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1.
Arch Endocrinol Metab ; 68: e230055, 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38394157

RESUMO

Objective: To evaluate glycemic control according to the number of daily basal rates (BRs) in type 1 diabetes patients using continuous subcutaneous insulin infusion (CSII). Subjects and methods: Cross-sectional study of patients treated with an open-loop CSII for at least 6 months and using a flash glucose monitoring system. Patients were divided into 2 groups: group 1 (G1) and group 2 (G2), with ≤4 and >4 BRs/24h, respectively. The groups were compared regarding HbA1c, time in range (TIR), time above range (TAR), time below range (TBR), glucose management indicator (GMI), glucose variability and data related to hypoglycemia. Regression models were performed. Results: The study included 99 patients (n = 55 in G1; n = 44 in G2). Median (Interquartile range) overall age was 30 (17) years, with 19.5 (48) and 51 (77) months of CSII use, respectively. The median number of different BRs was 3 (2) for G1 and 6 (2) for G2. There were no differences concerning age, sex, educational stage, weight, and insulin analog used. G2 had longer disease duration, longer CSII use, and higher total basal daily dose/kg. No significant differences regarding HbA1c, median glucose, GMI, TIR, TAR, and CV were found. G2 patients had more hypoglycemia, more asymptomatic hypoglycemia, and higher TBR. After adjusting for potential confounders, G1 maintained a lower risk of asymptomatic hypoglycemia. Conclusion: Programming open-loop CSII devices with more than 4 BRs does not improve metabolic control. Additionally, it seems to be a risk factor for hypoglycemia and was an independent predictor for asymptomatic hypoglycemia.


Assuntos
Diabetes Mellitus Tipo 1 , Hipoglicemia , Humanos , Adulto , Insulina/uso terapêutico , Hipoglicemiantes/uso terapêutico , Hemoglobinas Glicadas , Automonitorização da Glicemia , Estudos Transversais , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemia/induzido quimicamente , Sistemas de Infusão de Insulina/efeitos adversos
2.
Acta Med Port ; 35(3): 209-215, 2022 Mar 02.
Artigo em Português | MEDLINE | ID: mdl-35077347

RESUMO

INTRODUCTION: Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that increase the efficiency of the immune system in the destruction of neoplastic cells. In recent years, these drugs have been increasingly used in the treatment of many neoplasms in advanced stages. However, the change in the regulation of the immune system induced by these drugs has the potential adverse effect of inducing autoimmunity in practically all organ systems. Endocrinopathies are one of the most common autoimmune adverse eventsof these drugs. MATERIAL AND METHODS: Non-systematic review of endocrinopathies reported in the context of treatment with ICIs. A search was carried out on PubMed until January 31st, 2020, and articles were selected based on their relevance and excluded in case of redundant content. The following search terms were used: "immune checkpoint inhibitor" and "endocrinopathy" / "endocrine system diseases" / "pituitary" / "thyroid" / "diabetes" / "adrenal" / "parathyroid". RESULTS: Endocrinopathies with all classes of ICIs (anti-CTLA-4, anti-PD-1, anti-PD-L1) have been reported. Thyroid dysfunction is the most frequently reported endocrinopathy, mainly with anti-PD-1 and anti-PD-L1. Hypophysitis is the most prevalent with anti-CTLA-4. The incidence of autoimmune diabetes in this context is increasing, mainly with anti-PD-1 and anti-PD-L1. Rare cases of primary adrenal insufficiency, Graves' disease and primary hypoparathyroidism have also been reported. CONCLUSION: Knowing the spectrum of endocrinopathies triggered by ICI, as well as their clinical features, diagnosis and treatment criteria is essential, given its high prevalence and the increasing number of cancer patients treated with these new drugs.


