Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism.

Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

Changes in the Proteomic Profile of Acquired Enamel Pellicles as a Function of Their Time of Formation and Hydrochloric Acid Exposure.

OBJECTIVE: Changes in the protein profile of acquired enamel pellicles (AEP) formed in vivo over different time periods were evaluated after the application of hydrochloric acid (HCl). METHODS: Nine subjects were submitted to dental prophylaxis with pumice. After 3 or 120 min, the teeth were isolated with cotton rolls and 50 µL of 0.1 M HCl (pH 1.0), 0.01 M HCl (pH 2.0), or deionized water were applied on the buccal surface of the teeth for 10 s. The AEP was then collected using an electrode filter paper presoaked in 3% citric acid. After protein extraction, the samples were submitted to reverse-phase liquid chromatography coupled to mass spectrometry (nano LC-ESI-MS/MS). Label-free quantification was performed (Protein Lynx Global Service software). RESULTS: A total of 180 proteins were successfully identified in the AEP samples. The number of identified proteins increased with the time of pellicle formation. Only 4 proteins were present in all the groups (isoforms of IgA, serum albumin, and statherin). The greatest number of proteins identified uniquely in one of the groups was obtained for the groups treated with HCl after 2 h of pellicle formation (approx. 50 proteins). CONCLUSION: Proteins resistant to removal by HCl, such as serum albumin and statherin, were identified even in the short-term AEP. In addition, 120-min pellicles present many proteins that are resistant to removal by HCl. This suggests an increase in protection against intrinsic acids with the time of pellicle formation, which should be evaluated in future studies.

Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

Protein Profile of the Acquired Enamel Pellicle after Rinsing with Whole Milk, Fat-Free Milk, and Water: An in vivo Study.

This study detected changes in the protein profile of the acquired enamel pellicle (AEP) formed in vivo after rinsing with whole milk, fat-free milk, or water. Nine subjects in good oral condition took part in the study. The acquired pellicle was formed in the morning, for 120 min, after prophylaxis with pumice. Following this, the volunteers rinsed with 10 mL of whole milk, fat-free milk, or deionized water for 30 s, following a blinded crossover protocol. After 60 min, the pellicle was collected with filter paper soaked in 3% citric acid and processed for analysis by liquid chromatography-electrospray ionization tandem mass spectrometry. The obtained tandem mass spectrometry spectra were searched against a human protein database (Swiss-Prot). The proteomic data related to protein quantification were analysed using the PLGS software. A total of 260 proteins were successfully identified in the AEP samples collected from all groups. Forty-nine were common to all 3 groups, while 72, 62, and 49 were specific to the groups rinsing with whole milk, fat-free milk, and water, respectively. Some were typical components of the AEP, such as cystatin-B, cystatin-SN, isoforms of α-amylase, IgA and IgG, lysozyme C, protein S100 A78, histatin-1, proline-rich protein 27, statherin, and lactotransferrin. Other proteins are not commonly described as part of the AEP but could act in defence of the organism against pathogens. Distinct proteomic profiles were found in the AEP after rinsing with whole or fat-free milk, which could have an impact on bacterial adhesion and tooth dissolution. The use of fat-free milk could favourably modulate the adhesion of bacteria to the AEP as well as biofilm formation when compared with whole milk.

Growth hormone isoforms in acromegalic patients before and after treatment with octreotide LAR.

