Acompanhamento clínico-laboratorial de obesidade associada ao hipotireoidismo em cão / Clinical-laboratory follow-up of obesity associated with hypothyroidism in a dog

O hipotireoidismo canino é uma endocrinopatia comumente diagnosticada em cães. Os principais sinais clínicos presentes são os metabólicos (letargia, ganho de peso e intolerância a exercícios) e dermatológicos (pelagem seca e quebradiça, alopecia endócrina e mixedema). No entanto, alterações neuromusculares, cardíacas e reprodutivas também podem estar presentes. O diagnóstico é realizado através de informações do histórico do animal, sinais clínicos, exames de triagem e testes hormonais. O tratamento de escolha é a suplementação com levotiroxina sódica e a resposta do tratamento é satisfatória com remissão dos sinais clínicos, em até 6 meses de suplementação. O objetivo deste trabalho foi relatar um caso de hipotireoidismo em um cão. Uma paciente canina, SRD, fêmea, castrada, quatro anos e pesando 44,5kg foi encaminhada para a consulta endocrinológica apresentando letargia, ganho de peso, termofilia e discreta rarefação pilosa na cauda. No hemograma e nas dosagens bioquímicas (ALT, GGT, FA, triglicerídeos e colesterol) não foram observadas alterações significativas. As dosagens hormonais de TSH e T4 livre foram realizadas e os resultados mostraram um TSH acima dos valores de referência para a normalidade (3,58 ng/mL) e um T4 livre abaixo dos valores de referência para a normalidade (0,41 ng/mL), assim o diagnóstico foi de hipotireoidismo. O tratamento instituído foi com levotiroxina sódica na dose de 20 mcg/ kg uma vez ao dia. Após 60 dias foi realizado o teste de reposição com levotiroxina e a reavaliação da paciente. Houve resposta satisfatória ao tratamento, com remissão dos sinais clínicos de letargia, intolerância a exercícios e ganho de peso.

Canine hypothyroidism is an endocrinopathy usually diagnosed in dogs. The main clinical signs present are metabolic (lethargy, weight gain and exercise intolerance) and dermatologic (dry, brittle hair coat, endocrine alopecia and myxedema). However, neuromuscular, cardiac, and reproductive changes may also be present. The diagnosis is accomplished by history, physical examination findings, clinicopathologic and measurement of hormones. The treatment of choice is levothyroxine sodium supplementation and treatment response is satisfactory with remission of clinical signs within 6 months of supplementation. This study aimed to report a case of hypothyroidism in a dog. A canine, mixed-breed, female, neutered, 4 years and weight 44.5 kg was forwarded to endocrinology assignment showing lethargy, weight gain, cold intolerance and discrete hair rarefaction on the tail. At the complete blood count and serum biochemistry (ALT, GGT, AP, triglycerides and cholesterol) no significant changes were observed. Baseline serum TSH and free T4 concentration were performed and the diagnosis of hypothyroidism was achieved by results of high TSH (3.58 ng / mL) and low free T4 (0.41 ng / mL). The treatment instituted was levothyroxine sodium dose of 20 mcg/ kg SID, after 60 days the replacement assay with levothyroxine and patient's evaluation was applied. There was a satisfactory response to the treatment by remission of clinical signs of lethargy, exercise intolerance and weight gain.

Acompanhamento clínico-laboratorial de obesidade associada ao hipotireoidismo em cão / Clinical-laboratory follow-up of obesity associated with hypothyroidism in a dog