Introdução: Os inibidores do checkpoint imunológico (ICI) são anticorpos monoclonais que permitem aumentar a eficiência do sistema imunitário na destruição das células neoplásicas. Nos últimos anos, estes fármacos têm sido cada vez mais utilizados no tratamento de muitas neoplasias em estadios avançados. Contudo, a alteração da regulação do sistema imunitário induzida por estes fármacos tem como potencial efeito adverso o aparecimento de autoimunidade em praticamente todos os órgãos. As endocrinopatias são um dos eventos adversos autoimunes mais frequentes com estes fármacos.Material e Métodos: Revisão não sistemática sobre as endocrinopatias reportadas em contexto de tratamento com ICI. Foram pesquisados artigos publicados na PubMed até 31 de janeiro de 2020, selecionados com base na sua relevância e excluídos em caso de conteúdo redundante. Foram utilizados os seguintes termos de pesquisa: "immune checkpoint inhibitor" e "endocrinopathy" / "endocrine system diseases" / "pituitary" / "thyroid" / "diabetes" / "adrenal" / "parathyroid".Resultados: Foram já reportadas endocrinopatias com todas as classes de ICI (anti-CTLA-4, anti-PD-1, anti-PD-L1). A disfunção tiroideia é a endocrinopatia mais frequentemente reportada, principalmente sob anti-PD-1 e anti-PD-L1. A hipofisite é a mais prevalente sob anti-CTLA-4. É crescente a incidência de diabetes autoimune neste contexto, principalmente sob anti-PD-1 e anti-PD-L1. Foram reportados também casos raros de insuficiência suprarrenal primária, doença de Graves e hipoparatiroidismo primário.Conclusão: O conhecimento do espectro de endocrinopatias desencadeadas pela terapêutica com ICI, assim como as suas manifestações clínicas, critérios de diagnóstico e tratamento, é essencial, dada a sua elevada prevalência e o cada vez maior número de doentes oncológicos tratados com estes novos fármacos.


Assuntos
Antineoplásicos Imunológicos , Doenças do Sistema Endócrino , Hipofisite , Neoplasias , Antineoplásicos Imunológicos/efeitos adversos , Doenças do Sistema Endócrino/induzido quimicamente , Doenças do Sistema Endócrino/tratamento farmacológico , Doenças do Sistema Endócrino/epidemiologia , Humanos , Hipofisite/induzido quimicamente , Inibidores de Checkpoint Imunológico , Imunoterapia/efeitos adversos , Neoplasias/tratamento farmacológico
3.
Arch Endocrinol Metab ; 65(5): 640-647, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34591409

RESUMO

OBJECTIVE: Flash glucose monitoring (FGM) is increasingly used in type 1 diabetes mellitus (T1D) management. This study aimed to assess glycated hemoglobin (HbA1c) and body mass index (BMI) in the first year of FGM use in patients with T1D and to identify predictive factors of benefit associated with its use. METHODS: Retrospective study of T1D patients, using FGM for ≥ 6 months and under intensive insulin therapy with multiple daily injections. RESULTS: In 179 patients with a median (Md) age of 43.0 years (P25 31.0; P75 52.0) and disease duration of 18.0 years (P25 10.0; P75 28.0), initial HbA1c was 7.9% (P25 7.2; P75 8.8) and initial BMI was 24.0 kg/m2 (P25 21.9; P75 26.2). With FGM, HbA1c improved significantly to 7.6% (P25 7.0; P75 8.3) at 6 months and 7.7% (P25 6.95; P75 8.5) at 12 months (p < 0.05), with more patients with HbA1c < 7% (16.1% vs 22.5%) and fewer patients with HbA1c ≥ 8% (49.1% vs 35.8%) (p < 0.05). Initial HbA1c 8.0-8.9% (HR 1.886; 95% CI 1.321-2.450) and ≥ 9.0% (HR 3.108, 95% CI 2.454-3.761) predicted greater HbA1c reduction. BMI increased significantly, especially between 6 and 12 months (BMI Md 23.8 [P25 21.9; P75 26.2] kg/m2 and 24.0 [P25 22.0; P75 26.2] kg/m2, respectively) (p < 0.05). Overweight (HR 4.319, 95% CI 3.185-5.453) and obesity (HR 8.112, 95% CI 3.919-12.306) predicted greater weight gain. CONCLUSION: FGM use was associated with significant improvement in HbA1c, mainly in patients with worse previous glycemic control. It was also associated with increased BMI, especially if baseline BMI ≥ 25 kg/m2, so weight control strategies should be emphasized.


