Correlations of the glycemic variability with oxidative stress and erythrocytes membrane stability in patients with type 1 diabetes under intensive treatment.

OBJECTIVES: This study aimed to evaluate the correlations of glycemic variability with erythrocyte membrane stability parameters and oxidative stress markers in patients with type 1 diabetes mellitus (T1DM) under intensive treatment. MATERIAL AND METHODS: 90 patients with T1DM and under intensive treatment of the disease were evaluated in relation to anthropometric indices, records of glycemic averages and parameters of glycemic variability, biochemical dosages (glucose, uric acid, lipidogram, glycated hemoglobin, microalbuminuria, creatinine and iron) reticulocyte count, erythrocyte membrane stability parameters and oxidative stress markers (thiobarbituric acid reactive substances, TBARS, and glutathione reductase, GR). RESULTS: Indicators of glycemic variability in the short and long term showed correlations with parameters of membrane stability and markers of oxidative stress (GR). In addition, the comparison of these same parameters between the subgroups consisting of quartiles of GV or glycemic control also showed significant differences. CONCLUSION: In the T1DM patients studied here, glycemic variability showed correlations with oxidative stress and erythrocyte membrane stability variables. This corroborates the hypothesis that glycemic fluctuations interfere with lipid peroxidation and cell membrane behavior, emphasizing its participation in mechanisms related to the development of chronic complications of diabetes.

HIGH PREVALENCE OF HYPOTHYROIDISM IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITHOUT AN INCREASE IN CIRCULATING ANTI-THYROID ANTIBODIES.

OBJECTIVE: Because routine investigations are necessary for the early detection of thyroid disease, this study aimed to assess the prevalence of autoimmune thyroid disease (ATD) and thyroid dysfunction (TD) in patients with systemic lupus erythematosus (SLE). METHODS: Seventy-nine SLE patients (American College of Rheumatology criteria) and 159 control patients with no diagnosis of autoimmune diseases (except for ATD) were consecutively evaluated regarding changes in laboratory assessments of thyroid function and the presence of ATD. RESULTS: ATD was detected in 11.4% of the SLE patients and 13.8% of the control patients (P = .747), whereas TD was detected in 25.3 and 9.4% (P = .002), hypothyroidism was detected in 21.5 and 6.9% (P = .002), and hyperthyroidism was detected in 3.8 and 2.5% (P = .426) of the SLE and control patients, respectively. The mean duration of SLE was longer in patients with TD (P = .036). Mild hypothyroidism was more frequent in the SLE patients with anti-Smith antibodies (P = .029). CONCLUSION: Because hypothyroidism was more frequent in SLE patients and the frequency of ATD was high in both groups, the authors suggest that TSH and anti-thyroid antibody levels be assessed in SLE patients. ABBREVIATIONS: ACA = anti-cardiolipin antibodies; ANF = anti-nuclear factor; anti-CCP = anti-cyclic citrullinated peptide; anti-dsDNA = anti-double-stranded DNA; anti-RNP = anti-ribonucleoprotein; anti-Scl70 = anti-topoisomerase I antibodies; anti-SM = anti-Smith antigen antibodies; anti-SS-A/Ro = anti-Sjögren syndrome-related antigen A (Ro); anti-SS-B/La = anti-Sjögren syndrome-related antigen B (La); anti-Tg = anti-thyroglobulin; anti-TPO = anti-thyroid peroxidase; ATD = autoimmune thyroid disease; ENA = extractable nuclear antigen; fT4 = free thyroxine; OR = odds ratio; RF = rheumatoid factor; SLE = systemic lupus erythematosus; SLEDAI = SLE Disease Activity Index; TD = thyroid dysfunction; TSH = thyroid-stimulating hormone; TT3 = total triiodothyronine.

High-risk alcohol use and anxiety and depression symptoms in adolescents and adults with type 1 diabetes mellitus: a cross-sectional study.

BACKGROUND: The medical literature shows that alcohol consumption is common among diabetic individuals and is associated with poor adherence to treatment, resulting in increased morbidity and mortality. However, no study has assessed the association between high-risk alcohol consumption and the presence of anxiety and depression in individuals with type 1 diabetes mellitus (1DM). METHODS: The present cross-sectional study was conducted in Uberlândia, Brazil, and it assessed 209 outpatients in relation to alcohol consumption and the presence of anxiety and depression symptoms, using the Alcohol Use Disorders Identification Test (AUDIT), the Hospital Anxiety and Depression (HAD) scale, and glycemic control, according to the levels of glycated hemoglobin (HbA1c). The chi-square test and logistic regression analysis were used to investigate the association between the investigated variables. RESULTS: The prevalence of high-risk alcohol consumption (AUDIT ≥ 8) among individuals with 1DM was high, specifically 24.9% among the entire group of subjects, 12.9% among the adolescents, 14.7% among the females, and 34.6% among the males. In comparisons based on gender and age, the odds of high-risk drinking were higher among males and participants aged 30 to 40 years (33.9%). The frequency of high-risk alcohol consumption did not differ as a function of gender among adolescents (females: 9.0%, males: 16.2%; p = 0.374). There was a linear trend in proportions related to the scores of anxiety and depression symptoms with high-risk alcohol consumption scores, indicating the association of these variables (p = 0.0229 and p = 0.0262, respectively). Moreover, the odds of female subjects exhibiting anxiety and depression symptoms were higher (odds ratio - OR: 4.4 and OR: 7.4, respectively). Glycemic control did not exhibit an association between high-risk alcohol consumption and the presence of anxiety and depression symptoms. CONCLUSIONS: The frequency of high-risk drinking increased along with age and was greater among males; however, this frequency did not exhibit differences in terms of gender among adolescents. There was a positive association between high risk alcohol consumption and anxiety and depression symptoms, although glycemic control was inadequate in most of the sample independent of alcohol consumption and the presence of anxiety and depression symptoms.