BACKGROUND: Human growth hormone (hGH) circulates as a mixture of different isoforms. It has been previously reported that the ratio of 20kDa to 20kDa plus 22kDa (%20kDa-hGH) is increased in patients with active acromegaly. OBJECTIVES: To evaluate the GH isoforms (20kDa- and 22kDa-hGH) in acromegalic patients before and after six months of treatment with octreotide LAR, and to compare the results with those in healthy controls. In addition, the relationships between the %20kDa-hGH, tumor size and biochemical measurements were also investigated. DESIGN: Random serum samples from 23 acromegalic patients evaluated before and after six months of treatment with octreotide LAR and from 23 matched healthy controls were studied. Growth hormone, IGF-I and prolactin (PRL) were measured by chemiluminescence immunometric assay and the 20kDa- and 22kDa-hGH isoforms were measured by specific time-resolved fluorescence immunoassays. RESULTS: In acromegalic patients before treatment, there was a significantly higher median %20Da-hGH in comparison to healthy controls (14.31% vs. 9.59%, p<0.001). After six months of treatment, the median %20kDa-hGH was similar to the baseline values. Patients with GH<2.5ng/mL after six months of treatment had already lower GH and %20kDa-hGH at baseline (p<0.01). The IGF-I (SD-scores) was positively correlated to total GH levels in acromegalic patients after treatment. There was no correlation between the %20kDa-hGH and PRL levels or tumor size. CONCLUSIONS: Our study confirmed that acromegalic patients have an increased proportion of circulating 20kDa-hGH isoform. Consequently, the use of a 22kDa-hGH specific assay may underestimate the tumor production of total GH. Although octreotide LAR promoted a significant decrease in the GH and IGF-I levels, it did not normalize the GH isoforms composition and suggests that the secretion of GH isoforms is equally inhibited by somatostatin analogues and that it is the disease control that normalizes the GH isoforms composition in acromegaly.

A importância da prática de alimentação, higiene bucal e fatores sócio-econômicos na prevalência da cárie precoce da infância em pré-escolares de Itatiba-SP / The importance of feeding practices, oral hygiene and socioeconomic factors in the early childhood caries prevalence in preschool children from Itatiba-SP

Objetivo: Verificar se a dieta, incluindo hábitos de aleitamento, a higiene bucal e os fatores sócio-econômicos podem ser considerados indicadores de risco para a cárie precoce da infância (CPI) em pré-escolares de Itatiba-SP. Material e método: A amostra foi constituída por 288 crianças, de 3 a 4 anos, que freqüentavam pré-escolas públicas do município de Itatiba-SP. Uma cirurgiã-dentista calibrada (Kappa=0,78) realizou exame físico para a determinação da presença de biofilme dentário e do índice de cárie. Para a avaliação da dieta foi empregado um diário alimentar, enquanto hábitos de aleitamento, higiene bucal, etnia, renda familiar e escolaridade materna foram avaliados por um questionário. Os dados foram analisados pelo teste qui-quadrado/exato de Fisher, seguido de regressão logística múltipla (alfa=0,05) expressa por razão de chances (odds ratio -OR). Resultados: A ingestão de açúcar na forma sólida 3 ou mais vezes ao dia (OR=4,5), a amamentação não exclusiva no peito por 12 meses ou mais (OR=2,0), a presença de biofilme dentário nos incisivos superiores (OR=3,1) e o fato de levar lanche para consumir na escola (OR=2,1), além da merenda, apresentaram associação significativa com a CPI (<0,05). Já os fatores etnia, escolaridade, renda familiar e freqüência de higiene bucal não se mostraram estatisticamente significativos (p>0,05). Conclusão: Os resultados sugerem que a exposição frequente aos açúcares na forma sólida, a presença de biofilme dentário e o fato de levar lanche para escola, principalmente os cariogênicos, são indicadores de risco expressivos para a cárie precoce da infância na população estudada.

Purpose: This study aimed to verify if the cariogenic diet, including nursing habits, the oral hygiene and the socioeconomic factors could be considered risk indicators for early childhood caries (ECC) in preschool children from Itatiba-SP. Methods: The sample was composed of 288 children, 3 to 4 years old, who attended public preschools from Itatiba-SP. Clinical examinations were conducted by one calibrated dentist (Kappa=0.78) for biofilm presence and caries index determination. For the diet evaluation, a diet chart was used, whereas the nursing habits, oral hygiene, ethnicity, family income and mothers´ level of education were evaluated by a questionnaire. Data were analyzed by chi-square/fisher´s exact test and multiple logistic regression (alfa=0.05) expressed by odds ratios (OR). Results: Sugar consumption in the solid form three or more times a day (OR=4.5), non-exclusive breast-feeding for 12 months or more (OR=2.0), presence of biofilm on the maxillary incisors (OR=3.1) and intake of snacks or drinks at school (OR=2.1), in addition to school meals were significantly associated with ECC (p<0.05). Besides, the factors ethnicity, level of education, family income and oral hygiene frequency did not show statistical significance (p>0.05). Conclusion: The results suggest that frequent exposure to solid sugar, biofilm presence and snacks as complement to school meals, particularly the cariogenic ones, are expressive risk indicators for early childhood caries in the population studied.