Vitamin D status and prevalence of hypovitaminosis D in different genders throughout life stages: A Brazilian cross-sectional study.

OBJECTIVES: To evaluate the mean concentration of 25-hydroxivitamin D [25(OH) D] and prevalence of hypovitaminosis D in individuals residing in Rio de Janeiro, Brazil. METHODS: The data of 80,000 consecutive individuals who had 25(OH) D measurements performed by electrochemiluminescence between 1/2/2018 and 2/5/2018 were selected. Patients who reported the use of therapies/supplements were excluded. Levels of 25(OH) D ≥20 ng/mL (ages <60 years) and ≥30 ng/mL (ages ≥60 years) were considered adequate. RESULTS: We analyzed the data of 24,074 individuals (1-95 years old, 64.7% female). Descriptive curves showed that, in both sexes, the mean values of 25(OH) D decreased from the first years of life until adolescence, then slightly increased, and then tended to stabilize during adulthood. Levels of 25(OH) D <20 ng/mL were observed in 6% of girls versus 3.6% of boys and in 13.6% of adolescent girls versus 12.6% of adolescent boys and 11% of adults. The percentage of seniors with serum levels of 25(OH) D <20 ng/mL was 13.6% in women and 12.7% in men; 53.2% of women and 50.6% of men had levels <30 ng/mL. CONCLUSIONS: Mean 25(OH) D values were higher in children and lower in adolescents and women. Approximately 90% of non-seniors and presumably healthy residents of the urban metropolitan region of Rio de Janeiro presented satisfactory levels of 25(OH) D during the summer months; however, in over half of the elderly, the serum concentrations of 25(OH) D were inadequate. Therefore, strategies for the prevention of hypovitaminosis D should be considered in the senior population.

Vitamin D status and prevalence of hypovitaminosis D in different genders throughout life stages: A Brazilian cross-sectional study

OBJECTIVES: To evaluate the mean concentration of 25-hydroxivitamin D [25(OH) D] and prevalence of hypovitaminosis D in individuals residing in Rio de Janeiro, Brazil. METHODS: The data of 80,000 consecutive individuals who had 25(OH) D measurements performed by electrochemiluminescence between 1/2/2018 and 2/5/2018 were selected. Patients who reported the use of therapies/supplements were excluded. Levels of 25(OH) D ≥20 ng/mL (ages <60 years) and ≥30 ng/mL (ages ≥60 years) were considered adequate. RESULTS: We analyzed the data of 24,074 individuals (1-95 years old, 64.7% female). Descriptive curves showed that, in both sexes, the mean values of 25(OH) D decreased from the first years of life until adolescence, then slightly increased, and then tended to stabilize during adulthood. Levels of 25(OH) D <20 ng/mL were observed in 6% of girls versus 3.6% of boys and in 13.6% of adolescent girls versus 12.6% of adolescent boys and 11% of adults. The percentage of seniors with serum levels of 25(OH) D <20 ng/mL was 13.6% in women and 12.7% in men; 53.2% of women and 50.6% of men had levels <30 ng/mL. CONCLUSIONS: Mean 25(OH) D values were higher in children and lower in adolescents and women. Approximately 90% of non-seniors and presumably healthy residents of the urban metropolitan region of Rio de Janeiro presented satisfactory levels of 25(OH) D during the summer months; however, in over half of the elderly, the serum concentrations of 25(OH) D were inadequate. Therefore, strategies for the prevention of hypovitaminosis D should be considered in the senior population.

Short-term effects of low-dose estradiol on endothelial function and blood viscosity in nondiabetic postmenopausal overweight women: a double-blind, placebo-controlled study.