O hipotireoidismo canino é uma endocrinopatia comumente diagnosticada em cães. Os principais sinais clínicos presentes são os metabólicos (letargia, ganho de peso e intolerância a exercícios) e dermatológicos (pelagem seca e quebradiça, alopecia endócrina e mixedema). No entanto, alterações neuromusculares, cardíacas e reprodutivas também podem estar presentes. O diagnóstico é realizado através de informações do histórico do animal, sinais clínicos, exames de triagem e testes hormonais. O tratamento de escolha é a suplementação com levotiroxina sódica e a resposta do tratamento é satisfatória com remissão dos sinais clínicos, em até 6 meses de suplementação. O objetivo deste trabalho foi relatar um caso de hipotireoidismo em um cão. Uma paciente canina, SRD, fêmea, castrada, quatro anos e pesando 44,5kg foi encaminhada para a consulta endocrinológica apresentando letargia, ganho de peso, termofilia e discreta rarefação pilosa na cauda. No hemograma e nas dosagens bioquímicas (ALT, GGT, FA, triglicerídeos e colesterol) não foram observadas alterações significativas. As dosagens hormonais de TSH e T4 livre foram realizadas e os resultados mostraram um TSH acima dos valores de referência para a normalidade (3,58 ng/mL) e um T4 livre abaixo dos valores de referência para a normalidade (0,41 ng/mL), assim o diagnóstico foi de hipotireoidismo. O tratamento instituído foi com levotiroxina sódica na dose de 20 mcg/ kg uma vez ao dia. Após 60 dias foi realizado o teste de reposição com levotiroxina e a reavaliação da paciente. Houve resposta satisfatória ao tratamento, com remissão dos sinais clínicos de letargia, intolerância a exercícios e ganho de peso.(AU)

Canine hypothyroidism is an endocrinopathy usually diagnosed in dogs. The main clinical signs present are metabolic (lethargy, weight gain and exercise intolerance) and dermatologic (dry, brittle hair coat, endocrine alopecia and myxedema). However, neuromuscular, cardiac, and reproductive changes may also be present. The diagnosis is accomplished by history, physical examination findings, clinicopathologic and measurement of hormones. The treatment of choice is levothyroxine sodium supplementation and treatment response is satisfactory with remission of clinical signs within 6 months of supplementation. This study aimed to report a case of hypothyroidism in a dog. A canine, mixed-breed, female, neutered, 4 years and weight 44.5 kg was forwarded to endocrinology assignment showing lethargy, weight gain, cold intolerance and discrete hair rarefaction on the tail. At the complete blood count and serum biochemistry (ALT, GGT, AP, triglycerides and cholesterol) no significant changes were observed. Baseline serum TSH and free T4 concentration were performed and the diagnosis of hypothyroidism was achieved by results of high TSH (3.58 ng / mL) and low free T4 (0.41 ng / mL). The treatment instituted was levothyroxine sodium dose of 20 mcg/ kg SID, after 60 days the replacement assay with levothyroxine and patient's evaluation was applied. There was a satisfactory response to the treatment by remission of clinical signs of lethargy, exercise intolerance and weight gain.(AU)

Systemic illness moderates the impact of N-acetyl cysteine in bipolar disorder.

OBJECTIVES: Bipolar disorder (BD) is intricately associated with chronic clinical conditions. Medical comorbidity is not only more prevalent in mood disorders, but is associated with increased costs, cognitive impairment and, ultimately, premature mortality. Oxidative stress and inflammation may mediate part of this association. To further investigate the association between medical comorbidity status and clinical improvement with adjuvant N acetyl cysteine (NAC) in the context of a placebo-controlled trial. METHODS: Placebo-controlled randomized clinical trial assessing the effect of NAC over 24 weeks. Symptomatic and functional outcomes were collected over the study period. Medical comorbidities were self-reported, and we took special interest in cardiovascular and endocrine conditions. We evaluated change from baseline to endpoint and the interaction between change and reported medical comorbidities. RESULTS: Fifty-one percent of patients reported have a cardiovascular or endocrine comorbidity. Although not found for depressive symptoms or quality of life, a significant interaction between medical comorbidity and change scores was consistently found for all functional outcomes. This indicated an advantage of NAC over placebo in those with a clinical comorbidity. CONCLUSION: Systemic illness moderated only the effect of NAC on functioning, not on depression. Demonstrating an improvement in functional outcomes with an agent that modulates redox and inflammatory pathways, this study lends empirical support to the idea that medical and psychiatric comorbidity are additive in contributing to allostatic states. One intriguing possibility is that comorbid clinical illness could be a marker for more severe oxidative stress states--and thus guide antioxidant use--in BD.

