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2.
Endocrine ; 66(2): 405-415, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31317524

RESUMO

PURPOSE: The prevalence of postoperative hypoparathyroidism has been studied in registries and in surgical series with highly variable and imprecise results. However, the frequency of this hormonal deficiency in the clinical practice of endocrinologists is not known with accuracy. We aimed to assess the prevalence and risk factors of hypoparathyroidism in patients undergoing total thyroidectomy in Spain. METHODS: We designed a retrospective, multicentre and nation-wide protocol including all patients with total thyroidectomy who were seen in the endocrinology clinic of the participant centers from January to March 2018. Prevalence of hypoparathyroidism was evaluated at discharge of surgery, 3-6 months after surgery, 12 months after surgery and at last visit. Twenty hospitals participated in the study. RESULTS: Of 1792 patients undergoing total thyroidectomy, 866 (48.3%) developed postoperative hypoparathyroidism at discharge of surgery. Most of them recover parathyroid function over time. Prevalence of hypoparathyroidism at 3-6 months, 12 months and at last visit was 22.9%, 16.7% and 14.5%, respectively. The risk of developing definitive hypoparathyroidism was related to the presence of parathyroid tissue at histology, lymph node dissection, and two-stage thyroidectomy. Patients with thyroid cancer, with higher postoperative calcium levels and treated by expert surgical teams exhibited lower risk of developing permanent hypoparathyroidism. CONCLUSIONS: Although most patients with postsurgical hypoparathyroidism recover parathyroid function, the prevalence of permanent disease in clinical practice is non negligible (14.5%). Postoperative calcium, extent and timing of surgery, the presence of cancer, expert surgical team, and parathyroid tissue at histology are predictors of permanent hypoparathyroidism.

3.
Endocrine ; 55(1): 231-238, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27704480

RESUMO

Giant prolactinomas are rare tumors characterized by their large size, compressive symptoms, and extremely high prolactin secretion. The aim of this study is to describe our experience with a series of 16 giant prolactinomas cases in terms of clinical presentation, therapeutic decisions, and final outcomes. Retrospective analysis of adult patients diagnosed with giant prolactinomas at the endocrine departments of three university tertiary hospitals. We included 16 patients (43.7 % women); mean age at diagnosis: 42.1 ± 21 years. The most frequent presentation was compressive symptoms. The delay in diagnosis was higher in women (median of 150 months vs. 12 in men; p = 0.09). The mean maximum tumor diameter at diagnosis was 56.9 ± 15.5 mm, and mean prolactin levels were 10,995.9 ± 12,157.8 ng/mL. Dopamine agonists were the first-line treatment in 11 patients (mean maximum dose: 3.9 ± 3.2 mg/week). Surgery was the initial treatment in five patients and the second-line treatment in six. Radiotherapy was used in four cases. All patients but one, are still with dopamine agonists. After a mean follow-up of 9 years, prolactin normalized in 7/16 patients (43.7 %) and 13 patients (81 %) reached prolactin levels lower than twice the upper limit of normal. Mean prolactin level at last visit: 79.5 ± 143 ng/mL. Tumor volume was decreased by 93.8 ± 11.3 %, and final maximum tumor diameter was 18.4 ± 18.8 mm. Three patients are actually tumor free. Giant prolactinomas are characterized by a large tumor volume and extreme prolactin hypersecretion. Multimodal treatment is frequently required to obtain biochemical and tumor control.


Assuntos
Agonistas de Dopamina/uso terapêutico , Procedimentos Neurocirúrgicos/métodos , Hipófise/cirurgia , Neoplasias Hipofisárias/terapia , Prolactinoma/terapia , Radioterapia , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Prolactina/sangue , Prolactinoma/sangue , Resultado do Tratamento , Adulto Jovem
7.
Endocrinol Nutr ; 56(2): 85-91, 2009 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-19627716

RESUMO

Subclinical thyroid disease is a biochemical diagnosis and is common during pregnancy. Because of the physiological hormonal changes that take place during pregnancy and the absence of normal ranges for thyroid hormones during this period, subclinical thyroid disease is difficult to interpret during pregnancy. Subclinical hyperthyroidism during pregnancy has few clinical consequences and no treatment is required. In contrast, subclinical hypothyroidism seems to improve with thyroxine treatment. Iodine supplements during pregnancy and lactation, even in iodine-sufficient areas, are also indicated.


Assuntos
Hipertireoidismo/diagnóstico , Hipertireoidismo/tratamento farmacológico , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Adulto , Desenvolvimento Embrionário , Feminino , Doenças Fetais/etiologia , Doenças Fetais/prevenção & controle , Humanos , Hipertireoidismo/sangue , Hipotireoidismo/sangue , Iodo/administração & dosagem , Iodo/deficiência , Iodo/uso terapêutico , Lactação , Necessidades Nutricionais , Gravidez , Complicações na Gravidez/sangue , Transtornos Puerperais/tratamento farmacológico , Hormônios Tireóideos/sangue , Tireoidite Autoimune/sangue , Tireoidite Autoimune/diagnóstico , Tireoidite Autoimune/tratamento farmacológico , Tireotropina/sangue , Tiroxina/uso terapêutico
8.
Endocrinol. nutr. (Ed. impr.) ; 56(2): 85-91, feb. 2009. tab
Artigo em Espanhol | IBECS | ID: ibc-61759

