Timing of thyroid ultrasonography in the etiological investigation of congenital hypothyroidism

ABSTRACT Objectives To describe the findings of thyroid ultrasonography (T-US), its contribution to diagnose congenital hypothyroidism (CH) and the best time to perform it. Subjects and methods Forty-four patients with CH were invited to undergo T-US and 41 accepted. Age ranged from 2 months to 45 years; 23 patients were females. All were treated with L-thyroxine; 16 had previously undergone scintigraphy and 30 had previous T-US, which were compared to current ones. Results At the current T-US, the thyroid gland was not visualized in its normal topography in 10 patients (24.5%); 31 T-US showed topic thyroid, 17 with normal or increased volume due to probable dyshormonogenesis, 13 cases of hypoplasia and one case of left-lobe hemiagenesis. One patient had decreased volume due to central hypothyroidism. Scintigraphy scans performed 3-4 years earlier showed 100% agreement with current results. Comparisons with previous T-US showed concordant results regarding thyroid location, but a decrease in current volume was observed in eight due to the use of L-thyroxine, calling the diagnosis of hypoplasia into question. Conclusions The role of T-US goes beyond complementing scintigraphy results. It allows inferring the etiology of CH, but it must be performed in the first months of life. An accurate diagnosis of CH will be attained with molecular study and the T-US can guide this early assessment, without therapy withdrawal.

Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM): Experience Report.

OBJECTIVE:: To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro. METHODS:: Cross-sectional and retrospective study of thirty cases treated over a period of two decades. RESULTS:: 17 men (56.7%) aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%), somatostatin receptor ligands + radiotherapyin 5 patients (17.8%), radiotherapy in 3 patients (10.7%), and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%). Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65%) have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels. CONCLUSION:: The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes.

Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM): Experience Report

OBJECTIVE: To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro. METHODS: Cross-sectional and retrospective study of thirty cases treated over a period of two decades. RESULTS: 17 men (56.7%) aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%), somatostatin receptor ligands + radiotherapyin 5 patients (17.8%), radiotherapy in 3 patients (10.7%), and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%). Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65%) have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels. CONCLUSION: The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes.

Timing of thyroid ultrasonography in the etiological investigation of congenital hypothyroidism.

OBJECTIVES: To describe the findings of thyroid ultrasonography (T-US), its contribution to diagnose congenital hypothyroidism (CH) and the best time to perform it. SUBJECTS AND METHODS: Forty-four patients with CH were invited to undergo T-US and 41 accepted. Age ranged from 2 months to 45 years; 23 patients were females. All were treated with L-thyroxine; 16 had previously undergone scintigraphy and 30 had previous T-US, which were compared to current ones. RESULTS: At the current T-US, the thyroid gland was not visualized in its normal topography in 10 patients (24.5%); 31 T-US showed topic thyroid, 17 with normal or increased volume due to probable dyshormonogenesis, 13 cases of hypoplasia and one case of left-lobe hemiagenesis. One patient had decreased volume due to central hypothyroidism. Scintigraphy scans performed 3-4 years earlier showed 100% agreement with current results. Comparisons with previous T-US showed concordant results regarding thyroid location, but a decrease in current volume was observed in eight due to the use of L-thyroxine, calling the diagnosis of hypoplasia into question. CONCLUSIONS: The role of T-US goes beyond complementing scintigraphy results. It allows inferring the etiology of CH, but it must be performed in the first months of life. An accurate diagnosis of CH will be attained with molecular study and the T-US can guide this early assessment, without therapy withdrawal.

Clonidine-stimulated growth hormone concentrations (cut-off values) measured by immunochemiluminescent assay (ICMA) in children and adolescents with short stature.