OBJECTIVE: The beneficial effects of estrogen on endothelial function depend on its integrity. This study evaluates the short-term effects of low-dose transdermal estradiol on endothelial function, insulin sensitivity, and blood viscosity in nondiabetic overweight/obese women. METHODS: Forty-four nondiabetic overweight/obese women with a history of recent menopause were randomly allocated, in a double-blind fashion, to receive transdermal estradiol (1 mg/d, n = 22) or placebo (n = 22). The following parameters were assessed: endothelial reactivity (venous occlusion plethysmography and nailfold videocapillaroscopy), plasma levels of soluble adhesion molecules, insulin sensitivity (homeostasis model assessment of insulin resistance and areas under the curve of insulin and glucose during an oral glucose tolerance test), and blood and plasma viscosity. Data were expressed as means ±â€ŠSD or medians [first to third quartiles]. RESULTS: Participants were aged 51.8 ±â€Š2.3 years with a body mass index of 31.5 ±â€Š2.5 kg/m and time since menopause was 3 [2-5] years. At baseline, no differences between the groups were observed; however, after 3 months of treatment, the following changes were observed in the estradiol group compared with the placebo group: a decrease in the forearm vascular resistance at baseline (36.37 [24.9-51.27] vs 51.3 [40.88-70.03] mm Hg/mL per min 100 mL tissue, P < 0.01) and during the postocclusive reactive hyperemia response (15.93 [11.32-22.29] vs 22.13 [16.46-29.7] mm Hg/mL per min 100 mL tissue, P < 0.01), and an increase in red blood cell velocity at rest (0.316 [0.309-0.326] vs 0.303 [0.293-0.308] mm/s, P < 0.001) and during postocclusive reactive hyperemia response (0.374 [0.353-0.376] vs 0.341 [0.333-0.355] mm/s, P < 0.001). Furthermore, blood viscosity was lower in the estradiol group than in the placebo group (3.57 ±â€Š0.12 vs 3.76 ±â€Š0.22 mPa.s; P < 0.01). CONCLUSIONS: Short-term use of low-dose transdermal estradiol in nondiabetic overweight/obese women with a history of recent menopause improved endothelial function and decreased blood viscosity compared with placebo.

Menstrual cycle alterations during adolescence: early expression of metabolic syndrome and polycystic ovary syndrome.

STUDY OBJECTIVE: To assess the importance of the menstrual pattern as a marker for clinical and laboratory alterations related to metabolic syndrome (MS) and polycystic ovary syndrome (PCOS) among Brazilian adolescents. DESIGN: A cross-sectional study. SETTING: Endocrine Gynecology Outpatient Clinic of the Adolescent Health Studies Center (NESA) at the Pedro Ernesto University Hospital. PARTICIPANTS: 59 girls (12-19 years old) were classified by their menstrual cycles as regular (n = 23) and irregular (n = 36). INTERVENTION: None. MAIN OUTCOME MEASURES: Biochemical collections were made of peripheral blood after fasting for 12 hours, and the oral glucose tolerance test with 75 g of anhydrous glucose. RESULTS: PCOS, MS, and the criteria for MS were significantly more frequent (P < .05) in the subgroup with irregular menstruation. Adolescents with irregular cycles presented a significant increase in waist circumference, glycemia 2 hours after oral glucose overload (2 h), fasting and 2-h insulin, HOMA-IR, and triglycerides. In contrast, the glucose/insulin ratio, quantitative insulin-sensitivity check index, and HDL serum levels were significantly lower among patients with irregular menstruation, compared to those with regular cycles. In the logistic regression, we noted that insulin 2 h ≥ 75 µIU/mL (r = 1.90; P = .018), waist circumference > 95 cm (r = 2.21; P = .006) and diagnosis of PCOS (r = 1.93; P = .023) were significantly correlated to irregular cycles. CONCLUSIONS: We concluded that close observation of menstrual cycle patterns is an important tool for identifying adolescents at higher risk of developing PCOS and MS.

Nonobese Young Females with Polycystic Ovary Syndrome have Nutritive Microvascular Dysfunction: A Pilot Study.

