Parto/sangue , Tireoidite Pós-Parto/tratamento farmacológico , Tiroxina/uso terapêutico , Vitamina D/administração & dosagem , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/terapia , Vitaminas/administração & dosagem , Adulto JovemRESUMO
BACKGROUND: One of the most frequent adverse effects of interferon-α therapy is thyroiditis. Metformin was found to improve insulin sensitivity in hepatitis C patients, as well as to reduce elevated thyrotropin levels in patients with hypothyroidism. The aim of this study was to investigate the effect of metformin on hypothalamic-pituitary-thyroid axis activity in patients with interferon-induced thyroiditis. METHODS: The study included 2 matched groups of women with type 2 diabetes and untreated subclinical hypothyroidism: patients with interferon-induced thyroiditis (n=8) and patients with Hashimoto's thyroiditis (n=12). Fasting plasma glucose, the homeostatic model assessment 1 of insulin resistance ratio (HOMA1-IR), glycated hemoglobin, the estimated glomerular filtration rate, as well as serum levels of thyrotropin, thyroid hormones, prolactin and insulin-like growth factor-1 (IGF-1) were assessed at baseline and after 4 months of metformin treatment. RESULTS: Apart from reducing plasma glucose, HOMA1-IR and glycated hemoglobin, metformin decreased serum levels of thyrotropin. Circulating levels of thyroid hormones, prolactin and IGF-1 remained at a similar level throughout the study. The effect of metformin on serum thyrotropin was stronger in patients with interferon-induced thyroiditis than in patients with Hashimoto's thyroiditis, as well as correlated with its impact on insulin sensitivity. CONCLUSIONS: Our results indicate that metformin may be an effective agent in patients with interferon-induced hypothyroidism.
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Sistema Hipotálamo-Hipofisário/metabolismo , Hipotireoidismo/sangue , Resistência à Insulina , Interferons/efeitos adversos , Metformina/administração & dosagem , Sistema Hipófise-Suprarrenal/metabolismo , Adulto , Idoso , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Jejum/sangue , Feminino , Doença de Hashimoto/sangue , Doença de Hashimoto/induzido quimicamente , Doença de Hashimoto/tratamento farmacológico , Humanos , Hipotireoidismo/induzido quimicamente , Fator de Crescimento Insulin-Like I/metabolismo , Interferons/administração & dosagem , Masculino , Metformina/efeitos adversos , Pessoa de Meia-Idade , Projetos Piloto , Hormônios Tireóideos/sangueRESUMO
Non-classic congenital adrenal hyperplasia (NC-CAH), one of the most common genetic disorders, is often associated with the presence of hyperandrogenism. Recently both simvastatin and metformin were found to reduce plasma steroid hormone levels in this disorder. This study included 8 women with NC-CAH and diabetes or impaired glucose tolerance, as well as 12 matched women with similar glucose metabolism abnormalities but normal adrenal function. Both groups of women, receiving metformin for at least 6 months, were then treated with simvastatin (20 mg daily) for the following 12 weeks. Compared to patients with normal adrenal function, metformin-treated women with NC-CAH showed increased plasma levels of 17-hydroxyprogesterone, total testosterone, free testosterone, androstenedione and DHEA-S. Simvastatin reduced total and LDL cholesterol levels in both patients with NC-CAH and normal adrenal function. Moreover, in the former group of women, statin therapy decreased plasma levels of testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulphate and tended to reduce 17-hydroxyprogesterone. Our results suggest that metformin-statin combination therapy may be useful in the management of symptomatic women with NC-CAH.