Aposentadorias por invalidez e Doenças Crônicas entre os servidores da Prefeitura Municipal de Uberlândia, Minas Gerais, 1990-2009 / Retirement for disability and chronic diseases among workers at the Municipality of Uberlândia, Minas Gerais, 1990-2009

OBJETIVO: Descrever as causas de aposentadoria por incapacidade permanente entre servidores municipais de Uberlândia, Minas Gerais, e associar com fatores sociodemográficos. MÉTODOS: Foi realizado um levantamento epidemiológico no período de janeiro de 1990 a dezembro de 2009, utilizando dados secundários sobre os servidores da Prefeitura Municipal de Uberlândia. RESULTADOS: Foram avaliadas 403 aposentadorias. Em 46% delas os indivíduos tinham idade inferior a 50 anos. A maioria (96%) se aposentou devido à doença. Os transtornos mentais e comportamentais (22,6%) e as doenças do sistema osteomuscular (23,6%) foram os mais frequentes quando o motivo da aposentadoria foi determinado por causa única ou por causa múltipla, respectivamente. Os indivíduos do gênero masculino se aposentaram mais velhos e com maior contribuição de tempo de serviço. Mesmo assim, o tempo perdido de produtividade foi maior neste gênero. CONCLUSÃO: o estudo revelou o impacto negativo das doenças crônicas em uma população em idade produtiva, com alta percentagem de aposentadorias precoces. Políticas públicas no âmbito ocupacional com o objetivo de promoção, prevenção e reabilitação dos trabalhadores constituem em ações imperativas para a reversão deste quadro. .

OBJECTIVE: To describe the causes of retirement for permanent disability among workers at the Municipality of Uberlândia, Minas Gerais, associating them with sociodemographic factors. METHODS: An epidemiological survey was conducted from January 1990 to December 2009, using data on the employees of the municipality of Uberlândia. RESULTS: Were evaluated 403 retirements. In 46% of these individuals were younger than 50 years. Most (96%) retired due to illness. Mental and behavioral disorders (22.6%) and diseases of the musculoskeletal system (23.6%) were the most frequent reason of retirement when it was determined because single or multiple causes, respectively. The male individuals retired older and with more service time contribution. Still, the time lost productivity was higher in this genre. CONCLUSION: The study revealed the negative impact of non-communicable chronic diseases in a population of working age, with a high percentage of early retirements. Public policies in the occupational context with the objective of promotion, prevention and rehabilitation of workers constitute mandatory actions to reverse this situation. .

Metástases hepáticas de insulinoma 14 anos após a ressecção do turmor primário / Liver metástases 14 years after the insulinoma resection of the primary tumor

A Insulinoma é um tumor que pertence ao grupo de tumores neuroendócrinos do pâncreas. Sua incidência é rara (1-4 casos por milhão de pessoas por ano). A ressecção cirúrgica é o tratamento de escolha para o tumor localizado no pâncreas. Cerca de 90% dos tumores Exibiram um benigno comportamento e menos de 10% dos pacientes podem apresentar doença metastática, principalmente no fígado e nos linfonodos regionais. Na doença metastática, o controle da hipoglicemia, frequentemente grave e persistente, é o principal desafio para o médico da equipe que cuida do paciente. Descrevemos o caso de um paciente de 61 anos, que foi encaminhado à Unidade de Gastroenterologia no HC-UFU (Universidade Federal de Uberlândia), em julho de 2011, para a investigação de tumores no fígado, evidenciado na ultrassonografia abdominal. Também apresentou um histórico de episódios frequentes de diminuição de nível de consciência e comportamento anormal, além de 3 episódios de convulsões nos últimos 10 meses. Como história pessoal, a paciente relatou ter sido submetida a uma ressecção cirúrgica do nódulo no pâncreas em 1997 por episódio de hipoglicemia desde 1995, que se resolveu após a cirurgia. Ela relatou diagnóstico de hipertensão e de diabetes mellitus desde 2003, quando começou a usar anti-hipertensivos e metformina, sendo que o uso desta foi suspenso por 2 anos para a normalização da glicemia. No exame físico, ficou evidenciada apenas uma leve hepatomegalia,sem outras normalidades. Ela também teve glicemia no sangue de 51 mg/dl e diminuição do nível de consciência depois de um curto período de jejum. Foi necessária a aplicação de glicose em bomba de infusão no dia da internação para a enfermaria. Na revisão, verificou-se nos registros médicos da paciente que, em 1997, ela foi submetida à ressecção de um tumor no pâncreas por enucleação de 5 cm (a cabeça do pâncreas), com histopatologia que confirmou o diagnóstico de insulinoma. Para o diagnóstico em laboratório, a paciente foi mantida em jejum, com suspensão de infusão de glicose e, após 9 minutos, verificou-se a redução da consciência; em seguida, foi recolhida uma amostra periférica de insulina no sangue, de glicose, de dosagem de sulfonilureia, proinsulina e C-peptídeo. Os testes mostraram altos níveis de insulina, pró-insulina, além do peptídeo C alto dosagem de sulfonilureias negativa. A proporção de insulina / glicose de 5,95 era baseada em critérios laboratoriais de hiperinsulinismo. A TC de abdômen evidenciou múltiplos nódulos sugestivos de metástase do fígado e pâncreas normal. Em seguida, uma biópsia foi realizada da maior lesão hepática, guiada por ultrassom. O estudo imuno-histoquímico da lesão confirmou um tumor neuroendócrino de origem pancreática, sugestivo bem diferenciado de insulinoma. A lâmina de 1997 também foi revisada com estudo imuno-histoquímica e era consistente com o diagnóstico de lesões do fígado. No fim do estágio da doença, a paciente foi submetida a exame de cintilografia rotulados com 111In-DTPA-octreotid a, que mostrou captação do traçador em zonas múltiplas do fígado, sem evidências de lesões extra-hepáticas. Eles também foram condenados testes de laboratório que excluída a associação com neoplasia endócrina múltipla síndrome tipo 1. Foram prescritos propranolol, verapamil e hidroclorotiazida, numa tentativa de melhorar os níveis de glicemia, além de uma dose de depósito de octreotida (octreotida LAR) com boa resposta clínica, com a possível diminuição gradual em infusão de glicose e suspenso em 25 dias de aplicação da droga. A paciente está recebendo uma dose mensal de octreotida LAR. A paciente permanece em bom estado geral, sem queixas, apesar de envolvimento hepático difuso por lesões. Mantém normais testes laboratoriais (AST, ALT, fosfatase alcalina, Gama GT, bilirrubina e albumina TAP). Mantém os exames ambulatoriais regulares.