OBJECTIVE: To investigate nutritive microvascular function in young nonobese females with polycystic ovary syndrome (PCOS) and to correlate microvascular reactivity with sex steroids, inflammatory markers, and metabolic variables. METHODS: Fourteen nonobese females with PCOS (24.6 ± 2.7 years, body mass index [BMI] 23.7 ± 3.1 kg/m2) and 13 age- and BMI-matched controls (22.8 ± 2.3 years, 22.5 ± 3.4kg/m2) underwent anthropometric, hormonal, and microvascular evaluations. The main outcome measures were capillary density, red blood cell velocity (RBCV) at resting and peak during postocclusive reactive hyperemia (RBCVmax), and time taken to reach RBCVmax (TRBCVmax). RESULTS: Subjects with PCOS had lower RBCV and higher TRBCVmax compared to controls, respectively (0.237 [0.220-0.324] vs. 0.362 [0.297-0.382] mm/s, P<.01) and (5 [5-6] vs. 4 [3-5] s, P<.05]. The free androgen index (FAI) and sex hormone-binding globulin (SHBG) level were different between groups. FAI correlated to RBCVmax (ρ = -0.49, P<.05) and to TRBCVmax (ρ = 0.41, P<.05). SHBG correlated with RBCVmax (ρ = 0.52, P<.01) while estradiol (E2) levels correlated with RBCV (ρ = 0.80, P<.001) and RBCVmax (ρ = 0.46, P<.05). CONCLUSION: Microvascular dysfunction characterized by reduced RBCVmax and prolonged TRBCVmax was present in young, nonobese PCOS subjects. FAI was associated with observed impairments, suggesting a possible common mechanism linking sex hormones and microvascular dysfunction.

[Acute suppurative thyroiditis with multiple complications]. / Tireoidite supurativa aguda com múltiplas complicações.

Acute suppurative thyroiditis is a rare disorder, most often caused by Staphylococcus aureus or Streptococcus pneumoniae, which affects particularly children with pyriform sinus fistula. In adults, the main pathogenic mechanism seems to be hematogenous dissemination from a focus of infection in the oropharynx or respiratory tract. The initial signs and symptoms of acute thyroiditis are similar to those of acute pharyngitis and subacute thyroiditis. This fact often delays diagnosis and increases the risk of complications. We report the case of a previously healthy, 28-year-old man who, after being affected by tonsillitis, developed suppurative thyroiditis complicated by thyrotoxicosis; a large abscess in the right lobe of the thyroid extending to the thorax introitus, which caused a trachea deviation and compressed large vessels; associated with internal jugular vein thrombosis, and sepsis.

Tireoidite supurativa aguda com múltiplas complicações / Acute suppurative thyroiditis with multiple complications

A tireoidite supurativa aguda é uma desordem rara, mais frequentemente causada pelo Staphylococcus aureus ou Streptococcus pneumoniae, e atinge particularmente crianças com fístula do seio piriforme. Em adultos, a disseminação por via hematogênica a partir de foco infeccioso em orofaringe ou trato respiratório parece ser o principal mecanismo patogênico. Os sinais e sintomas iniciais da tireoidite aguda são semelhantes aos da faringite aguda e da tireoidite subaguda. Esse fato frequentemente retarda o diagnóstico dessa doença e aumenta o risco de complicações. Relatamos o caso de um paciente masculino de 28 anos, previamente saudável, que, após quadro de amigdalite, apresentou tireoidite aguda complicada por tireotoxicose, volumoso abscesso no lobo direito da tireoide, que se estendia à abertura superior do tórax com desvio da traqueia e compressão de grandes vasos, associado à trombose de veia jugular interna e sepse.

Acute suppurative thyroiditis is a rare disorder, most often caused by Staphylococcus aureus or Streptococcus pneumoniae, which affects particularly children with pyriform sinus fistula. In adults, the main pathogenic mechanism seems to be hematogenous dissemination from a focus of infection in the oropharynx or respiratory tract. The initial signs and symptoms of acute thyroiditis are similar to those of acute pharyngitis and subacute thyroiditis. This fact often delays diagnosis and increases the risk of complications. We report the case of a previously healthy, 28-year-old man who, after being affected by tonsillitis, developed suppurative thyroiditis complicated by thyrotoxicosis; a large abscess in the right lobe of the thyroid extending to the thorax introitus, which caused a trachea deviation and compressed large vessels; associated with internal jugular vein thrombosis, and sepsis.

[Dunnigan-type familial partial lipodystrophy: attention to precocious diagnosis]. / Lipodistrofia parcial familiar do tipo Dunnigan: atenção ao diagnóstico precoce.

Dunnigan-type familial partial lipodystrophy (FPLD) is an autosomal dominant disease that results from heterozygous missense mutations in LMNA, the gene that encodes nuclear lamin A/C. FPLD is characterized by a progressive disappearance of subcutaneous adipose tissue in the limbs, gluteal region, abdomen and trunk, beginning at the time of or after puberty, and excessive amount of fat in the face, chin, labia majora, and intra-abdominal region, leading to a Cushingoid appearance and increased muscularity phenotype. Affected women are particularly predisposed to insulin resistance and its complications, including features of polycystic ovary syndrome. To emphasize the importance of an early FPLD diagnosis, which is necessary to prevent serious metabolic disturbances, we report a woman diagnosed at about 50 years of age. Increased muscularity and significant labia majora fat deposit made the diagnosis possible by gynecologists.