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Hiperplasia Suprarrenal Congênita/sangue , Hiperplasia Suprarrenal Congênita/tratamento farmacológico , Hormônios Esteroides Gonadais/sangue , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Sinvastatina/farmacologia , Adulto , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipoglicemiantes/administração & dosagem , Metformina/administração & dosagem , Pessoa de Meia-Idade , Sinvastatina/administração & dosagemRESUMO
The study was conducted to determine whether the expression of behavioral supersensitivity induced by haloperidol (HAL) administered once daily (2 mg/kg i.p.) for 14 days is associated with the alterations in activity of neuropeptide Y (NPY) system in the striatum (caudate-putamen) and nucleus accumbens. Dopamine supersensitivity was tested by measurement of locomotor activity and stereotyped behavior after administration of the dopamine D2/D3 receptor agonist quinpirole (1 mg/kg i.p.) on day 1, 3 and 7 after HAL withdrawal. Neuropeptide Y-like immunoreactivity (NPY-LI) was determined in the striatum and nucleus accumbens isolated 6 h after quinpirole injection on day 1, 3 and 7 after the end of HAL treatment. NPY mRNA was quantified in these structures on day 7 after HAL withdrawal. HAL increased spontaneous locomotor activity and prevalence of rearing, grooming and head-down sniffing. At the same time, striatal NPY-LI increased progressively from the reduced level found on day 1 of haloperidol withdrawal. NPY mRNA remained unchanged. In saline-treated rats, quinpirole enhanced locomotion, rearing, and induced intense head-down sniffing and oral activity. These behavioral effects were accompanied by a decrease in striatal NPY-LI. NPY mRNA was slightly increased. HAL treatment altered response to quinpirole, namely it increased locomotion, intensified oral activity and reduced rearing and head-down sniffing. The second and the third quinpirole injection decreased NPY-LI levels. NPY mRNA was unchanged. In the nucleus accumbens, apart from a decrease in NPY-LI on day 1 after the last haloperidol dose, the level of NPY-LI and NPY mRNA in any experimental group did not differ from the control value. The presented results suggest that the alterations in the activity of the striatal but not nucleus accumbens NPY system contribute to adaptive changes induced by long-term haloperidol treatment and may be of significance to the motor hyperactivity induced by intermittent stimulation of postsynaptic dopamine D2 receptors.
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Comportamento Animal/efeitos dos fármacos , Corpo Estriado/efeitos dos fármacos , Antagonistas de Dopamina/farmacologia , Haloperidol/farmacologia , Atividade Motora/efeitos dos fármacos , Neuropeptídeo Y/metabolismo , Animais , Corpo Estriado/citologia , Corpo Estriado/metabolismo , Agonistas de Dopamina/farmacologia , Hibridização In Situ , Masculino , Neuropeptídeo Y/genética , Quimpirol/farmacologia , RNA Mensageiro/metabolismo , Ratos , Ratos WistarRESUMO
Statins decreased serum androgen levels in hyperandrogenemic women with polycystic ovary syndrome. No previous study has investigated whether this effect is dose-dependent and observed in patients simultaneously treated with other hypolipidemic agents. The study included 23 premenopausal women with elevated total testosterone levels coexisting with hypercholesterolemia, unsuccessfully treated for at least 6 months with atorvastatin (20 mg daily). These patients were then treated with either an increased dose of atorvastatin (40 mg daily, n=11) or atorvastatin (20 mg daily) plus ezetimibe (10 mg daily) (n=12). Plasma lipids, glucose homeostasis markers and serum levels of androgens, sex hormone-binding globulin and gonadotropins were assessed at baseline and after 3 months of treatment. Although both treatments decreased plasma levels of total and LDL-cholesterol levels, only high-dose atorvastatin reduced serum levels of total testosterone, free testosterone and androstendione. The effect of high-dose atorvastatin on serum androgen levels did not differ between insulin-resistant and insulin-sensitive subjects. The obtained results suggest that atorvastatin reduces serum androgen levels in a dose-dependent manner and that its administration in a higher dose is associated with a more pronounced effect on serum androgens than combination therapy with low-dose atorvastatin and ezetimibe.