OBJECTIVES: To establish cut-off values for growth hormone concentrations using clonidine as a secretagogue and an immunochemiluminescent assay as the method of measurement and to analyze the response time as well as the influence of gender, nutritional status and pubertal stage. METHODS: A total of 225 tests were performed in 3 patient groups, categorized as group 1 (normal), group 2 (idiopathic short stature) and group 3 (growth hormone deficiency). Among the 199 disease-free individuals, 138 were prepubertal, and 61 were pubertal. Clonidine (0.1 mg/m2) was orally administered, and the growth hormone level was measured by immunochemiluminescent assay. The growth hormone peak and the difference between the growth hormone peak and the baseline level were then analyzed. Statistical analyses were performed using Student's t-test or the Mann-Whitney test and Kruskal-Wallis test followed by Dunn's post hoc test. Cut-off values were determined using a receiver operating characteristic curve. RESULTS: Group 1 and group 2 had no difference in growth hormone peak, gender, body mass index standard deviation score, or pubertal stage. Group 3 exhibited a significantly lower growth hormone peak than the other groups did. The receiver operating characteristic curve demonstrated that growth hormone concentrations ≥ 3.0 ng/mL defined responsiveness to clonidine. In total, 3.02% of individuals in group 1 and group 2 were considered false positive, i.e., these children lacked growth hormone deficiency and had a peak below 3.0 ng/mL. CONCLUSION: Clonidine-stimulated growth hormone concentrations ≥3 ng/mL, as measured by immunochemiluminescent assay, suggest responsiveness to the stimulus regardless of gender, body mass index standard deviation score or pubertal stage.

Clonidine-stimulated growth hormone concentrations (cut-off values) measured by immunochemiluminescent assay (ICMA) in children and adolescents with short stature

OBJECTIVES: To establish cut-off values for growth hormone concentrations using clonidine as a secretagogue and an immunochemiluminescent assay as the method of measurement and to analyze the response time as well as the influence of gender, nutritional status and pubertal stage. METHODS: A total of 225 tests were performed in 3 patient groups, categorized as group 1 (normal), group 2 (idiopathic short stature) and group 3 (growth hormone deficiency). Among the 199 disease-free individuals, 138 were prepubertal, and 61 were pubertal. Clonidine (0.1 mg/m2) was orally administered, and the growth hormone level was measured by immunochemiluminescent assay. The growth hormone peak and the difference between the growth hormone peak and the baseline level were then analyzed. Statistical analyses were performed using Student’s t-test or the Mann-Whitney test and Kruskal-Wallis test followed by Dunn’s post hoc test. Cut-off values were determined using a receiver operating characteristic curve. RESULTS: Group 1 and group 2 had no difference in growth hormone peak, gender, body mass index standard deviation score, or pubertal stage. Group 3 exhibited a significantly lower growth hormone peak than the other groups did. The receiver operating characteristic curve demonstrated that growth hormone concentrations ≥ 3.0 ng/mL defined responsiveness to clonidine. In total, 3.02% of individuals in group 1 and group 2 were considered false positive, i.e., these children lacked growth hormone deficiency and had a peak below 3.0 ng/mL. CONCLUSION: Clonidine-stimulated growth hormone concentrations ≥3 ng/mL, as measured by immunochemiluminescent assay, suggest responsiveness to the stimulus regardless of gender, body mass index standard deviation score or pubertal stage.

Evaluation of central precocious puberty treatment with GnRH analogue at the Triangulo Mineiro Federal University (UFTM)

Objective To report our experience of treating central precocious puberty (CPP) with a GnRH analogue with respect to the final heights (FH) attained in patients who completed treatment. Subjects and methods Among 105 records of children diagnosed with precocious puberty, 62 cases (54 girls and 8 boys), who were treated with leuprolide acetate/3.75 mg/monthly, were selected, and divided into 4 groups: group 1 (G1), 25 girls who attained FH; group 2 (G2), 18 girls who completed treatment but did not reach FH; group 3 (G3), 11 girls still under treatment; and group 4 (G4), 8 boys, 5 of which attained FH. Treatment was concluded at a bone age of 12 years, and follow-up continued until FH was achieved. Results In both G1 and G2 groups, height standard deviation score (SDS), weight-SDS and percentile of body mass index (PBMI) did not show intra/intergroup differences at the beginning and at interruption of treatment, but when added, G1+G2, height-SDS and weight-SDS differed significantly (p = 0.002 and 0.0001, respectively). In G1, 19 of 25 cases attained TH, and average height gain was 16.7 cm (7.7- 27.1); there was significant difference between FH and prediction of FH at the start (PFH at start) (p = 0.0001), as well as between PFH at interruption vs TH and vs FH (p = 0.007) with FH higher than TH (p = 0.004). Significant correlation was identified between FH and height gain after treatment. Conclusion As shown by some studies, GnRH analogue treatment was effective in children with CPP reaching FH near the genetic target.