Lipodistrofia parcial familiar do tipo Dunnigan: atenção ao diagnóstico precoce / Dunnigan-type familial partial lipodystrophy: attention to precocious diagnosis

A lipodistrofia parcial familiar tipo Dunnigan é uma doença autossômica dominante rara. Em sua forma clássica, é resultante de uma mutação missense heterozigótica no gene LMNA, que codifica a proteína nuclear denominada lâmina tipo A/C. Caracteriza-se pelo desaparecimento progressivo do tecido adiposo subcutâneo nos membros, região glútea, abdome e tronco, que se inicia na puberdade, acompanhado de acúmulo de gordura em outras áreas, como a face, queixo, grandes lábios e região intra-abdominal, conferindo o aspecto de hipertrofia muscular e simulando o fenótipo de síndrome de Cushing. Mulheres afetadas são particularmente predispostas à resistência à insulina e suas complicações, incluindo sinais da síndrome dos ovários policísticos. Com o objetivo de alertar para o diagnóstico precoce, que possibilita a adoção de medidas que minimizam os graves distúrbios metabólicos vinculados à desordem, relatamos o caso de uma paciente em que a investigação foi realizada somente ao final da quinta década de vida. A aparente hipertrofia muscular e o acentuado depósito de gordura nos grandes lábios possibilitam aos médicos ginecologistas a suspeita diagnóstica.

Dunnigan-type familial partial lipodystrophy (FPLD) is an autosomal dominant disease that results from heterozygous missense mutations in LMNA, the gene that encodes nuclear lamin A/C. FPLD is characterized by a progressive disappearance of subcutaneous adipose tissue in the limbs, gluteal region, abdomen and trunk, beginning at the time of or after puberty, and excessive amount of fat in the face, chin, labia majora, and intra-abdominal region, leading to a Cushingoid appearance and increased muscularity phenotype. Affected women are particularly predisposed to insulin resistance and its complications, including features of polycystic ovary syndrome. To emphasize the importance of an early FPLD diagnosis, which is necessary to prevent serious metabolic disturbances, we report a woman diagnosed at about 50 years of age. Increased muscularity and significant labia majora fat deposit made the diagnosis possible by gynecologists.

Síndrome dos ovários policísticos e insulina: revisão do vínculo fisiopatológico e do tratamento com sensibilizadores de insulina / Polycistic ovary syndrome and insulin: revision of entail physiopathologic and insulin sensitizing agents treatment

A síndrome dos ovários policísticos (SOP) é uma desordem complexa que engloba um amplo espectro de sinais e sintomas, predominando aqueles de disfunção ovariana. Acomete cerca de 10 por cento das mulheres em idade reprodutiva. Resistência insulínica e hiperinsulinemia desempenham papel importante na patogênese da doença. Nesse contexto, a utilização de sensibilizadores de insulina (metformina e glitazonas) tem sido recentemente proposta como terapia de escolha para muitas mulheres com SOP. O uso desse agentes está associado a decréscimo nos níveis de androgênios e gonadotropinas, melhora na tolerência à glicose, perfil lipídico e função endotelial com redução dos marcadores de doença aterosclerótica subclínica. O tratamento é potencialmente útil no controle do hiperandrogenismo, das alterações metabólicas e particularmente da fertilidade.

Polycystic ovary syndrome is a complex disorder that encompasses a wide range of signs and symptoms, mainly those related with ovarian dysfunction, and affects about 10 per cent of women during their reproductive years. Insulin resistance and hyperinsulinemia play important role in the pathogenesis of the disease. So, insulin-sensitizing agents (metformin and glitazones) have been recently proposed as the therapy of choice for many women with polycystic ovary syndrome. Insulin sensitizer treatment has been associated with a reduction in serum androgen levels and gonadotropins, improvement in glucose tolerance, lipid profile and endothelial function with reduction in sub-clinica atherosclerotic markers. The treatment is potentially useful in the control of hyperandrogenism, metabolic changes and improvement of fertility.