Insulinoma is a tumor that belongs to the group of neuroendocrine tumors of the pancreas. Its incidence is rare (1-4 cases per million people per year). Surgical resection is the treatment of choice for localized tumor in the pancreas. About 90% of the tumors exhibited a benign behavior and less than 10% of patients may show metastatic disease (mainly in liver and regional lymph nodes). In metastatic disease, the control of hypoglycemia, often serious and persistent is the key challenge for the medical team that cares of the patient. We describe a case of a patient of 61 years that was referred to the gastroenterology unit on HC-UFU in July 2011 for investigation of liver tumors (evidenced in abdominal ultrasonography)also presenting a history of frequent episodes of decreased level of consciousness and abnormal behavior, in addition to 3 episodes of seizures in the past 10 months. As personal history, the patient reported having undergone a surgical resection of the nodule in the pancreas in 1997 by hypoglycemic episodes since 1995 and which resolved after surgery. He also reported diagnoses of hypertension and diabetes mellitus since 2003, when it began using antihypertensives and metformin, with the use of this suspended for 2 years for normalization of glycemia. On arrival it was evident on physical examination only a mild hepatomegaly without other abnormalities. She also had blood glucose of 51 mg / dl and decreased level of consciousness after short periods of fasting. It required glucose infusion pump on the day of admission to the ward. In reviewing the medical records of the patient, it was found that in 1997 the patient underwent resection of a pancreatic tumor by enucleation (the head of the pancreas) of 5 cm, with histopathology confirmed the diagnosis of Insulinoma. For laboratory diagnosis, the patient was kept fasting, with suspension of glucose infusion and after 9 minutes showed decreased level of consciousness, and then collected in a sample of peripheral blood insulin,glucose; dosage of sulfonylurea; proinsulin and C-peptide The tests showed high levels of insulin, pro-insulin and C peptide Blood glucose was low in value and dosage of sulfonylurea was negative. The ratio insulin / glucose of 5.95 was laboratory criteria of hyperinsulinism. A CT of the abdomen showed multiple nodules suggestive of liver metastasis and normal pancreas. Then a biopsy was performed of the largest lesion liver guided by ultrasound. The immunohistochemical study of the lesion confirmed a neuroendocrine tumor of pancreatic origin suggestive of well-differentiated insulinoma. The blade of 1997 was also reviewed with immunohistochemical study and was consistent with the diagnosis of liver lesions. In order to stage the disease, the patient underwent the examination of scintigraphy labeled with 111In-DTPA-Octreotide, which showed tracer uptake in multiple areas of the liver, without evidence of extrahepatic lesions. They were also ordered laboratory tests that excluded the association with multiple endocrine neoplasia syndrome type 1. We prescribed propranolol, verapamil and hydrochlorothiazide in an attempt to improve blood glucose levels, plus a dose of Octreotide depot (Octreotide LAR) with good clinical response, with the possible gradual decrease in glucose infusion and suspended in 25 ° day application of the drug. The patient is receiving a monthly dose of Octreotide LAR. The patient remains in good condition overall, no complaints, despite diffuse liver involvement by injuries, maintains normal laboratory tests (AST, ALT, alkaline phosphatase, Gamma GT, bilirubin, and albumin TAP). Keeps regular outpatient follow.

Difference between the prevalence of symptoms of depression and anxiety in non-diabetic smokers and in patients with type 2 diabetes with and without nicotine dependence.