Evaluation of central precocious puberty treatment with GnRH analogue at the Triangulo Mineiro Federal University (UFTM).

OBJECTIVE: To report our experience of treating central precocious puberty (CPP) with a GnRH analogue with respect to the final heights (FH) attained in patients who completed treatment. SUBJECTS AND METHODS: Among 105 records of children diagnosed with precocious puberty, 62 cases (54 girls and 8 boys), who were treated with leuprolide acetate/3.75 mg/monthly, were selected, and divided into 4 groups: group 1 (G1), 25 girls who attained FH; group 2 (G2), 18 girls who completed treatment but did not reach FH; group 3 (G3), 11 girls still under treatment; and group 4 (G4), 8 boys, 5 of which attained FH. Treatment was concluded at a bone age of 12 years, and follow-up continued until FH was achieved. RESULTS: In both G1 and G2 groups, height standard deviation score (SDS), weight-SDS and percentile of body mass index (PBMI) did not show intra/intergroup differences at the beginning and at interruption of treatment, but when added, G1+G2, height-SDS and weight-SDS differed significantly (p = 0.002 and 0.0001, respectively). In G1, 19 of 25 cases attained TH, and average height gain was 16.7 cm (7.7- 27.1); there was significant difference between FH and prediction of FH at the start (PFH at start) (p = 0.0001), as well as between PFH at interruption vs TH and vs FH (p = 0.007) with FH higher than TH (p = 0.004). Significant correlation was identified between FH and height gain after treatment. CONCLUSION: As shown by some studies, GnRH analogue treatment was effective in children with CPP reaching FH near the genetic target.

[Evaluation of the final stature reached by type 1 diabetes mellitus patients followed at an outsourced service]. / Avaliação da estatura final atingida por pacientes com diabetes melito tipo 1 acompanhados em serviço terciário.

UNLABELLED: Metabolic changes resulting from type 1 diabetes mellitus (DM1) may put growth and development at risk. OBJECTIVE: To evaluate the final stature of DM1 patients and the interference of DM1 in growth. SUBJECTS AND METHODS: The final height reached by 58 DM1 patients was evaluated according to anthropometric data and metabolic control. RESULTS: Mean age was 26.4 years (15.0-51.0) and the duration of disease was of 9.6 years (1.4-25.0). Final stature was 165.1 cm (149.3-183.0) and the z-score for height was 0.09 (-1.76-2.85). In a subgroup (n = 34), it was possible to evaluate the effect of metabolic control on growth. Mean glycosylated hemoglobin was 12.2% (6.8-24.1) and the correlation between anthropometric data and glucose control was not considered statistically significant (p > 0.05). CONCLUSION: We conclude that DM1 had no effect on the final stature, to the detriment of a poor metabolic control.

Avaliação da estatura final atingida por pacientes com diabetes melito tipo 1 acompanhados em serviço terciário / Evaluation of the final stature reached by type 1 diabetes mellitus patients followed at an outsourced service

As alterações metabólicas decorrentes do diabetes melito tipo 1 (DM1) podem prejudicar o crescimento e o desenvolvimento. OBJETIVO: Avaliar a estatura final de pacientes com DM1 e a interferência da doença no crescimento. PACIENTES E MÉTODOS: A estatura final de 58 pacientes com DM1 foi avaliada em relação aos dados antropométricos e controle metabólico. RESULTADOS: A idade média foi de 26,4 anos (15,0-51,0) e a duração da doença, de 9,6 anos (1,4-25,0). A estatura final foi 165,1 cm (149,3-183,0) e o z-escore da estatura final foi igual a 0,09 (-1,76-2,85). Num subgrupo (n = 34), foi possível avaliar o controle glicêmico durante a fase de crescimento estatural. A média de hemoglobina glicosilada foi 12,2 por cento (6,8-24,1) e as correlações entre dados antropométricos e controle glicêmico não foram estatisticamente significantes (p > 0,05). CONCLUSÃO: Não houve interferência do DM1 na estatura final, apesar do controle glicêmico inadequado.