Assuntos
Diabetes Mellitus Tipo 1 , Adulto , Glicemia , Automonitorização da Glicemia , Índice de Massa Corporal , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hemoglobinas Glicadas/análise , Controle Glicêmico , Humanos , Hipoglicemiantes , Insulina , Estudos Retrospectivos
4.
Cureus ; 13(2): e13364, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33747659

RESUMO

Addison's disease is a rare and potentially life-threatening clinical condition that often presents with an insidious onset of nonspecific symptoms and signs, frequently resulting in a significant delay in diagnosis. Clinical presentation usually includes fatigue and electrolyte imbalance disorders such as hyponatremia. However, specific diagnostic features, such as hyperpigmentation, should raise clinical suspicion. This case report describes a 43-year-old Caucasian male who presented with general malaise, fatigue, anorexia, and weight loss (7 Kg in four weeks). On physical examination, he was found to have severe hyperpigmentation of the skin and mucosal surfaces as well as hypotension. Laboratory tests revealed hypoosmolar hyponatremia and serum potassium levels in the upper limit of normal. Findings of high serum adrenocorticotropic hormone (ACTH) and renin, as well as low cortisol and aldosterone levels, helped establish a diagnosis of Addison's disease. After the initiation of treatment, the patient experienced full recovery of symptoms, normalization of hyponatremia, and improvement of hyperpigmentation. Patients with Addison's disease have the potential to resume normal daily activities with a highly functional status. However, this condition requires lifelong follow-up and surveillance.

5.
BMJ Case Rep ; 14(3)2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33753383

RESUMO

A previously healthy postpartum 33-year-old woman was admitted at the emergency department after two episodes of syncope. In the waiting room, she collapsed, ventricular fibrillation was detected, and she was reanimated by electric cardioversion. At admission, she was conscient, with blood pressure of 102/74 mm Hg and heart rate of 78 bpm. In the laboratory workup, severe hypokalaemia was found (K+ 1.77 mEq/L). Abdominopelvic CT revealed a 27 mm nodule in the right adrenal gland. High aldosterone and low plasma renin levels were detected, and the diagnosis of primary hyperaldosteronism was made, although she never had hypertension. Posteriorly, a cosecretion of aldosterone and cortisol was found. Two months after admission, the patient remained stable with normal K+ levels under spironolactone and a right adrenalectomy was performed. The cure of primary hyperaldosteronism and a partial adrenal insufficiency were confirmed. K+ levels and blood pressure remained normal without treatment and 10 months after surgery hydrocortisone was suspended.


Assuntos
Hiperaldosteronismo , Hipertensão , Hipopotassemia , Adrenalectomia , Adulto , Aldosterona , Feminino , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/cirurgia , Hipertensão/etiologia , Hipopotassemia/etiologia , Período Pós-Parto , Renina
6.
Arch. endocrinol. metab. (Online) ; 65(5): 640-647, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1345205

RESUMO

ABSTRACT Objective: Flash glucose monitoring (FGM) is increasingly used in type 1 diabetes mellitus (T1D) management. This study aimed to assess glycated hemoglobin (HbA1c) and body mass index (BMI) in the first year of FGM use in patients with T1D and to identify predictive factors of benefit associated with its use. Subjects and methods: Retrospective study of T1D patients, using FGM for ≥ 6 months and under intensive insulin therapy with multiple daily injections. Results: In 179 patients with a median (Md) age of 43.0 years (P25 31.0; P75 52.0) and disease duration of 18.0 years (P25 10.0; P75 28.0), initial HbA1c was 7.9% (P25 7.2; P75 8.8) and initial BMI was 24.0 kg/m2 (P25 21.9; P75 26.2). With FGM, HbA1c improved significantly to 7.6% (P25 7.0; P75 8.3) at 6 months and 7.7% (P25 6.95; P75 8.5) at 12 months (p < 0.05), with more patients with HbA1c < 7% (16.1% vs 22.5%) and fewer patients with HbA1c ≥ 8% (49.1% vs 35.8%) (p < 0.05). Initial HbA1c 8.0-8.9% (HR 1.886; 95% CI 1.321-2.450) and ≥ 9.0% (HR 3.108, 95% CI 2.454-3.761) predicted greater HbA1c reduction. BMI increased significantly, especially between 6 and 12 months (BMI Md 23.8 [P25 21.9; P75 26.2] kg/m2 and 24.0 [P25 22.0; P75 26.2] kg/m2, respectively) (p < 0.05). Overweight (HR 4.319, 95% CI 3.185-5.453) and obesity (HR 8.112, 95% CI 3.919-12.306) predicted greater weight gain. Conclusions: FGM use was associated with significant improvement in HbA1c, mainly in patients with worse previous glycemic control. It was also associated with increased BMI, especially if baseline BMI ≥ 25 kg/m2, so weight control strategies should be emphasized.