Influence of methyltestosterone postmenopausal therapy on plasma lipids, inflammatory factors, glucose metabolism and visceral fat: a randomized study.

BACKGROUND: There has been a growing interest in treating postmenopausal women with androgens. However, hyperandrogenemia in females has been associated with increased risk of cardiovascular disease. OBJECTIVE: We aimed to assess the effects of androgen replacement on cardiovascular risk factors. DESIGN: Thirty-seven postmenopausal women aged 42-62 years that had undergone hysterectomy were prospectively enrolled in a double-blind protocol to receive, for 12 months, percutaneous estradiol (E2) (1 mg/day) combined with either methyltestosterone (MT) (1.25 mg/day) or placebo. METHODS: Along with treatment, we evaluated serum E2, testosterone, sex hormone-binding globulin (SHBG), free androgen index, lipids, fibrinogen, and C-reactive protein; glucose tolerance; insulin resistance; blood pressure; body-mass index; and visceral and subcutaneous abdominal fat mass as assessed by computed tomography. RESULTS: A significant reduction in SHBG (P < 0.001) and increase in free testosterone index (P < 0.05; Repeated measures analysis of variance) were seen in the MT group. Total cholesterol, triglycerides, fibrinogen, and systolic and diastolic blood pressure were significantly lowered to a similar extent by both regimens, but high-density lipoprotein cholesterol decreased only in the androgen group. MT-treated women showed a modest rise in body weight and gained visceral fat mass relative to the other group (P < 0.05), but there were no significant detrimental effects on fasting insulin levels and insulin resistance. CONCLUSION: This study suggests that the combination of low-dose oral MT and percutaneous E2, for 1 year, does not result in expressive increase of cardiovascular risk factors. This regimen can be recommended for symptomatic postmenopausal women, although it seems prudent to perform baseline and follow-up lipid profile and assessment of body composition, especially in those at high risk of cardiovascular disease.

[Female androgen insufficiency and potential risks of therapeutic replacement]. / Insuficiência androgênica na mulher e potenciais riscos da reposição terapêutica.

Women in their fourth decade and older experience a decrease in androgen serum levels. This may lead to the clinical syndrome of female androgen insufficiency expressed by insidious tiredness, diminished sense of well-being and libido, alterations in body composition and bone loss. If there is a past history of bilateral oophorectomy, hypopituitarism, androgen adrenal suppression and/or free testosterone serum levels are low, it is probable that these signs and symptoms could be relieved by a discerning androgen administration, which has been largely accepted. When current recommended doses are used, it appears that the benefits regarding bone mass, sexuality and well-being may be achieved without important signs of masculinizing. Nonetheless, it is necessary to conduct well-controlled, long-term studies, in order to validate the hypothesis that therapeutic administration of androgens to women does not lead to an increased incidence of breast cancer or metabolic complications.

Terapia hormonal da menopausa: posicionamento do Departamento de Endocrinologia Feminina e Andrologia da SBEM em 2004 / Hormonal therapy of menopause: 2004 position of the Department of Female Endocrinology and Andrology of the Brazilian Society of Endocrinology and Metabolism

Após os estudos clínicos randomizados produzirem impacto e questionamentos sobre terapia hormonal da menopausa (THM) na comunidade médica, o Departamento de Endocrinologia Feminina e Andrologia da SBEM reuniu um grupo de especialistas para formular um documento informativo, crítico e de posicionamento que pudesse servir de orientação aos que praticam ou opinam sobre tratamento da menopausa. THM está indicada para alívio dos sintomas motores, conservação do trofismo vaginal, preservação de massa óssea e colágeno, melhora do bem estar e sexualidade. Os estudos sobre prevenção cardiovascular primária não são conclusivos, portanto insuficientes para indicar ou deixar de indicar THM com este objetivo. Esquemas e tipos de associação devem ser individualizados. Sempre que possível deve-se optar pelas menores doses eficazes de 17-beta estradiol, associado a progesterona natural ou seus derivados nas mulheres com útero. A duração do tratamento é vinculada a seus objetivos, devendo ser reavaliada periodicamente através de um balanço individual entre indicação e contra-indicação. Orientação quanto a um estilo de vida mais saudável, com eliminação de tabagismo, alimentação adequada em cálcio e pobre em gorduras e atividade física regular são fundamentais como cuidados associados durante a menopausa.