Metabolic changes resulting from type 1 diabetes mellitus (DM1) may put growth and development at risk. OBJECTIVE: To evaluate the final stature of DM1 patients and the interference of DM1 in growth. SUBJECTS AND METHODS: The final height reached by 58 DM1 patients was evaluated according to anthropometric data and metabolic control. RESULTS: Mean age was 26.4 years (15.0-51.0) and the duration of disease was of 9.6 years (1.4-25.0). Final stature was 165.1 cm (149.3-183.0) and the z-score for height was 0.09 (-1.76-2.85). In a subgroup (n = 34), it was possible to evaluate the effect of metabolic control on growth. Mean glycosylated hemoglobin was 12.2 percent (6.8-24.1) and the correlation between anthropometric data and glucose control was not considered statistically significant (p > 0.05). CONCLUSION: We conclude that DM1 had no effect on the final stature, to the detriment of a poor metabolic control.

Lesões císticas não tumorais intraselares: cisto de Rathke ede aracnóide: relato de dois casos e revisão da literatura / Intraselar non neoplasic cystic lesions: Rathke cystic and arachnoidal cyst: report of two cases and literature review

São discutidos os aspectos clínicos, endocrinológicos, radiológicos e cirúrgicos de dois pacientes: um portador de cisto de bolsa de Rathke e outro de cisto aracnóide, ambos em localização intraselar, de uma série de 123 pacientes portadores de lesão intra e supraselar abordados por via transesfenoidal. Lesões císticas puras são raras e as dificuldades diagnósticas pré-operatórias assim como os aspectos neurocirúrgicos relativos a estas patologias são destacados. É feita uma revisão da literatura.

[Alcoholization in the treatment of thyroid nodule in colloid goiter endemic region]. / Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide.

Thyroid nodular disease is a common clinical disorder mainly in iodine lacking regions. This study has evaluated the effectiveness of percutaneous ethanol injection (PEI) in the treatment of single, multiple, solid, and cystic thyroid nodules of different sizes with or without glandular dysfunction, in goiter endemic region. Forty-two patients with diagnosis of colloid goiter or colloid nodular hyperplasia in fine-needle aspiration (FNA) were selected for analysis, after having been submitted to at least two PEI. Thyroid nodules were multiple (solid and or cystic) in 52.4% of the patients, single and solid or mixed in 35.7%, and single and cystic in 11.9%. The mean reduction of nodules after ethanol injection was of 58.2% in the single and of 60.8% in the cystic ones. The reduction of the whole thyroid lobe was evaluated in the multiple nodules and it reached 52.4%. The side-effects were registered only as a consequence of the application discomfort. This study points out that the percutaneous ethanol injection reaching volume mean reductions, varying from 49% to 60%, is a safe, effective, and simple method for the treatment of benign thyroid nodules.

Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide / Alcoholization in the treatment of thyroid nodule in colloid goiter endemic region

A doença nodular tiroidiana é problema clínico comum, principalmente em regiões com carência de iodo. Esse estudo avaliou a eficácia da injeção percutânea de etanol (IPE) no tratamento de nódulos tiroidianos únicos, múltiplos, sólidos, císticos, de diferentes tamanhos com ou sem disfunção glandular, em região endêmica de bócio. Quarenta e dois pacientes com diagnóstico de bócio colóide ou hiperplasia nodular colóide, na punção biópsia aspirativa por agulha fina (PBAAF), foram selecionados para análise após terem sido submetidos a pelo menos duas IPEs. Os nódulos tiroidianos eram múltiplos (sólidos e ou císticos) em 52,4 por cento dos pacientes, únicos e sólidos ou mistos em 35,7 por cento e únicos e císticos em 11,9 por cento. A redução média dos nódulos após injeção de etanol foi de 58,2 por cento para os únicos e 60,8 por cento nos císticos. Nos nódulos múltiplos, avaliou-se a redução de todo o lobo tiroidiano, alcançando 52,4 por cento de redução. Os efeitos colaterais registrados foram decorrentes apenas do desconforto na aplicação. Este estudo indica que a injeção percutânea de etanol (IPE), alcançando reduções médias de volume que variam de 49 a 60 por cento, é método seguro, eficaz e simples para o tratamento de nódulos tiroidianos benignos.