Assuntos
Humanos , Adulto , Diabetes Mellitus Tipo 1/tratamento farmacológico , Glicemia , Hemoglobinas Glicadas/análise , Automonitorização da Glicemia , Índice de Massa Corporal , Estudos Retrospectivos , Controle Glicêmico , Hipoglicemiantes , Insulina
7.
Endocrine ; 62(2): 470-476, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30088141

RESUMO

PURPOSE: To assess biochemical and imaging therapeutic response rates, when these occur and their predictive factors in patients with macroprolactinomas treated with dopamine agonists (DA). METHODS: Retrospective, longitudinal study of patients with macroprolactinomas treated with DA for ≥12 months. OUTCOMES: prolactin normalization, reduction in maximum tumor diameter ≥50% and time until therapeutic responses. RESULTS: We included 67 patients; 49.3% females, with median age at diagnosis of 43 years, 61.2% only treated with bromocriptine, 10.4% only with cabergoline, and 28.4% with both DA. Median follow-up time was 73 months. Prolactin levels normalized in 87%, mostly during the first 2 years. Prolactin levels after 6 months (HR 0.994, p = 0.012), 1 year (HR 0.970, p = 0.003), and 2 years (HR 0.970, p = 0.015) predicted its normalization time. Only 62% of the patients achieved a ≥50% reduction in maximum tumor diameter. Percent tumor diameter reduction after 1 year (OR 1.098, p = 0.022) and 2 years (OR 1.102, p = 0.008) predicted a ≥50% size reduction. Size reduction occurred later than prolactin normalization. Initial tumor diameter (HR 1.050, p = 0.032) and its percent reduction at 6 months (HR 1.110, p = 0.002), 1 (HR 1.060, p < 0.001), 2 (HR 1.045, p < 0.001), 3 (HR 1.048, p = 0.002), and 4 years (HR 1.074, p = 0.042) predicted the time until imaging response. CONCLUSION: A significant number of patients did not obtain an imaging response. Biochemical and imaging responses were asynchronous and occurred mainly in the first 4 years of treatment. This may allow an earlier identification of partially resistant and resistant macroprolactinomas, with consequent change in the therapeutic approach.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/terapia , Prolactinoma/diagnóstico , Prolactinoma/terapia , Adulto , Biomarcadores Tumorais/sangue , Bromocriptina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Feminino , Humanos , Hiperprolactinemia/tratamento farmacológico , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/patologia , Prolactinoma/sangue , Prolactinoma/patologia , Estudos Retrospectivos , Carga Tumoral , Adulto Jovem
8.
Endocrine ; 62(3): 602-610, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30088142