RESUMO

La disfunción tiroidea subclínica es de diagnóstico bioquímico y es una entidad frecuente durante la gestación. Los cambios hormonales fisiológicos que acontecen durante la gestación, junto con la falta de valores de referencia de las hormonas tiroideas en este periodo, hacen que la disfunción tiroidea subclínica sea de difícil interpretación. Mientras el hipertiroidismo subclínico en la gestación carece de repercusión clínica y no requiere una actuación específica, el hipotiroidismo subclínico, en ese periodo, parece beneficiarse del tratamiento sustitutivo con tiroxina. Los suplementos de yodo en la gestación y lactación son necesarios incluso en zonas de yodosuficiencia (AU)


Subclinical thyroid disease is a biochemical diagnosis and is common during pregnancy. Because of the physiological hormonal changes that take place during pregnancy and the absence of normal ranges for thyroid hormones during this period, subclinical thyroid disease is difficult to interpret during pregnancy. Subclinical hyperthyroidism during pregnancy has few clinical consequences and no treatment is required. In contrast, subclinical hypothyroidism seems to improve with thyroxine treatment. Iodine supplements during pregnancy and lactation, even in iodine-sufficient areas, are also indicated (AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto , Hipertireoidismo/diagnóstico , Hipotireoidismo/diagnóstico , Complicações na Gravidez/diagnóstico , Hipertireoidismo/tratamento farmacológico , Hipotireoidismo/tratamento farmacológico , Iodo/uso terapêutico , Suplementos Nutricionais , Tiroxina/uso terapêutico , Hormônios Tireóideos
9.
Endocrinol. nutr. (Ed. impr.) ; 54(7): 395-397, ago. 2007. tab
Artigo em Espanhol | IBECS | ID: ibc-056835

RESUMO

La disminución brusca de concentraciones plasmáticas de corticoides puede producir un auténtico síndrome de abstinencia similar al que se produce con cualquier droga. Presentamos el caso de una mujer con síndrome de abstinencia tras el tratamiento quirúrgico de un síndrome de Cushing, que no fue identificado, por lo que se mantuvo de forma innecesaria el tratamiento con glucocorticoides (AU)


Sharp reductions in plasma corticosteroid levels can produce a genuine withdrawal syndrome similar to that induced by withdrawal of any other drug. We describe the case of a woman who, after undergoing surgical treatment for Cushing's syndrome, suffered from a withdrawal syndrome. Because this syndrome was not identified, the patient was unnecessarily maintained on glucocorticoid treatment (AU)


Assuntos
Feminino , Pessoa de Meia-Idade , Humanos , Corticosteroides/deficiência , Síndrome de Cushing/tratamento farmacológico , Glucocorticoides/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias , Testes de Função Tireóidea
10.
Endocrinol. nutr. (Ed. impr.) ; 54(1): 44-52, ene. 2007. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-052499

RESUMO

En la práctica clínica son frecuentes los pacientes con disfunción tiroidea subclínica. Es decir, pacientes con concentraciones de tirotropina (TSH) fuera de los valores de referencia pero con concentraciones de tiroxina libre y triyodotironina libre normales. En el presente artículo, se describe qué es la disfunción tiroidea subclínica, se revisa su epidemiología, se recomienda el abordaje más apropiado, se evalúan los riesgos y beneficios del tratamiento y se establece la utilidad de su cribado en ciertos grupos de población. En definitiva, son limitadas las evidencias que sugieren una asociación de la disfunción tiroidea subclínica con ciertos síntomas o con el beneficio o riesgos de su tratamiento. Las consecuencias de la disfunción tiroidea subclínica (TSH: 0,1-0,45 mU/l o 4,5-10 mU/l) son escasas y no se puede recomendar el tratamiento rutinario de estos pacientes. Asimismo, no se puede recomendar el cribado indiscriminado de la población. No obstante, se debe buscar con insistencia en mujeres embarazadas de riesgo, mujeres mayores de 60 años y en ciertos grupos de riesgo (AU)


Patients with serum thyroid-stimulating hormone (TSH) outside the reference range and levels of free thyroxine and free triiodothyronine within the reference range are common in clinical practice. In the present article, subclinical thyroid disease is defined and its epidemiology reviewed. Recommendations on appropriate evaluation and the risks and benefits of treatment and consequences of non-treatment are explored. The question of whether population-based screening is warranted is also discussed. Data supporting an association between subclinical thyroid disease and symptoms or adverse clinical outcomes or benefits of treatment are scarce. The consequences of subclinical thyroid disease (serum TSH 0.1-0.45 mU/l or 4.5-10.0 mU/l) are minimal and recommendations against routine treatment of patients with TSH levels in these ranges are provided. There is insufficient evidence to support population-based screening. Nevertheless, pertinacious case finding is appropriate in pregnant women at risk, women older than 60 years, and others at high risk for thyroid dysfunction (AU)


Assuntos
Humanos , Hipertireoidismo , Hipotireoidismo , Hipertireoidismo/etiologia , Hipertireoidismo/diagnóstico , Hipertireoidismo/terapia , Hipotireoidismo/etiologia , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia
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