Thyroid nodular disease is a common clinical disorder mainly in iodine lacking regions. This study has evaluated the effectiveness of percutaneous ethanol injection (PEI) in the treatment of single, multiple, solid, and cystic thyroid nodules of different sizes with or without glandular dysfunction, in goiter endemic region. Forty-two patients with diagnosis of colloid goiter or colloid nodular hyperplasia in fine-needle aspiration (FNA) were selected for analysis, after having been submitted to at least two PEI. Thyroid nodules were multiple (solid and or cystic) in 52.4 percent of the patients, single and solid or mixed in 35.7 percent, and single and cystic in 11.9 percent. The mean reduction of nodules after ethanol injection was of 58.2 percent in the single and of 60.8 percent in the cystic ones. The reduction of the whole thyroid lobe was evaluated in the multiple nodules and it reached 52.4 percent. The side-effects were registered only as a consequence of the application discomfort. This study points out that the percutaneous ethanol injection reaching volume mean reductions, varying from 49 percent to 60 percent, is a safe, effective, and simple method for the treatment of benign thyroid nodules.

Avaliação do desenvolvimento somático-sexual de portadores de anemia falciforme com idades entre 12 e 25 anos / Evaluation of the somatic-sexual development in patients with sickle-cell disease, between the ages of 12 and 25

Introdução: Pacientes com anemia falciforme (HbSS) estão geralmente acometidos com algum retardo do desenvolvimento físico e sexual. A idade da puberdade e do pico de crescimento geralmente estão atrasados. Objetivo: Avaliar o desenvolvimento somático-sexual de portadores de anemia falciforme e comparar com o desenvolvimento de indivíduos normais. Métodos: Foram examinados 12 pacientes falcêmicos, 12 indivíduos normais do sexo masculino, oito pacientes do sexo feminino com anemia falciforme e 10 pacientes que não apresentavam essa doença. Os pacientes responderam a interrogatório dirigido e foram submetidos a exame clínico. Os dados foram quantificados e submetidos a análise estatística. Resultados: Obteve-se, no grupo dos homens, relações estatisticamente válidas para as variáveis idade de início da puberdade, aparecimento de pêlos, primeira ejaculação, largura e volume testicular, sendo que as outras variáveis não mostraram diferenças estatisticamente válidas. A ocorrência de ginecomastia não se mostrou significativa quando foram comparados os dois grupos. Nas mulheres observou-se um atraso significativo da menarca e da pubarca nas pacientes falcêmicas. Não se conseguiu demonstrar que o desenvolvimento somático de pacientes do sexo feminino falcêmicas está atrasado quando comparado com pacientes normais. Conclusões: Trata-se de um levantamento de grande importância, pois é importante conhecer até que ponto existe uma diferença de desenvolvimento somático-sexual entre indivíduos falcêmicos e aqueles considerados normais.

Avaliação do tratamento definitivo do hipertireoidismo com radioiodo na Faculdade de Medicina do Triângulo Mineiro / Evaluation of radioiodine therapy as a definitive treatment for hyperthyroidism in the Triângulo Mineiro School of Medicine