BACKGROUND: Individuals with diabetes who are smokers have higher risks of cardiovascular disease, premature death, and microvascular complications. The present study aims to determine the prevalence of symptoms of depression and anxiety in smokers with type 2 diabetes mellitus (T2D) and to evaluate if the prevalence of symptoms of depression and anxiety differ between the three groups studied (patients with T2D who smoke; patients with T2D who do not smoke; smokers without T2D), and finally determine if the degree of nicotine dependence is related to symptoms of anxiety and depression in smokers (with or without T2D). METHODS: Three study groups were formed: 46 T2D smokers (DS), 46 T2D non-smokers (D), and 46 smokers without diabetes (S), totaling 138 participants. Hospital Anxiety and Depression (HAD) scale and Fagerström Test were applied. RESULTS: The prevalence of symptoms of depression and anxiety in smokers with T2D was 30.4% and 50%, respectively. There was no significant difference in the proportion of individuals with symptoms of anxiety (p = 0.072) or depression (p = 0.657) in the DS group compared to group D or S. Among male patients with T2D, the smokers had a higher prevalence of anxiety symptoms (19.6%) than non-smokers (4,3%) (p = 0,025). The prevalence of high nicotine dependence among smokers with and without T2D was 39.1% and 37.1%, respectively (p = 0.999). Fagerström scores showed no significant correlation with the scores obtained on the subscale of anxiety (p = 0,735) or depression (p = 0,364). CONCLUSIONS: The prevalence of depression and anxiety among smokers with and without diabetes and non-smokers T2D is similar. Among male individuals with T2D, the smokers have more symptoms of anxiety than the non-smokers. There is no difference in the prevalence of nicotine dependence among smokers with and without diabetes. The presence of symptoms of anxiety or depression is similar between patients who are dependent and not dependent on nicotine.

The effect of different training programs on antioxidant status, oxidative stress, and metabolic control in type 2 diabetes.

We compared the effects of 12 weeks of 3 different exercise types on type 2 diabetic (T2DM) male and female human subjects, randomly divided into 4 groups: aerobic training (AT; n = 11), strength training (ST; n = 10), combined training (CBT; n = 10), and no training (NT; n = 12). Metabolic control, anthropometric parameters, lipid and hematological profiles, kidney and liver function markers, hormones, antioxidant enzymes, and oxidative stress markers were assessed prior to and after the training programs. At baseline, fasting blood glucose and hemoglobin A(1c) in the ST group were higher than in the NT group; after the training, we no longer observed differences in these groups, suggesting an improvement on these parameters. In the AT group, catalase and superoxide dismutase activity, nitrite concentration, levels of sulfhydryl groups, and peak rate of oxygen consumption were elevated after the training (p < 0.05). No changes were observed in antioxidant enzymes or oxidative stress markers in the ST group. The levels of sulfhydryl groups diminished in the NT group (p < 0.01) and increased in the CBT group (p < 0.05). These data demonstrate that the AT program for the T2DM subjects provided important upregulation in antioxidant enzymes and increased nitric oxide bioavailability, which may help minimize oxidative stress and the development of the chronic complications of diabetes. We propose that the beneficial effects observed in the metabolic parameters of the ST group occurred in response to the poor baseline metabolic health n this group, and not necessarily in response to the training itself.

The effects of aerobic, resistance, and combined exercise on metabolic control, inflammatory markers, adipocytokines, and muscle insulin signaling in patients with type 2 diabetes mellitus.

The purpose of this study was to compare the effects of 3 different modalities of exercise on metabolic control, insulin resistance, inflammatory markers, adipocytokines, and tissue expression of insulin receptor substrate (IRS)-1 after 12 weeks of training among patients with type 2 diabetes mellitus. Forty-eight patients with type 2 diabetes mellitus were randomly assigned to 4 groups of training (3 times a week, 60 minutes per session): aerobic group (n = 12), resistance group (n = 12), combined (aerobic and resistance) group (n = 12), and control group (n = 12). Fasting and postprandial blood glucose, glycated hemoglobin, lipid profile, insulin resistance index (homeostasis model assessment of insulin resistance), adipocytokines (adiponectin, visfatin, and resistin), tumor necrosis factor, interleukin, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline and at the end of the study. Patients also underwent a muscle microbiopsy before and after training to quantify IRS-1 expression. All 4 groups displayed decreases in blood pressure, fasting plasma glucose, postprandial plasma glucose, lipid profile, and hs-CRP (P < .05); and there was no difference across the groups. After training, the IRS-1 expression increased by 65% in the resistance group (P < .05) and by 90% in the combined group (P < .01). Exercise training favorably affects glycemic parameters, lipid profile, blood pressure, and hs-CRP. In addition, resistance and combined training can increase IRS-1 expression.

[Prevalence of thyroid dysfunction and antithyroid antibodies in type 1 diabetic mellitus patients and their first degree relatives]. / Prevalência de disfunção tireoidiana e anticorpos antitireoidianos em pacientes portadores de diabetes melito tipo 1 e em seus familiares de primeiro grau.