Insuficiência androgênica na mulher e potenciais riscos da reposicão terapêutica / Female androgen insufficiency and potencial risks of therapeutic replacement

Na mulher, os androgênios decrescem lenta e progressivamente a partir da quarta década e por toda a vida. O declínio dos androgênios pode gerar um estado de deficiência que se manifesta insidiosamente por diminuicão da funcão sexual, bem estar e energia, alteracões na composicão corporal e perda de massa óssea. Se há história de ooforectomia bilateral, pan-hipopituitarismo, supressão da androgênese adrenal e/ou os níveis séricos de testosterona biodisponível se encontram reduzidos, é provável que estes sinais e sintomas sejam aliviados pela administracão criteriosa de androgênios, cuja prática tem se difundido. Nas doses atualmente preconizadas, parece que os benefícios sobre massa óssea, sexualidade e qualidade de vida são alcancados sem importantes efeitos colaterais de virilizacão. Entretanto, trabalhos bem controlados são necessários para validar a hipótese de que a administracão terapêutica de androgênios em mulheres não tem, a longo prazo, repercussões significativas na incidência sobre câncer de mama ou conseqüências metabólicas indesejáveis.

[Hormonal therapy of menopause: 2004 position of the Department of Female Endocrinology and Andrology of the Brazilian Society of Endocrinology and Metabolism]. / Terapia hormonal da menopausa: posicionamento do Departamento de Endocrinologia Feminina e Andrologia da SBEM em 2004.

After randomized clinical trials produced impact and questions at the medical community on menopause hormonal therapy (MHT), the Department of Female Endocrinology and Andrology of the Brazilian Society of Endocrinology convened a group of specialists to produce an informative, critical and position paper, offering guidelines for those who practice or are called to express their opinion on menopause therapy. MHT is indicated for relief of vasomotor symptoms, maintenance of vaginal tropism, bone mass and collagen preservation, sexual and general well-being. Studies on primary cardiovascular prevention are not conclusive, and thus insufficient to indicate or not MHT for this purpose. Schemes and forms of association should de individualized. Whenever possible, one should use 17-beta estradiol, associated to natural progesterone or its derivatives in women with an intact uterus, at the lowest effective doses. Duration of therapy depends on its aims, and should be periodically re-evaluated through an individual indication/contra-indication balance. Orientation toward a healthier lifestyle, with smoking cessation, adequate calcium intake and a low fat diet, together with regular physical activity is fundamental during menopause.

Tireotoxicose por triiodotironina e sua variante: relato de três casos / Triiodothyronine thyreotoxicosis and its variant: report of three cases

Tireotoxicose ocorre na presença de níveis séricos elevados de triiodotironina (T3) e tiroxina (T4) totais ou livres (L) e baixos de tirotropina (TSH). Em áreas endêmicas, pode-se encontrar um aumento da concentração de T3 com T4 total e T4L normal ou baixo. Tal condição é conhecida como "tireotoxicose por T3" (TpT3). Uma variante, conhecida como "tireotoxicose por T3 livre" (TpT3L) tem sido descrita, apresentando-se com valores séricos subnormais de TSH e T3 total, T4L normais, mas altos níveis de T3L. A tireotoxicose aumenta a reabsorção óssea e, portanto, a incidência de fraturas; altera o sistema cardiovascular por modificações hemodinâmicas e dos receptores no músculo cardíaco, mostrando a importância do seu diagnóstico e tratamento precoces, a fim de reduzir a morbidade dos riscos de osteoporose e arritmias. O diagnóstico precoce e o tratamento do hipertireoidismo podem previnir estas complicações. Descrevemos três pacientes com critérios para o diagnóstico de TpT3 - um deles com TpT3L. Todos moravam em área não-endêmica e eram portadores de bócio difuso. Como o rastreamento para doenças tireoidianas consta apenas das dosagens de TSH e T4L, sugerimos que, em caso de TSH suprimido, seja avaliado o nível de T3 total. Caso este seja normal, dosar o T3L a fim de se diagnosticar a TpT3L. Acreditamos que o estudo desses casos possa esclarecer melhor tais considerações.