O hipertireoidismo de origem auto-imune ou devido a doença autonômica da tireóide pode ser eficientemente controlado seja pela inibição temporária da hormoniogênese com as tiouréias, seja pela redução definitiva da massa folicular funcionante pela tireoidectomia ou administração de radioiodo. Com a intenção de conhecer os efeitos da radioiodoterapia na Faculdade de Medicina de Triângulo Mineiro, foram revisados 255 prontuários de pacientes com hipertireoidismo atendidos no ambulatório de tireóide entre janeiro de 1991 e 2001. O 1¹³¹ foi administrado a 61 pacientes portadores de doença de Basedow-Graves (DBG) (n=143), a seis com bócio multinodular tóxico (BMT) (n=17), e a 3 com bócio uninodular tóxico (BUI) (n=7). Apenas 1 caso de Hashitoxicese (n=40) de mais longa duração recebeu o mesmo tratamento. A maioria dos pacientes com DBG recebeu de 185 a 370MBq (5-10mCi) de 1¹³¹ e em dez pacientes com bócios volumosos foi necessário repetir a dose. Os pacientes com BMT e BUT receberam de 185 a 925MBg (5-25mCi) e uma segunda dose foi dada a três deles.Todos os pacientes foram curados do hipertireoidismo, não foram observadas complicações agudas, entretanto, o seguimento pós-dose até o momento detectou hipotireoidismo em 63% dos pacientes.

Hyperthyroidism either auto-immune or due to autonomic thyroid disease can be efficiently controlled by hormoniogenesis inhibition with antithyroid drugs or definitive reduction of functioning thyroid follicles number by either subtotal thyroidectomy or radioiodine administration. The effects of radioiodine therapy in the Triângulo Mineiro Medical School was investigated in 255 hyperthyroid patients treated between 1991 and 2001. 1¹³¹ was administered to 61 patients with Basedow-Graves disease (BGD), to six patients with multinodular toxic goiter (MTG), and to three patients with solitary toxic goiter (STG). Only one patient with Hashitoxicose ot unusual and longer duration received the same treatment. Patients with BGD were treated with 185 to 370MBq (5-10mCi) of 1¹³¹ but in ten of them with larger goiters it was necessary a second dose. Patients with MTG and STG received 185 to 925MBq (5-25mCi) and a second dose was given to three of them. All patients were considered cured from hyperthyroidism without acute complications, however follow up so far detected hypothyroidism in 63%.

Pseudopuberdade precoce causada por tumor de células da granulosa juvenil / Psedo-precocious puberty due to a juvenile granulosa cell tumor

Descrevemos um caso de tumor ovariano das células da granulosa cuja manifestaçäo inicial foi puberdade precoce isossexual, em criança de 7 anos e 4 meses, de evoluçäo progressiva e rápida, associada a massa hipogástrica palpável. A avaliaçäo hormonal demonstrou estradiol: 296pg/ml; 17aOH-progesterona: 20ng/ml; S-DHEA: 27µg/dl; PhCG: 0,66mU1/ml; testosterona: 120ng/dl; progesterona: 3,4ng/ml; LH: 0,5mUl/ml; e FSH: 0,01 mUl/ml e näo responsivos ao estímulo com o GnRH, (Relisorm: 100µg iv). Exames de imagem confirmaram massa tumoral em ovário esquerdo. A paciente foi submetida à salpingo-ooforectomia esquerda com retirada completa do tumor que pesou 656g e mediu 14,5 x 10,0 x 7,Ocm, restrito ao ovário e cujo exame histopatológico demonstrou tumor de cérúlas da granulosa juvenil. Durante a cirurgia amostras sangüíneas foram obtidas da veia ovariana ipsilateral ao tumor e as concentraçöes de esteróides foram estudadas. Níveis elevados de estradiol (969pg/ml), progesterona (15,8ng/ml), 17aOH-progesterona (34ng/ml) e testosterona (158ng/dl) foram encontrados. No pós-operatório observou-se rápida regressäo das mamas, dos pêlos pubianos, com normalizaçäo das concentraçöes hormonais. Durante o seguimento, a paciente apresentou desenvolvimento puberal normal, e näo há sinais de reincidência do tumor.

