ABSTRACT
Hypoglycemia due to endogenous hyperinsulinism (EH) is diagnosed in a symptomatic patient with low levels of plasma glucose concomitant with elevated plasma insulin and C-peptide. Causes of EH are pancreatic islet-cells disease, use of insulin secretagogues, and autoimmune hypoglycemia. In this review, the authors studied 24 patients with hypoglycemia due to endogenous hyperinsulinism in order to describe aspects of diagnosis and treatment. Our study demonstrated that after 12 hours of fasting (mini-fasting test; at least three samples), all patients presented the diagnostic criteria for EH. Additionally, we found that 11 of 12 patients (91.7%) who underwent glucagon test achieved glucose levels less than 50 mg/dL and below baseline after 120 minutes. Mini-fasting (3 samples) and glucagon test may be useful to prevent prolonged fasting test to clarify the diagnosis of endogenous hyperinsulinism.
Subject(s)
Fasting/physiology , Hyperinsulinism/complications , Hypoglycemia/etiology , Adolescent , Adult , Aged , Contraindications , Female , Follow-Up Studies , Gastrointestinal Agents , Glucagon , Glucose Tolerance Test/methods , Humans , Hyperinsulinism/diagnosis , Hypoglycemia/diagnosis , Hypoglycemia/surgery , Male , Middle Aged , Statistics, Nonparametric , Young AdultABSTRACT
Nodular corticotrope hyperplasia is a rare pathology causing Cushing's syndrome owing to a primary pituitary disease or ectopic CRH production. In this study, we evaluated the laboratory and pathological findings and results of transsphenoidal pituitary surgery in four patients with Cushing's disease. Dynamic tests of pituitary-adrenal function (dexamethasone suppression, metyrapone, CRH, and DDAVP tests) were done before and after transsphenoidal pituitary surgery. Plasma and total urinary cortisol, serum 11-deoxycortisol, and plasma ACTH were determined by RIA. Hormonal dynamic tests and radiologic studies were compatible with a pituitary ACTH source. The transsphenoidal surgery revealed the presence of corticotrope hyperplasia confirmed by immunoperoxidase stain and a preserved reticulum framework in the removed pituitary tissue of these four patients. The pituitary surgery led to a short period of improvement in two of the patients (1 and 4), a 3-yr remission in one patient (patient 2), and no improvement in one (patient 3). We conclude that although our patients appear to have inadequate suppression with high-dose dexamethasone, there is no way to diagnose this pathology presurgically, and that total hypophysectomy, bilateral adrenalectomy, and irradiation are the only alternatives for definitive treatment. A CRH-secreting ectopic tumor could not be found in our patients either before or after surgery in the follow-up period.
ABSTRACT
Os autores estudaram 24 casos de carcinoma funcionante do cørtex adrenal com o objetivo de revisar o tratamento cir£rgico e quimioter pico. Procurou-se fazer correlaüoes com o tipo de cirurgia e a efi cia da quimioterapia com a sobrevida. Observou-se que tanto a adrenalectomia como a nefroadrenalectomia ofereceram resultados semelhantes em termos de sobrevida e significativamente a sobrevida. (Arq Bras Endocrinol Metab 1994; 38/1:16-22).
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Adrenal Cortex Neoplasms/diagnosis , Adrenal Cortex Neoplasms/mortality , Adrenocortical Carcinoma/diagnosis , Adrenocortical Carcinoma/mortality , Steroids/analysis , Adrenal Cortex Neoplasms/therapy , Adrenocortical Carcinoma/therapy , Mitotane/adverse effects , Mitotane/therapeutic use , Neoplasm Metastasis , Neoplasm Recurrence, Local , Neoplasm Staging , Survival RateABSTRACT
O proposito deste estudo e avaliar as alteracoes morfologicas da tireoide nos pacientes acromegalicos atraves da ultra-sonografia de alta resolucao, correlacionando-as com as dosagens hormonais da glandila. Os autores concluem que todos os acromegalicos apresentam aumento da tireoide, sendo que esta pode apresentar bocio tanto difusos quanto nodulares