UNLABELLED: Diabetes Mellius Type 1 (DM1) is frequently associated to Autoimmune Thyroid Disease (AITD). The prevalence of AITD among diabetic patients varies between 3 to 50% and the incidence is also big among their family members, when compared to the population in general. OBJECTIVES: To investigate the prevalence of AITD in patients with DM1; to evaluate possible differences concerning the clinical-evolutive behavior of DM1 among diabetic patients with or without AITD and to study the prevalence of AITD among the diabetes patients' relatives. MATERIALS AND METHODS: 124 prontuaries of diabetic patients (type 1) were revised and data was gathered concerning the thyroid function and the anti-thyroid antibodies. Patients with and without AITD were compared in relation to the level of glycosylated hemoglobin, the presence of acute and chronic complications, the age of the patient at the time of the diagnosis, time of evolution of the disease, daily dose of insulin and other factors. A control case study was conducted with 54 first degree relatives of the diabetic patients who took part in the study; the thyroid function as well as the presence of anti-thyroid antibodies were evaluated in 32 of those first degree relatives with AITD, and in 22 of those without AITD. RESULTS: The prevalence of AITD and of hormonal dysfunction among diabetic patients was 35.5% and 19.3%, respectively. No significant differences were found between groups in respect to clinical outcome or to diabetic chronic complications. However, prevalence of AITD and hormonal dysfunction were found to be higher among first degree relatives of diabetic patients with AITD than among relatives of diabetic patients without AITD. CONCLUSIONS: The prevalence of autoimmune thyroid disease in diabetic patients and in their first degree relatives is high. Thyroid function screening is therefore justified in these cases, especially in first degree relatives of diabetics with autoimmune thyroid disease.

Prevalência de disfunção tireoidiana e anticorpos antitireoidianos em pacientes portadores de diabetes melito tipo 1 e em seus familiares de primeiro grau / Prevalence of thyroid dysfunction and antithyroid antibodies in type 1 diabetic mellitus patients and their first degree relatives

O diabetes melito tipo 1 (DM1) freqüentemente encontra-se associado à doença auto-imune da tireóide (DAT). A prevalência de DAT varia de 3 por cento a 50 por cento entre diabéticos, e é maior também entre seus familiares, comparada à população geral. OBJETIVOS: Investigar a prevalência da DAT em pacientes com DM1, avaliar possíveis diferenças de comportamento clínico-evolutivo do DM1 entre diabéticos com e sem DAT e estudar a prevalência de DAT nos familiares dos pacientes diabéticos. MATERIAIS E MÉTODOS: Os prontuários de 124 diabéticos tipo 1 foram revisados e coletados os dados referentes à função e aos anticorpos tireoidianos; pacientes com e sem DAT foram comparados em relação à média de Hb glicosilada, complicações agudas e crônicas, idade ao diagnóstico e tempo de evolução do DM, dose de insulina e outros. Um estudo caso-controle foi realizado com 54 familiares em primeiro grau destes pacientes; foram avaliadas a função tireoidiana e a presença de anticorpos antitireoidianos em 32 familiares de diabéticos sem DAT e 22 familiares de diabéticos com DAT. RESULTADOS: As prevalências de DAT e de disfunção hormonal entre os diabéticos foram de 35,5 por cento e 19,3 por cento, respectivamente. Quanto à avaliação dos parâmetros de evolução do DM1, comportamento clínico e controle metabólico não houve diferenças significantes entre os diabéticos com e sem DAT. Houve maior prevalência de DAT nos familiares de diabéticos com DAT do que no grupo dos familiares dos diabéticos sem DAT, sem diferença significativa quanto à prevalência de disfunção hormonal. CONCLUSÕES: A prevalência de doença auto-imune de tireóide em diabéticos e em seus familiares é elevada, justificando-se, nesses casos, a investigação rotineira da função tireoidiana, particularmente dos familiares de primeiro grau de diabéticos com DAT.

Diabetes Mellius Type 1 (DM1) is frequently associated to Autoimmune Thyroid Disease (AITD). The prevalence of AITD among diabetic patients varies between 3 to 50 percent and the incidence is also big among their family members, when compared to the population in general. OBJECTIVES: To investigate the prevalence of AITD in patients with DM1; to evaluate possible differences concerning the clinical-evolutive behavior of DM1 among diabetic patients with or without AITD and to study the prevalence of AITD among the diabetes patients' relatives. MATERIALS AND METHODS: 124 prontuaries of diabetic patients (type 1) were revised and data was gathered concerning the thyroid function and the anti-thyroid antibodies. Patients with and without AITD were compared in relation to the level of glycosylated hemoglobin, the presence of acute and chronic complications, the age of the patient at the time of the diagnosis, time of evolution of the disease, daily dose of insulin and other factors. A control case study was conducted with 54 first degree relatives of the diabetic patients who took part in the study; the thyroid function as well as the presence of anti-thyroid antibodies were evaluated in 32 of those first degree relatives with AITD, and in 22 of those without AITD. RESULTS: The prevalence of AITD and of hormonal dysfunction among diabetic patients was 35.5 percent and 19.3 percent, respectively. No significant differences were found between groups in respect to clinical outcome or to diabetic chronic complications. However, prevalence of AITD and hormonal dysfunction were found to be higher among first degree relatives of diabetic patients with AITD than among relatives of diabetic patients without AITD. CONCLUSIONS: The prevalence of autoimmune thyroid disease in diabetic patients and in their first degree relatives is high. Thyroid function screening is therefore justified in these cases, especially in first degree relatives of diabetics ...