Punção-biópsia aspirativa da tireóide em região endémica de bócio colóide / Fine nedle aspiration citology in an endemic colloid goiter region

Propusemo-nos verificar a frequência de tireoidopatias em região endêmica de bócio colóide, por meio de punção-biópsia aspirativa com agulha fina (PBAAF). Foram avaliados os diagnósticos obtidos por intermédio dessa técnica em 527 pacientes portadores de tireoidopatias tratados na cidade de Uberaba, Minas Gerais, no período de 1993 a 1999, correlacionando-os com sexo e idade. As tireoidopatias mais freqüentemente encontradas foram bócio colóide (58,75%), tireoidite crônica de Hashimoto (23,06 %) e tumor folicular (10,10 %), predominantemente no sexo feminino (92 %) e na faixa etária entre 30 e 60 anos (60 %). A tireoidite de Hashimoto apresentou uma incidência dez vezes maior que as relatadas em outras regiões endêmicas e não-endêmicas de bócio, observando-se elevada freqüência de tumores foliculares, os quais foram cerca de 15 vezes mais freqüentes que o carcinoma papilífero.

The thyroid disease frequency was verified in an endemic goiter region, based on fine needle aspiration cytology (FNAC). 527 FNAC were evaluated in thyroid diseases in Uberaba, Minas Gerais, Brazi I, between 1993 and 1999, according to sex and age. Colloid goiter was found in 58,75%, followed by Hashimoto's chronic thyroiditis (23,06%) and follicular tumors (10,10%), mainly in the female sex (92%), between 30 and 60 years old (60%). These results show that Hashimoto's chronic thyroiditis is 10 times more frequent than those seen in endemic regions and non-endemic goiter region. In addition, there was a high frequency of follicular tumors (around 15 times higher than papillary carcinoma).

Causas de morte e achados de necropsia de pacientes diabéticos em um hospital universitário / Causes of death and necropsy findings in diabetic patients on a medical school hospital

O presente trabalho tem como objetivo correlacionar as manifestaçöes clínicas com os achados anátomo-patológicos, estabelecendo as causas mais frequentes de óbitos em diabéticos, no Hospital Escola da Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG. De 103 pacientes diabéticos que foram a óbito nos últimos 10 anos, 36 (35,0 por cento) foram necropsiados, sendo a maioria (55,6 por cento) de diabéticos do tipo II. Doze pacientes eram do sexo feminino (33,3 por cento) e 24 pacientes do sexo masculino (66,7 por cento), com medianas de idade de 53 e 50 anos respectivamente. As infecçöes, principalmente pulmonares, foram responsáveis por 44,5 por cento dos óbitos, seguidas dos eventos cardiovasculares (38,9 por cento). Complicaçöes metabólicas agudas constituíram a minoria dos óbitos (5,5 por cento). Cinquenta e oito por cento dos pacientes tinham duraçäo do diabetes igual ou inferior a 7 anos e apenas 13,9 por cento estavam num nível adequado de controle glicêmico. Estes dados indicam a necessidade de um controle glicêmico mais intensivo, atençäo especial aos fatores de risco cardiovasculares e melhora do controle de infecçöes em diabéticos.

Hipotireoidismo: experiência de atendimento em nível terciário na Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG / Hypothyroidism: experience on tertiary care at the Triângulo Mineiro School of Medicine, Uberaba, MG

A análise retrospectiva de 125 pacientes portadores de hipotireoidismo definitivo demonstrou que a tireoidite crônica auto-imune (Tireoidite de Hashimoto e Hipotrofia Tireoidiana) foi a causa mais comum de hipotireoidismo em nosso meio (52,8 por cento). A tireoidite de Hashimoto apresentou-se frequentemente como doença subclínica (64,3 por cento) e a Hipotrofia Tireoidiana como manifesta (94,7 por cento). Determinou-se a frequência relativa das outras causas de hipotireoidismo: Iatrogênicas 24,8 por cento (Pós-tireoidectomia 17,6 por cento, Pós-radioiodo 7,2 por cento), Congênitas 11,2 por cento e hipotálamo-hipofisárias 11,2 por cento. Todos os pacientes com hipotireoidismo congênito apresentaram-se com mixedema e retardamento mental, o que demonstra a necessidade de rastreamento neonatal, diagnóstico e tratamento mais precoces.