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Androgênios/sangue , Anticolesterolemiantes/uso terapêutico , Azetidinas/uso terapêutico , Colesterol/sangue , Ácidos Heptanoicos/uso terapêutico , Hiperandrogenismo/tratamento farmacológico , Hipercolesterolemia/tratamento farmacológico , Pirróis/uso terapêutico , Adulto , Atorvastatina , Quimioterapia Combinada , Ezetimiba , Feminino , Humanos , Hiperandrogenismo/sangue , Hiperandrogenismo/complicações , Hipercolesterolemia/sangue , Hipercolesterolemia/complicações , Pessoa de Meia-Idade , Globulina de Ligação a Hormônio Sexual , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The presence of hypothyroidism seems to be associated with increased cardiovascular risk. No previous study compared circulating levels of plasma lipids and other cardiovascular risk factors in statin-treated patients with different thyroid function states. METHODS: We studied 15 women with untreated subclinical hypothyroidism (group A), 16 women with treated hypothyroidism (group B) and 17 women with normal thyroid function (group C) who, because of coexistent hypercholesterolemia, were treated with atorvastatin. Plasma lipids, glucose homeostasis markers and plasma levels of cardiovascular risk factors were assessed before and after 12 weeks of therapy. 46 patients completed the study. RESULTS: Baseline lipid levels were similar in all groups of patients. Plasma levels of high-sensitivity C-reactive protein (hsCRP), homocysteine and fibrinogen were higher in group A than in groups B and C. Although the effect on total and LDL cholesterol was observed in all treatment groups, it was less pronounced in patients with untreated hypothyroidism. Similarly, the effect of atorvastatin on hsCRP, homocysteine, fibrinogen and uric acid was stronger in groups B and C than in group A. CONCLUSIONS: Our results suggest that the effect of atorvastatin on plasma lipids and circulating levels of other cardiovascular risk factors partially depends on thyroid function.
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Atorvastatina/farmacologia , Doenças Cardiovasculares/sangue , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Hipercolesterolemia/sangue , Hipotireoidismo/sangue , Adulto , Atorvastatina/administração & dosagem , Doenças Cardiovasculares/epidemiologia , Comorbidade , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/epidemiologia , Hipotireoidismo/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Resultado do TratamentoRESUMO
In hypothyroid patients, metformin was found to reduce serum levels of TSH. No previous study investigated metformin action on hypothalamic-pituitary-thyroid axis in patients with hyperthyroidism. The aim of our study was to assess the effect of metformin treatment on thyroid function tests in patients with untreated subclinical hyperthyroidism. We studied 15 patients with low but detectable TSH levels (0.1-0.4 mIU/L) (group 1), 12 patients with suppressed TSH levels (less than 0.1 mIU/L) (group 2) and 15 euthyroid patients with a history of hyperthyroidism, who because of coexisting 2 diabetes were treated with metformin (2.55-3 g daily). Glucose homeostasis markers, as well as serum levels of TSH and total and free thyroxine and triiodothyronine levels were assessed at baseline and after 3 and 6 months of therapy. As expected, metformin reduced plasma glucose, insulin resistance and glycated hemoglobin. However, with the exception of an insignificant decrease in TSH levels after 3-month therapy in group 2, metformin therapy did not affect thyroid function tests. Our results indicate that metformin has a negligible effect on hypothalamic-pituitary-thyroid axis activity in type 2 diabetic patients with subclinical hyperthyroidism.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipertireoidismo/complicações , Hipoglicemiantes/farmacologia , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Metformina/farmacologia , Glândula Tireoide/efeitos dos fármacos , Adolescente , Adulto , Glicemia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Hipertireoidismo/sangue , Hipertireoidismo/fisiopatologia , Hipoglicemiantes/uso terapêutico , Sistema Hipotálamo-Hipofisário/fisiopatologia , Resistência à Insulina/fisiologia , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Testes de Função Tireóidea , Glândula Tireoide/fisiopatologia , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue , Adulto JovemRESUMO
Metformin was found to reduce serum thyrotropin levels in patients with hypothyroidism. This effect was less pronounced if patients were additionally treated with bromocriptine. The study included 39 premenopausal women with autoimmune thyroiditis and thyrotropin levels exceeding 3.0 mU/L. All patients had been treated for at least 6 months with bromocriptine (5.0-7.5 mg daily) or cabergoline (0.5-1.0 mg weekly). Because of coexisting type 2 diabetes or impaired glucose tolerance, they were then given metformin (1.7-2.55 g daily). Glucose homeostasis markers, thyroid antibody titers, as well as serum levels of thyrotropin, total and free thyroid hormones and prolactin were determined before and after 6 months of metformin treatment. At baseline, cabergoline-treated patients were less insulin resistant as well as tended to have lower levels of prolactin than bromocriptine-treated patients. Although in both treatment groups, metformin decreased plasma levels of fasting and post-challenge plasma glucose and improved insulin receptor sensitivity, this effect was more prominent in patients receiving cabergoline. However, only in bromocriptine-treated patients, metformin decreased serum thyrotropin and this effect reached the level of significance in a subgroup of patients with subclinical hypothyroidism. Neither in cabergoline- nor in bromocriptine-treated patients, metformin affected thyroid hormone levels and thyroid antibody titers. Our results indicate that the effect of metformin on hypothalamic-pituitary-adrenal axis activity is partially determined by endogenous dopaminergic tone, thyrotrope activity and insulin sensitivity.