[Interference of the blood glucose control in the transition between phases I and II of lactogenesis in patients with type 1 diabetes mellitus]. / Interferência do controle glicêmico na transição entre as fases I e II da lactogênese em pacientes com diabetes melito tipo 1.

Lactogenesis is constituted by phases I and II. The transition between those phases is characterized by an increase of the lactose concentration in the colostrum. This study aimed to evaluate the interference of type 1 Diabetes mellitus in the transition between phases I and II of the lactogenesis. The lactose concentration was determined in colostrum samples of 11 puerperal women with pre-gestational Diabetes mellitus and 19 without the disease, during the five first days of the puerperium. The lactose concentration was determined by reaction with picric acid. In both groups there were progressive increases in the lactose levels along the time; however, the increase was significantly lower in the 3rd and 5th days for the group of the women with diabetes. The analysis of the transition between the lactogenesis phases revealed that the puerperal diabetic women with inadequate glycemic control presented a time delay of 18 hours to reach phase II, making difficult the establishment of breastfeeding.

Interferência do controle glicêmico na transição entre as fases I e II da lactogênese em pacientes com diabetes melito tipo 1 / Interference of the blood glucose control in the transition between phases I and II of lactogenesis in patients with type 1 diabetes mellitus

A lactogênese é constituída pelas fases designadas como I e II. A transição entre essas fases é caracterizada pelo aumento da concentração de lactose no colostro. Este estudo teve como objetivo analisar a interferência do diabetes melito tipo 1 (DM1) na transição entre as fases da lactogênese. A concentração de lactose foi determinada em amostras de colostro de 11 puérperas portadoras de DM1 e de 19 puérperas sem a doença, durante os cinco primeiros dias do puerpério. A determinação da concentração da lactose foi feita pela reação com ácido pícrico. Em ambos os grupos houve aumento progressivo da concentração da lactose em função do tempo; entretanto, o aumento foi significativamente menor no terceiro e no quinto dia no grupo das portadoras de diabetes. A análise da transição de fases da lactogênese revelou que as puérperas portadoras de diabetes melito com controle glicêmico inadequado apresentaram atraso de 18 horas para alcançar a fase II da lactogênese, dificultando o estabelecimento do aleitamento materno.

Lactogenesis is constituted by phases I and II. The transition between those phases is characterized by an increase of the lactose concentration in the colostrum. This study aimed to evaluate the interference of type 1 Diabetes mellitus in the transition between phases I and II of the lactogenesis. The lactose concentration was determined in colostrum samples of 11 puerperal women with pre-gestational Diabetes mellitus and 19 without the disease, during the five first days of the puerperium. The lactose concentration was determined by reaction with picric acid. In both groups there were progressive increases in the lactose levels along the time; however, the increase was significantly lower in the 3rd and 5th days for the group of the women with diabetes. The analysis of the transition between the lactogenesis phases revealed that the puerperal diabetic women with inadequate glycemic control presented a time delay of 18 hours to reach phase II, making difficult the establishment of breastfeeding.

[Assessment of association between autoimmune thyroid disease and chronic urticaria]. / Avaliação da associação entre doença auto-imune de tireóide e urticária crônica idiopática.

Several studies found a higher prevalence of Autoimmune Thyroid Disease (ATD) in patients with Chronic Urticaria (CU). This relationship may be due to the possible autoimmune etiology in up to one third of the cases of Chronic Idiopathic Urticaria (CIU). However, the frequency of ATD ranged from 1.14% to 28.6%. The study began by determining whether there is an association between ATD and CU, in a population seen at the same clinic. We compared the frequency of anti-thyroid antibodies and thyroid dysfunction in 49 patients with CIU (group 1) and 112 controls (group 2). In order to support the result found, we studied the prevalence of CIU in 60 patients with ATD (group 3) and compared with 29 patients who had non-immune thyroid disease (NITD) (group 4). We did not find a statistical difference for the presence of anti-thyroid antibodies or thyroid dysfunction between groups 1 and 2 (12.24% x 9.82% and 12.24% x 7.14%, respectively). The same occurred for the presence of CIU among groups 3 and 4 (3.33% x 3.44%). In our study it was not possible to demonstrate a relationship between ATD and CIU, which means that different populations may present a higher or lower degree of association between these illnesses.

Avaliação da associação entre doença auto-imune de tireóide e urticária crônica idiopática / Assessment of association between autoimmune thyroid disease and chronic urticaria

Vários estudos encontraram maior prevalência de Doença Auto-imune de Tireóide (DAT) em pacientes com Urticária Crônica (UC). Essa relação pode ocorrer devido à possível etiologia auto-imune em até um terço dos casos de Urticária Crônica Idiopática (UCI). No entanto, a freqüência de DAT variou de 1,14 por cento a 28,6 por cento. O princípio deste estudo foi determinar se ocorre associação entre DAT e UCI em uma população atendida em um mesmo centro de saúde. Comparamos a freqüência de anticorpos anti-tireoidianos e disfunção tireoidiana entre 49 pacientes com UCI (grupo 1) e 112 controles (grupo 2). Com a finalidade de fortalecer o resultado encontrado, estudamos a prevalência de UCI em 60 pacientes com DAT (grupo 3) comparados com 29 com doença não auto-imune de tireóide (DNAT) (grupo 4). Não encontramos diferença estatística quanto à presença de anticorpos anti-tireoidianos ou disfunção tireoidiana entre os grupos 1 e 2 (12,24 por cento x 9,82 por cento e 12,24 por cento x 7,14 por cento, respectivamente). O mesmo ocorreu quanto à presença de UCI entre os grupos 3 e 4 (3,33 por cento x 3,44 por cento). Em nosso estudo não foi possível demonstrar uma relação entre DAT e UCI, o que significa que diferentes populações podem apresentar maior ou menor grau de associação entre essas doenças.