RESUMO

PURPOSE: To compare women diagnosed with gestational diabetes mellitus (GDM) according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria based on the number of OGTT diagnostic criteria, which OGTT parameters are altered and the glycemic deviation from proposed diagnostic cutoffs. METHODS: Cross-sectional, multicentric study of women diagnosed with GDM between 24-28 weeks of pregnancy according to the IADPSG criteria, in Portugal, between 2012-2014. Primary outcomes: large for gestational age (LGA) and maternal glucose metabolism status after delivery. Secondary outcome: small for gestational age (SGA). RESULTS: Three-thousand three-hundred fourteen patients were included; 67% had 1 OGTT altered value; 3.6% had LGA and 13% had SGA newborns; 7% had prediabetes/diabetes after delivery. Three diagnostic criteria in OGTT (OR 3.02; p < 0.001), a diagnostic value at 0 min (OR 2.09; p = 0.002) and 60 min (OR 1.70; p = 0.022) and glucose deviation at 0 min (OR 1.02; p = 0.014) were predictors of LGA. Having 2 (OR 1.94; p < 0.001) or 3 (OR 3.93; p < 0.001) diagnostic criteria in OGTT, a diagnostic value at 0 min (OR 1.76; p = 0.002), at 60 min (OR 1.57; p = 0.007) and at 120 min (OR 3.11; p < 0.001), the glucose deviation at 0 (OR 1.02; p = 0.017) and 120 min (OR 1.02; p < 0.001) were predictors of prediabetes/diabetes after delivery. Insufficient weight gain in pregnancy (OR 1.49; p < 0.001) and lower maternal BMI (OR 0.97; p = 0.024) were associated with SGA. CONCLUSION: IADPSG diagnostic criteria include a heterogeneous group of women, for whom different management strategies should be adopted to obtain ideal pregnancy outcomes.


Assuntos
Glicemia , Diabetes Gestacional/terapia , Macrossomia Fetal/diagnóstico , Adulto , Peso ao Nascer , Estudos Transversais , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Gerenciamento Clínico , Feminino , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez
9.
Endocrinol. nutr. (Ed. impr.) ; 63(5): 239-249, mayo 2016. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-152536

RESUMO

Statin therapy has a very important role in decreasing cardiovascular risk, and treatment non-compliance may therefore be a concern in high cardiovascular risk patients. Myotoxicity is a frequent side effect of statin therapy and one of the main causes of statin discontinuation, which limits effective treatment of patients at risk of or with cardiovascular disease. Because of the high proportion of patients on statin treatment and the frequency of statin-related myotoxicity, this is a subject of concern in clinical practice. However, statin-related myotoxicity is probably underestimated because there is not a gold standard definition, and its diagnosis is challenging. Moreover, information about pathophysiology and optimal therapeutic options is scarce. Therefore, this paper reviews the knowledge about the definition, pathophysiology and predisposing conditions, diagnosis and management of statin-related myotoxicity, and provides a practical scheme for its management in clinical practice (AU)


El tratamiento con estatinas tiene un papel fundamental en la reducción del riesgo cardiovascular, y la falta de adherencia al mismo es motivo de preocupación en los pacientes con alto riesgo. La miotoxicidad es un efecto secundario frecuente y una de las principales causas de interrupción de las estatinas, lo que limita el tratamiento eficaz de los pacientes con riesgo de enfermedad cardiovascular. Considerando la elevada proporción de pacientes en tratamiento con estatinas, y la frecuencia de miotoxicidad asociada, este es un tema relevante en la práctica clínica. Sin embargo, la miotoxicidad por las estatinas está probablemente subestimada debido a que no hay una definición bien establecida y su diagnóstico resulta difícil. Además, la información sobre la fisiopatología y las opciones terapéuticas óptimas es escasa. En este artículo revisamos la definición, fisiopatología y condiciones predisponentes, diagnóstico y tratamiento de la miotoxicidad por las estatinas, y proponemos un esquema práctico para su manejo (AU)


Assuntos
Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/toxicidade , Doenças Musculares/induzido quimicamente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Fatores de Risco , Suplementos Nutricionais , Proteínas Quinases/análise
10.
Endocrinol Nutr ; 63(5): 239-49, 2016 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27005745