Assuntos
Bromocriptina/administração & dosagem , Ergolinas/administração & dosagem , Transtornos do Metabolismo de Glucose , Doença de Hashimoto , Sistema Hipotálamo-Hipofisário/metabolismo , Metformina/administração & dosagem , Glândula Tireoide/metabolismo , Adulto , Cabergolina , Feminino , Transtornos do Metabolismo de Glucose/sangue , Transtornos do Metabolismo de Glucose/tratamento farmacológico , Doença de Hashimoto/sangue , Doença de Hashimoto/tratamento farmacológico , Humanos , Pessoa de Meia-IdadeRESUMO
No previous study has investigated the effect of metformin, administered alone or together with testosterone, on cardiometabolic risk factors in men with hypogonadism. The study included 30 men with late-onset hypogonadism (LOH) and impaired glucose tolerance (IGT) who had been complying with lifestyle intervention. After 12 weeks of metformin treatment (1.7 g daily), the participants were allocated to one of 2 groups treated for the following 12 weeks with oral testosterone undecanoate (120 mg daily, n=15) or not receiving androgen therapy (n=15). Plasma lipids, glucose homeostasis markers, as well as plasma levels of androgens, uric acid, high-sensitivity C-reactive protein (hsCRP), homocysteine and fibrinogen were determined before and after 12 and 24 weeks of therapy with the final dose of metformin. Patients with LOH and IGT had higher levels of hsCRP, homocysteine and fibrinogen than subjects with only LOH (n=12) or only IGT (n=15). Metformin administered alone improved insulin sensitivity, as well as reduced 2-h postchallenge plasma glucose and triglycerides. Testosterone-metformin combination therapy decreased also total and LDL cholesterol, uric acid, hsCRP, homocysteine and fibrinogen, as well as increased plasma testosterone. The effect of this combination therapy on testosterone, insulin sensitivity, hsCRP, homocysteine and fibrinogen was stronger than that of metformin alone. The obtained results indicate that IGT men with LOH receiving metformin may gain extra benefits if they are concomitantly treated with oral testosterone.
Assuntos
Eunuquismo/sangue , Eunuquismo/tratamento farmacológico , Metformina/administração & dosagem , Testosterona/administração & dosagem , Idoso , Proteína C-Reativa/metabolismo , LDL-Colesterol/sangue , Fibrinogênio/metabolismo , Teste de Tolerância a Glucose , Homocisteína/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ácido Úrico/sangueRESUMO
BACKGROUND: Macroprolactinemia is a frequent cause of misdiagnosis and mismanagement of patients with elevated prolactin levels. Its pathogenesis and clinical significance are still controversial. METHODS: The aim of this study was to investigate the relationship between elevated macroprolactin content and vitamin D status. The study population included 20 premenopausal women with isolated macroprolactinemia, 10 of whom were later treated with vitamin D (2 000 IU daily). Serum prolactin, macroprolactin, 25-hydroxyvitamin D and PTH levels were assessed at baseline and after 4 months of treatment. RESULTS: Compared with the control age- and weight-women with normal prolactin levels (n=11), patients with macroprolactinemia were characterized by lower levels of 25-hydroxyvitamin D and slightly higher levels of PTH. Vitamin D administered to patients with macroprolactinemia increased 25-hydroxyvitamin, reduced total prolactin and macroprolactin, as well tended to reduce PTH. The effect of vitamin D on total prolactin and macroprolactin correlated with their baseline values and baseline 25-hydroxyvitamin D levels. CONCLUSIONS: The results of our study suggest the association between vitamin D status and elevated macroprolactin levels in premenopausal women.