Several studies found a higher prevalence of Autoimmune Thyroid Disease (ATD) in patients with Chronic Urticaria (CU). This relationship may be due to the possible autoimmune etiology in up to one third of the cases of Chronic Idiopathic Urticaria (CIU). However, the frequency of ATD ranged from 1.14 percent to 28.6 percent. The study began by determining whether there is an association between ATD and CU, in a population seen at the same clinic. We compared the frequency of anti-thyroid antibodies and thyroid dysfunction in 49 patients with CIU (group 1) and 112 controls (group 2). In order to support the result found, we studied the prevalence of CIU in 60 patients with ATD (group 3) and compared with 29 patients who had non-immune thyroid disease (NITD) (group 4). We did not find a statistical difference for the presence of anti-thyroid antibodies or thyroid dysfunction between groups 1 and 2 (12.24 percent x 9.82 percent and 12.24 percent x 7.14 percent, respectively). The same occurred for the presence of CIU among groups 3 and 4 (3.33 percent x 3.44 percent). In our study it was not possible to demonstrate a relationship between ATD and CIU, which means that different populations may present a higher or lower degree of association between these illnesses.

[Discrepancy between IGF-1 and GH during 75 g oral glucose tolerance test measures to acromegaly screening in a patient with macroprolactinoma--case report and literature review]. / Discordância entre IGF-1 e GH pós-sobrecarga de glicose no rastreamento de acromegalia em paciente com macroprolactinoma--relato de caso e revisão sobre o tema.

We describe a patient with macroprolactinoma and discrepant insulin-like growth factor (IGF-1) concentration (elevated) and growth hormone (GH) values during a 75 g oral glucose tolerance test (normal), that were measured to evaluate the co-secretion of GH by tumor. With the bromocriptin use, the patient achieved normalization of prolactin, but persisted with high levels of IGF1, suggesting to be subclinical acromegaly. After the development of new more sensitive GH assays, cases of discrepant GH and IGF-1 results have been observed and taken to some authors to suggest that GH nadir concentration during 75 g OGTT used to acromegaly diagnosis and treatment could be lower than values considered currently normal. Thus, if this is confirmed, subclinical and oligosymptomatic acromegaly cases could have earlier diagnoses.

Discordância entre IGF-1 e GH pós-sobrecarga de glicose no rastreamento de acromegalia em paciente com macroprolactinoma: relato de caso e revisão sobre o tema / Discrepancy between IGF-1 and GH during 75 g oral glucose tolerance test measures to acromegaly screening in a patient with macroprolactinoma: case report and literature review

Neste artigo, descrevemos o caso de um paciente com diagnóstico de macroprolactinoma, que apresentava valores discordantes entre IGF-1 (elevado) e GH (hormônio de crescimento) pós-teste de tolerância oral à glicose (normal) realizados para pesquisa de co-secreção de GH pelo tumor. Houve normalização dos níveis de prolactina após uso de bromocriptina, porém, durante o acompanhamento, o paciente persistiu com níveis elevados de IGF-1 sem clínica aparente, sugerindo tratar-se de possível forma subclínica de acromegalia. Após o desenvolvimento de novos métodos laboratoriais, mais sensíveis, para a dosagem de GH, casos de discordância entre esses testes vêm sendo observados, levando alguns autores a sugerir que o nadir de GH pós-teste de tolerância à glicose oral (TTGO) para diagnóstico e tratamento da acromegalia pode ser bem menor do que o limite considerado atualmente (1,2). Assim, se isto for confirmado, casos subclínicos ou oligossintomáticos de acromegalia serão diagnosticados mais precocemente.

We describe a patient with macroprolactinoma and discrepant insulin-like growth factor (IGF-1) concentration (elevated) and growth hormone (GH) values during a 75 g oral glucose tolerance test (normal), that were measured to evaluate the co-secretion of GH by tumor. With the bromocriptin use, the patient achieved normalization of prolactin, but persisted with high levels of IGF1, suggesting to be subclinical acromegaly. After the development of new more sensitive GH assays, cases of discrepant GH and IGF-1 results have been observed and taken to some authors to suggest that GH nadir concentration during 75 g OGTT used to acromegaly diagnosis and treatment could be lower than values considered currently normal. Thus, if this is confirmed, subclinical and oligosymptomatic acromegaly cases could have earlier diagnoses.