RESUMO

Statin therapy has a very important role in decreasing cardiovascular risk, and treatment non-compliance may therefore be a concern in high cardiovascular risk patients. Myotoxicity is a frequent side effect of statin therapy and one of the main causes of statin discontinuation, which limits effective treatment of patients at risk of or with cardiovascular disease. Because of the high proportion of patients on statin treatment and the frequency of statin-related myotoxicity, this is a subject of concern in clinical practice. However, statin-related myotoxicity is probably underestimated because there is not a gold standard definition, and its diagnosis is challenging. Moreover, information about pathophysiology and optimal therapeutic options is scarce. Therefore, this paper reviews the knowledge about the definition, pathophysiology and predisposing conditions, diagnosis and management of statin-related myotoxicity, and provides a practical scheme for its management in clinical practice.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Doenças Musculares/induzido quimicamente , Ensaios Clínicos como Assunto , Comorbidade , Creatina Quinase/sangue , Citocromo P-450 CYP3A/fisiologia , Suplementos Nutricionais , Gerenciamento Clínico , Suscetibilidade a Doenças , Interações Medicamentosas , Substituição de Medicamentos , Exercício Físico , Ezetimiba/uso terapêutico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Incidência , Masculino , Metanálise como Assunto , Doenças Musculares/epidemiologia , Doenças Musculares/genética , Doenças Musculares/fisiopatologia , Rabdomiólise/induzido quimicamente , Rabdomiólise/epidemiologia , Rabdomiólise/fisiopatologia , Fatores de Risco
11.
Endocrine ; 53(3): 754-60, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27000081

RESUMO

pT3 papillary thyroid carcinoma (PTC) can be divided into three subgroups according to the largest diameter >4 cm or evidence of minimal extrathyroidal extension (ETE): A >4 cm, no ETE; B ≤4 cm, with ETE; and C >4 cm, with ETE. The aim of this study was to analyze whether these subgroups are clinically different. A retrospective analysis of clinicopathological data of patients with pT3 PTC, with a minimum follow-up of 2 years, at a referral center was conducted. Outcome was evaluated after primary treatment and after 2 and 5 years of follow-up. Patients were classified as no evidence of disease (NED), biochemical evidence of disease (BED), and structural evidence of disease (SED) either locoregional (SED-L) or at distance (SED-D). The study patients were classified into three groups as follows: Group A (n = 91), Group B (n = 101), and Group C (n = 23). Most patients were female (80.0 %); mean age at diagnosis was 49.9 ± 16.5 years. 214 patients underwent total thyroidectomy; 208 patients were treated with (131)I. Median follow-up was 6.0 years. After primary treatment, the condition of NED was significantly different between the groups (A-87.9 %, B-68.3 %, C-43.5 %; p < 0.001). Recurrence rate, either biochemical or structural, was 8.8, 7.2, and 30.0 % in groups A, B, and C, respectively. Clinical status after 2 years anticipated clinical status after 5 years, except for Group B. ETE and tumor size were found to be predictors of disease status after primary treatment and after 2 years. ETE appeared as the strongest predictor of persistence of disease after primary treatment as well as of evidence of disease, either biochemical or structural, after 2 years of follow-up.


Assuntos
Carcinoma Papilar/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto , Idoso , Carcinoma Papilar/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Resultado do Tratamento
12.
BMJ Case Rep ; 20152015 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-26590188

RESUMO

Giant prolactinomas are rare pituitary tumours of which management can be a challenge. A 28-year-old man presented with headaches, visual impairment and behavioural changes. Clinically, the patient was found to have hypogonadism and bitemporal hemianopsia. A MRI demonstrated a pituitary tumour 76 mm in diameter and blood tests revealed a serum prolactin of 158,700 µU/mL (reference range 58-254). Initially, a craniotomy was performed. Immunohistochemistry of the tumour identified a prolactinoma with a high proliferative index and the patient was started on treatment with a dopamine agonist. A year later, neurological symptoms worsened due to regrowth of the lesion's cystic component, and so further surgery was performed. After 10 years of treatment with dopamine agonists, the prolactin levels decreased by 96.8%, there was an effective reduction in tumour size, and the neurological signs and symptoms resolved.