Endocrine therapies and QTc prolongation.

QT interval represents the period between the initiation of depolarization and the end of repolarization of the ventricular myocardium. Excessive prolongation of this interval may drive to a potentially fatal ventricular tachyarrhythmia known as "torsades de pointes". Agents used to manage many endocrine disorders have been linked with QTc alterations. Among them, oral antidiabetic agents, lipid lowering and anti-obesity drugs, somatostatin analogues, thyroid and anti-thyroid agents, and adrenal steroids should be considered. Nevertheless, it is very well known that some endocrine diseases are associated with constraints in the repolarization reserve, and, as a consequence, with QTc prolongation. Besides, some disturbances in the clearance of certain drugs are more frequent in patients affected by selected endocrine entities. Taking these into account, the purpose of this article is to review the behavior of the most widely used drugs in endocrinology with regards to their potential QTc prolongation effect in human beings.

Endocrine disorders in pediatric - onset Langerhans Cell Histiocytosis.

Langerhans Cell Histiocytosis (LCH) is a rare disorder with a great variety of clinical manifestations. The purpose of this retrospective study was to evaluate the pattern and the long-term course of clinical, laboratorial and radiological findings in pediatric-onset LCH. We reviewed 46 children with histological diagnosis of LCH. Ten children (22%) showed endocrine disorders. Central diabetes insipidus (DI) was observed in all ten patients; GH deficiency was confirmed in four and hypogonadism in two children. There were no adrenal, prolactin or thyroid axis abnormalities. Obesity was observed in three patients. Eight patients showed soft tissue infiltration and five bone involvement. The MRI showed a lack of posterior pituitary bright spot in all DI patients; infundibular infiltration (II) associated or not with sellar or supra-sellar mass was observed in 4 patients. We conclude that the investigation of LCH, a multi-systemic disease, should include central nervous system images. The presence of II and/or DI should raise the diagnosis of LCH. Complete endocrine evaluation, allowing an early hormone therapy, is required to obtain a better quality of life in children with LCH.

El proceso diagnóstico en las alteraciones endocrinológicas

Las alteraciones endocrinológicas, tanto diagnosticadas como no diagnosticadas, representan una gran parte de la practica médica. El presente artículo, dirigido al diagnostico y tratamiento de las alteraciones mas comunes y tambien de las menos comunes que afectan la glándula tiroides, las glándulas suprarenales y el metabolismo del calcio, constituyen una excelente guía para el médico sobre cuándo evaluar la función de una glándula, cuándo descartar la posibilidad de una enfermedad maligna y cuándo referir al paciente

[POEMS syndrome: report of a case and review of the literature]. / Síndrome de POEMS: presentación de un caso y revisión de la literatura.

A case of POEMS Syndrome of six years of evolution is reported. This syndrome is characterized by Raynaud phenomenon, polyneuropathy, edema, anasarca, papilledema, osteosclerosis and lymphadenopathy with the histopathology of Castleman's disease, hypothyroidism, hypogonadism, cutaneous sclerosis, hyperpigmentation, axillary alopecia and the presence of urinary lambda light chains. A bone marrow biopsy did not show plasmocytic infiltration and there was no evidence of extramedullary plasmocytoma. Methylprednisone was given at the dose of 1 mg/kg/day and subjective and objective improvement was observed. The edema and anasarca disappeared as well as the lymphadenopathies; muscle strength improved and the patient was able to walk without aid. Papilledema persisted. The pathogenesis of this syndrome remains unknown; some of the symptoms have been attributed to paraprotein deposits in peripheral nerves, high capillary permeability due to vascular alterations, accelerated conversion of androgen to estrogen, or to the production by plasma cells of a toxic substance. Mortality is related to complications of the polyneuropathy. Some patients in whom POEMS syndrome was associated, or not, with myeloma were treated with chemotherapy and/or radiotherapy with different responses; in others, corticosteroids were of short lived benefit. Our patients remains well after 42 months treatment with 20 mg methylprednisone every other day.