Primary pigmented nodular adrenocortical disease associated with Carney complex: case report and literature review

CONTEXT: Carney complex (CNC), a familial multiple neoplasm syndrome with dominant autosomal transmission, is characterized by tumors of the heart, skin, endocrine and peripheral nervous system, and also cutaneous lentiginosis. This is a rare syndrome and its main endocrine manifestation, primary pigmented nodular adrenal disease (PPNAD), is an uncommon cause of adrenocorticotropic hormone-independent Cushing's syndrome. CASE REPORT: We report the case of a 20-year-old patient with a history of weight gain, hirsutism, acne, secondary amenorrhea and facial lentiginosis. Following the diagnosing of CNC and PPNAD, the patient underwent laparoscopic bilateral adrenalectomy, and she evolved with decreasing hypercortisolism. Screening was also performed for other tumors related to this syndrome. The diagnostic criteria, screening and follow-up for patients and affected family members are discussed.

CONTEXTO: O complexo de Carney (CNC), uma síndrome de neoplasia múltipla familiar com transmissão autossômica dominante, caracteriza-se por tumores cardíacos, cutâneos, endócrinos e do sistema nervoso periférico, além de lentiginose cutânea. RELATO DE CASO: Devido à raridade da síndrome, bem como de sua principal manifestação endócrina, a doença adrenal nodular pigmentada primária (PPNAD), causa incomum de síndrome de Cushing ACTH-independente, relatamos o caso de uma paciente de 20 anos com história de ganho de peso, hirsutismo, acne, amenorréia secundária e lentiginose em face. Após estabelecido o diagnóstico de CNC e PPNAD, a paciente foi submetida a adrenalectomia bilateral via laparoscópica, evoluindo com melhora do hipercortisolismo. Também foi realizado rastreamento para os demais tumores relacionados à síndrome. Serão discutidos os critérios diagnósticos, o rastreamento e o acompanhamento dos pacientes e familiares afetados.

Primary pigmented nodular adrenocortical disease associated with Carney complex: case report and literature review.

CONTEXT: Carney complex (CNC), a familial multiple neoplasm syndrome with dominant autosomal transmission, is characterized by tumors of the heart, skin, endocrine and peripheral nervous system, and also cutaneous lentiginosis. This is a rare syndrome and its main endocrine manifestation, primary pigmented nodular adrenal disease (PPNAD), is an uncommon cause of adrenocorticotropic hormone-independent Cushing's syndrome. CASE REPORT: We report the case of a 20-year-old patient with a history of weight gain, hirsutism, acne, secondary amenorrhea and facial lentiginosis. Following the diagnosing of CNC and PPNAD, the patient underwent laparoscopic bilateral adrenalectomy, and she evolved with decreasing hypercortisolism. Screening was also performed for other tumors related to this syndrome. The diagnostic criteria, screening and follow-up for patients and affected family members are discussed.

Hipotireoidismo primário simulando volumoso macroadenoma hipofisário / Primary hypothyroidism mimicking pituitary macroadenoma

Mulher de 21 anos apresenta história de 2 anos de irregularidade menstrual, com períodos de amenorréia de até 8 meses e ganho ponderal e há 1 ano galactorréia e cefaléia holocraniana. Exames da ocasião: TSH: 1192 mUI/ml (0,27-4,2); T4T:1,0 mg/dl (4,4-11,4) ; T3T: 0,41 ng/ml (0,7-2,1); prolactina: 69,2 ng/ml (3-20). Em serviço de endocrinologia foi confirmado quadro de mixedema acompanhado de galactorréia. Ressonância magnética (RM) de hipotálamo-hipófise mostrou lesão expansiva intra e supra selar com 1,9 x 1,4 x 1,9 cm nos seus maiores diâmetros, determinando compressão e desvio do quiasma óptico. Diante da possibilidade de hiperplasia das células produtoras de TSH, optamos por iniciar o tratamento do hipotireoidismo com levotiroxina. Após 2 meses de tratamento e normalização dos níveis séricos dos hormônios tireoidianos e do TSH, nova RM mostrou hipófise de tamanho normal. A regressão do volume hipofisário após terapia com levotiroxina confirmou a hipótese diagnóstica de hiperplasia hipofisária decorrente do hipotireoidismo primário. Nossos achados reforçam a importância da avaliação dos hormônios tireoideanos e TSH na investigação de aumento de volume hipofisário prevenindo uma cirurgia desnecessária.

[Primary hypothyroidism mimicking pituitary macroadenoma]. / Hipotireoidismo primário simulando volumoso macroadenoma hipofisário.

A 21-year-old woman complaining of 8-month amenorrhea associated to weight gain, galactorrhea and frequent headaches, presented for clinical evaluation; her laboratory tests were: TSH: 1192 mUI/ml (0.27-4.2); TT4: 1.0 microg/dl (4.4-11.4 l); TT3: 0.41 ng/ml (0.7-2.1); prolactin: 69.2 ng/ml (3-20) and a diagnosis of myxedema associated to galactorrhea was made. A hypothalamic-pituitary magnetic resonance imaging (MRI) showed a suprasellar and intrasellar mass lesion of 1.9 x 1.4 x 1.9 cm, determining compression and deviation of the optic chiasm. Due to the possibility of hyperplasia of the TSH-producing cells, treatment of hypothyroidism was initiated with levothyroxine. Two months later, upon normalization of thyroid hormones and TSH levels, a second MRI showed an anatomically normal pituitary gland. Regression of the pituitary mass after treatment with levothyroxine confirmed the hypothesis of pituitary hyperplasia secondary to primary hypothyroidism. Our findings support the importance of determining thyroid function tests during the investigation of pituitary masses and thus avoiding an unnecessary surgery.