Assuntos
Craniotomia , Agonistas de Dopamina/uso terapêutico , Hipófise , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Adulto , Ergolinas/uso terapêutico , Seguimentos , Cefaleia/diagnóstico , Cefaleia/etiologia , Hemianopsia/diagnóstico , Hemianopsia/etiologia , Humanos , Hipogonadismo/sangue , Hipogonadismo/diagnóstico , Hipogonadismo/tratamento farmacológico , Hipogonadismo/etiologia , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Hipófise/patologia , Hipófise/cirurgia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia , Prolactina/sangue , Prolactinoma/complicações , Prolactinoma/diagnóstico , Prolactinoma/cirurgia , Baixa Visão/diagnóstico , Baixa Visão/etiologia
13.
Acta Med Port ; 28(6): 726-34, 2015.
Artigo em Português | MEDLINE | ID: mdl-26849757

RESUMO

INTRODUCTION: Although vitamin D deficiency is increasingly recognized around the world, there are few studies on the Portuguese reality. This study aims to analyse vitamin D levels in the assays performed in our hospital and their relationship with age, genre, requesting specialty and moment of sample collection. MATERIAL AND METHODS: Cross-sectional study of measurements of 25(HO)D performed in our Hospital between June 2012 and November 2014. Included variables: gender, age, requesting specialty, month of sample collection. Vitamin D status classified as: 'Deficiency' (≤ 20 ng/mL), 'Insufficiency' (21 - 29 ng/ml) and 'Sufficiency' (≥ 30 ng/mL). RESULTS: We included 5 439 assays; 55.0% from women; the median age was 64.0 years. Sixty per cent had 'Deficiency', 20.7% 'Insufficiency' and 18.9% 'Sufficiency'. We found a negative correlation between age and vitamin D level (p < 0.001). We didn't find differences in vitamin D levels between genres. Nine specialties requested 98% of the assays, namely Nephrology (56.2%). We found differences between specialties based on age and vitamin D level (p < 0.001). Vitamin D levels changed throughout the year, with higher levels in the summer, followed by autumn, spring and winter (p < 0.001). Despite this seasonal fluctuation, vitamin D sufficiency was only present in a minority of assays (27.8% in summer and 9.2% in winter). DISCUSSION: Vitamin D deficiency is prevalent in this population, affects individuals of all ages and is not offset by the seasonal variation of sunlight. CONCLUSION: Vitamin D deficiency is a real and prevalent problem in our population that needs further attention and action, given its clinical implications.


Introdução: Apesar da hipovitaminose D ser cada vez mais reconhecida em todo o mundo, existem poucos estudos sobre a realidade portuguesa. Este trabalho pretende analisar o nível de vitamina D nos doseamentos realizados no nosso hospital e sua relação com idade, sexo, especialidade requisitante e momento da colheita. Material e Métodos: Estudo observacional dos doseamentos de 25(OH)D realizados no nosso Hospital entre junho de 2012 e novembro de 2014. Variáveis estudadas: sexo, idade, especialidade requisitante, mês de colheita. O status de vitamina D foi classificado como: 'Deficiência' (≤ 20 ng/mL), 'Insuficiência' (21 ' 29 ng/mL) e 'Suficiência' (≥ 30 ng/mL). Resultados: Incluímos 5 439 doseamentos; 55,0% pertenciam a mulheres; a idade mediana foi 64,0 anos. Sessenta por cento apresentavam 'Deficiência', 20,7% 'Insuficiência' e 18,9% 'Suficiência'. Encontrámos uma correlação negativa entre idade e nível de vitamina D (p < 0,001), não havendo diferenças significativas entre sexos. Nove especialidades requisitaram 98% dos doseamentos, destacando-se a Nefrologia (56,2%). Encontrámos diferenças entre especialidades requisitantes relativamente à idade e nível de vitamina D (p < 0,001). O nível de vitamina D variou ao longo do ano, com níveis superiores no verão, seguido do outono, primavera e inverno (p < 0,001). Apesar desta variação sazonal, a suficiência de vitamina D foi sempre minoritária, sendo de 27,8% no Verão e 9,2% no Inverno. Discussão: A carência de vitamina D nesta população é elevada, transversal a todas as idades e não compensada pela variação sazonal da exposição solar.Conclusão: A hipovitaminose D é um problema real, prevalente e merecedor de atuação na nossa população, atendendo às suas implicações clínicas.


Assuntos
Deficiência de Vitamina D/epidemiologia , Idoso , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Luz Solar , Vitamina D , Vitaminas
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