RESUMO
Background: Pheochromocytoma and paraganglioma (PHEO/PGL) are rare neuroendocrine tumors which may cause potentially life-threatening complications, with about a third of cases found to harbor specific gene mutations. Thus, early diagnosis, treatment, and meticulous monitoring are of utmost importance. Because of low incidence of succinate dehydrogenase complex subunit A (SDHA)-related metastatic PHEO/PGL, currently there exists insufficient clinical information, especially with regards to its diagnostic and treatment characteristics. Methods: Ten patients with SDHA-related metastatic PHEO/PGL were followed-up prospectively and/or retrospectively between January 2010-July 2018. They underwent biochemical tests (n = 10), 123I-MIBG (n = 9) scintigraphy, and multiple whole-body positron emission tomography/computed tomography (PET/CT) scans with 68Ga-DOTATATE (n = 10), 18F-FDG (n = 10), and 18F-FDOPA (n = 6). Results: Our findings suggest that these tumors can occur early and at extra-adrenal locations, behave aggressively, and have a tendency to develop metastatic disease within a short period of time. None of our patients had a family history of PHEO/PGL, making them appear sporadic. Nine out of 10 patients showed abnormal PHEO/PGL-specific biochemical markers with predominantly noradrenergic and/or dopaminergic phenotype, suggesting their utility in diagnosing and monitoring the disease. Per patient detection rates of 68Ga-DOTATATE (n = 10/10), 18F-FDG (n = 10/10), 18F-FDOPA (n = 5/6) PET/CT, and 123I-MIBG (n = 7/9) scintigraphy were 100, 100, 83.33, and 77.77%, respectively. Five out of 7 123I-MIBG positive patients had minimal 123I-MIBG avidity or detected very few lesions compared to widespread metastatic disease on 18F-FDG PET/CT, implying that diagnosis and treatment with 123/131I-MIBG is not a good option. 68Ga-DOTATATE PET/CT was found to be superior or equal to 18F-FDG PET/CT in 7 out of 10 patients and hence, is recommended for evaluation and follow-up of these patients. All 7 out of 7 patients who received conventional therapies (chemotherapy, somatostatin analog therapy, radiation therapy, 131I-MIBG, peptide receptor radionuclide therapy) in addition to surgery showed disease progression. Conclusion: In our cohort of patients, SDHA-related metastatic PHEO/PGL followed a disease-course similar to that of SDHB-related metastatic PHEO/PGL, showing highly aggressive behavior, similar imaging and biochemical phenotypes, and suboptimal response to conventional therapies. Therefore, we recommend careful surveillance of the affected patients and a search for effective therapies.
RESUMO
OBJECTIVE: To determine the prevalence of depression in Filipino adult patients with type 2 diabetes mellitus (DM) and the risk factors associated in its development.METHODS:This is a prospective cross-sectional study. Adult patients (age 19 and above) with type 2 DM being seen at the outpatient department of the Makati Medical Center from January to March 2015 were included, taking into account the following: age, gender, marital status, body mass index, waist circumference, blood pressure, duration of diabetes, presence of other co-morbid illnesses, pill burden, insulin use, educational attainment, employment status, family income, and glycemic status. They were then screened for depression using the standardized PHQ-9 questionnaire. Bivariate analyses through Chi-square Test (for categorical variables) and Analysis of Variance (for interval/ratio variables) were used to determine which among the risk factors are significant for the development of depression.Significant risk factors were treated for multivariate and univariate analyses through ordinal logistic regression.RESULTS: A total of 110 adult patients with type 2 DM were enrolled in this study. There were no drop-outs. Sixty-nine percent of the patients had none to minimal depression, 24% had mild depression, and 7% had moderate depression. None of the patients had depression that warranted anti-depressants or psychotherapy.After step-wise analysis, increased BMI, elevated diastolic blood pressure and uncontrolled blood sugar were found to be associated with higher PHQ-9 scores while unemployment was associated with decreased PHQ-9 score.CONCLUSION:The prevalence of depression among Filipino type 2 diabetic patients is higher than in non-diabetic patients. Being obese, having an elevated diastolic blood pressure, and the presence of uncontrolled blood sugar were significant predictors and were associated with an increased likelihood of developing major depressive disorder. Being unemployed appears to have the opposite effect.
