Hormonal assessment of participants in a long distance walk.

BACKGROUND: Exercise can disrupt homeostasis and trigger many adaptive responses in different hormonal axes. The study of hormonal interactions with physical activity is highly complex due to the number of variables, such as exercise duration, exercise intensity, individual level of training, circadian rhythm, nutritional status, and environmental conditions. METHODS: This study was performed to assess daily variations of thyroid hormones, cortisol, testosterone, insulin and glucose during moderate to high intensity aerobic physical activity for 5 consecutive days. Sample collection was performed at baseline in the morning and in the evening, immediately after finishing the activity, on the 4 initial days of the activity. Statistical analysis was performed using software STATA V14. Continuous variables are presented as means and standard deviations, while categorical variables are presented as absolute and percentage values. We used Shapiro-Wilk, Wilcoxon Sign, Mann-Whitney and Student's T test, according the needs. RESULTS: The adrenocorticotropic axis showed an initial increase in the evening cortisol level compared to the baseline level in the morning (17.46 µg/dL and 15.97 µg/dL, respectively) and then exhibited a significant reduction between the 1st and 4th day of activity (17.46 µg/dL and 8.39 µg/dL, respectively; P = 0.001). The same pattern was observed for free thyroxine (T4) between the 1st and 4th day (1.31 and 1.14, respectively; P < 0.001). CONCLUSIONS: Moderate to intense long duration physical activity resulted in little variation in the hormones assessed, with a trend toward reduced levels of cortisol and free T4. These findings highlight an adaptive hormonal mechanism in response to stress that is repeated daily, as shown by cortisol and thyroid function in our study.

Multidisciplinary treatment of patients with diabetes and hypertension: experience of a Brazilian center.

BACKGROUND: Although multidisciplinary treatment is recommended for type 2 diabetes mellitus and hypertension (HTN), there is a lack of scientific literature supporting the hypothesis of extending this treatment strategy to patients with both diabetes and HTN. Aiming to report results of long-term multidisciplinary treatment for these patients and identify strategies to improve their management, we conducted this study. METHODS: Data of patients with diabetes and HTN with regular follow-up visits in a multidisciplinary HTN treatment center from Brazil's Midwest were retrospectively assessed. Patients ≥ 18 years enrolled in the service by June 2017 with a minimum of three visits were included. Anthropometric, blood pressure (BP), laboratory, pharmacological treatment, lifestyle, and cardiovascular events data were collected from first (V1), intermediate (V2) and most recent (V3) visits to the service. BP < 130 × 80 mmHg, LDL-cholesterol (LDL-C) < 70 mg/dL and HbA1C < 7.0% were defined as treatment targets. Wilcoxon signed-rank test was used to compare variables along study visits. A linear regression model was built to identify variables associated with better overall patient control. RESULTS: A total of 162 patients were included (mean age of 56.5 ± 10.8 years). Median follow-up time was 60 (IQR 40-109) months, 80.2% of the sample was female and 83.3% had no cardiovascular event history. BP, total cholesterol, LDL-C, triglycerides and HbA1C values showed a significant trend to improve along the study visits (p < 0.001). Growing trend in aspirin (p = 0.045) and statins (p < 0.001) use was found, in addition to treatment compliance increase (p < 0.001). Significant improvement trends in BP (p < 0.001), LDL-C (p = 0.004) and HbA1C (p = 0.002) control were also found across visits. Control rates of BP, LDL-C and HbA1C in combination were low in V1, V2 and V3 (1.2, 1.9 and 6.8%, respectively), but showed significant improvement trend (p < 0.001). Treatment compliance (ß-coefficient = 1.20; 95% CI 1.07-1.34; p < 0.001) was positively associated with better overall patients control. CONCLUSIONS: Multidisciplinary treatment of patients with diabetes and HTN significantly improved clinical and laboratory parameters, despite ageing of population evaluated. Although combined control of HbA1C, BP and LDL-cholesterol increased along follow-up, management of all these three conditions needs to improve, and focus on treatment compliance should be given to attain this goal.

Hiperplasia supra-renal congênita por deficiência de 11-ß-hidroxilase / Congenital adrenal hyperplasia due to 11-beta-hydroxylase deficiency

Este artigo tem o objetivo de relatar o diagnóstico e a evolução clínica de um paciente de 15 anos portador de uma disfunção congênita da esteroideogênese adrenal, que pode apresentar-se como hipertensão arterial de diagnóstico muitas vezes tardio (adolescência), virilização ou formas perdedoras de sal (nascimento e infância).

Clinical and hormonal features of selective follicle-stimulating hormone (FSH) deficiency due to FSH beta-subunit gene mutations in both sexes.

OBJECTIVE: To report the clinical, hormonal, and molecular features of a female adolescent with selective FSH deficiency. In addition, a complete review of previous cases is provided, focusing on hormonal aspects. DESIGN: Clinical study. SETTING: University hospital. PATIENT(S): A 16-year-old girl with primary amenorrhea and poor breast development due to isolated FSH deficiency. INTERVENTION(S): Blood drawing before and after GnRH stimulation and pelvic ultrasound examination. MAIN OUTCOME MEASURE(S): Gonadotropin and E(2) measurements and sequencing of the FSH beta-subunit gene. RESULT(S): The patient was referred for primary amenorrhea and partial breast development (Tanner III). Her basal and GnRH-stimulated LH levels were elevated (31 IU/L and 98 IU/L, respectively), whereas her FSH levels were undetectable (<1 IU/L) in both conditions. Estradiol levels were low (<13 pg/mL). Automatic sequencing showed a nucleotide substitution of C for A in exon 3, resulting in a homozygous nonsense mutation in amino acid position 76 (Tyr76X) of the FSH beta-subunit. CONCLUSION(S): The Tyr76X mutation of the FSH beta-subunit was associated with a partial phenotype of FSH deficiency. To date, only four loss-of-function mutations of the FSH beta-subunit have been described in eight patients with undetectable serum FSH and high serum LH levels. Therefore, this unusual hormonal profile strongly suggests a defect in the FSH beta-subunit in both sexes.

[Congenital adrenal hyperplasia due to 11-beta-hydroxylase deficiency]. / Hiperplasia supra-renal congênita por deficiência de 11-beta-hidroxilase.

The objective of this article is to relate the diagnostic and clinical evolution of a 15 year old patient with a congenital adrenal steroidogenesis dysfunction that can present as hypertension diagnosed later in life (adolescence), virilization or salt wasting (birth and childhood).