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1.
Eur J Endocrinol ; 183(4): D1-D13, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32698136

RESUMO

The literature on an association between acromegaly and cancer is particularly abundant on either colorectal cancer or thyroid cancer, and an endless debate is ongoing whether patients with acromegaly should be submitted to specific oncology screening and surveillance protocols. The aim of the present work is to review the most recent data on the risk of either colorectal cancer or thyroid cancer in acromegaly and discuss the opportunity for specific screening in relation to the accepted procedures in the general population.


Assuntos
Acromegalia/complicações , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Programas de Rastreamento , Monitorização Fisiológica , Neoplasias da Glândula Tireoide/diagnóstico , Acromegalia/diagnóstico , Acromegalia/epidemiologia , Acromegalia/terapia , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/epidemiologia , Adenoma/terapia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Endocrinologia/métodos , Endocrinologia/normas , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/epidemiologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/terapia , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Oncologia/métodos , Oncologia/normas , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Vigilância da População/métodos , Guias de Prática Clínica como Assunto/normas , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/epidemiologia
2.
Arch Endocrinol Metab ; 64(3): 269-275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555993

RESUMO

OBJECTIVE: Acromegaly is characterized by high neoplastic morbidity as a side effect of growth hormone (GH) hypersecretion. Increased incidence of goiter, thyroid carcinoma, and thyroid dysfunction is also reported. The aim of the present study was to find the prevalence of thyroid dysfunction and goiter in patients with acromegaly and determine its relationship to disease activity, disease duration, and the presence of secondary hypothyroidism. SUBJECTS AND METHODS: In a cross-sectional study of the period 2008-2012 were included 146 patients with acromegaly (56 men, 90 women) of mean age 50.3 ± 12.4 years. Acromegaly disease activity and thyroid function were evaluated in all patients. Thyroid ultrasonography was performed to calculate thyroid volume and detect the presence of nodular goiter. RESULTS: Ninety-one patients were determined to have an active disease, and 55, a controlled disease. The mean thyroid volume in patients without previous thyroid surgery was 37.6 ± 38.8 mL. According to disease activity, thyroid volume was significantly higher in patients with active disease (38.5 ± 45.4 mL vs. 27.2 ± 18.4 mL, p = 0.036). A weak positive correlation was found between thyroid volume and insulin-like growth factor 1 (IGF-1) in the whole group and in females (R = 0.218; p = 0.013, and R = 0.238; p = 0.037, respectively). There was no significant correlation of thyroid volume with disease duration and GH level in the whole group and in both sexes. The patients with secondary hypothyroidism had twofold smaller thyroid volume, relative to the rest of the group. The prevalence of thyroid dysfunction was 39%, with a female to male percentage ratio of 1.73. Goiter was diagnosed in 87% of patients, including diffuse goiter (17.1%) and nodular (69.9%), with no significant difference between patients with active and controlled disease or the presence of secondary hypothyroidism. CONCLUSIONS: Thyroid volume in patients with acromegaly depends on disease activity and the presence of secondary hypothyroidism as a complication. The increased prevalence of nodular goiter determines the need of regular ultrasound thyroid evaluation in the follow-up of patients with acromegaly. Arch Endocrinol Metab. 2020;64(3):269-75.


Assuntos
Acromegalia/complicações , Bócio Nodular/fisiopatologia , Hipotireoidismo/fisiopatologia , Glândula Tireoide/fisiopatologia , Acromegalia/fisiopatologia , Adulto , Estudos Transversais , Feminino , Bócio Nodular/diagnóstico , Humanos , Hipotireoidismo/diagnóstico por imagem , Hipotireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Testes de Função Tireóidea , Glândula Tireoide/diagnóstico por imagem , Hormônios Tireóideos/sangue , Ultrassonografia
3.
J Clin Neurosci ; 73: 130-135, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31932185

RESUMO

OBJECTIVE: Respiratory disorders are common complications of acromegaly patients. We conducted a large-scale survey in the patients with acromegaly and demonstrated the characteristics of their lung function and blood gas. METHODS: A prospective cohort study was conducted with 115 patients with active acromegaly and 56 patients with nonfunctioning pituitary adenomas. All patients underwent clinical, biological, radiological, lung functional and blood gas assessments. RESULTS: Acromegaly patients had a higher lung volume than those with nonfunctioning adenomas (forced vital capacity value (FVC) and FVC% predicted: p < 0.001). The small airway was less obstructive in acromegaly patients (higher FEV1% predicted, PEF% predicted, MEF75% predicted, MEF50% predicted, MEF25% predicted: p ≤ 0.001 for all analyses, FEV1/FVC: p = 0.151). The average partial pressure of carbon dioxide in acromegaly patients was higher (p < 0.001), but there was no significant difference in the average partial pressure of oxygen or oxygen saturation between the two groups (p > 0.05). In acromegaly patients, the average age of patients with small airway obstruction was higher than that of patients with normal lung function (p < 0.05), but no significant difference in GH or IGF-1 levels between the two groups were found (p > 0.05). CONCLUSION: The acromegaly patients in this cohort had increased lung volume. However, there was no evidence demonstrating hypoxemia in acromegaly patients. The small airway was less obstructive in acromegaly patents. Small airway obstruction was observed in elderly patients with acromegaly.


Assuntos
Acromegalia/fisiopatologia , Pulmão/fisiopatologia , Acromegalia/complicações , Adenoma/complicações , Adulto , Idoso , Obstrução das Vias Respiratórias/etiologia , Gasometria , Estudos de Coortes , Feminino , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Testes de Função Respiratória
4.
Eur J Endocrinol ; 182(3): 293-302, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31917679

RESUMO

Objective: Excess of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), as in acromegaly, is associated with increased risk of diabetes, but whether retinal vessels are altered is unknown. The aim of this study was to evaluate retinal vessel morphology in patients with acromegaly at diagnosis and after treatment and to describe the prevalence of diabetic retinopathy in patients with long-standing acromegaly and diabetes. Design: Two independent observational studies, one being prospective and the other retrospective and cross-sectional. Methods: Retinal vessel morphology of 26 patients with acromegaly was examined at diagnosis and 1 year after treatment and compared to 13 healthy controls. Cross-sectional evaluation of 39 patients with long-standing acromegaly and diabetes was performed. Fundus photographs were digitally analyzed for vessel morphology. Results: Patients with acromegaly had a median (interquartile range) of 34.3 (30.0-39.0) vessel branching points compared to 27.0 (24.0-29.0) for healthy controls (P < 0.001). Tortuosity of arterioles and venules remained unchanged. Vessel morphology did not change significantly after treatment. Patients with acromegaly and diabetes for a median of 14 years also had a high number of branching points (34.2 (32.5-35.6)), but the prevalence of diabetic retinopathy was not higher than expected in diabetic patients without acromegaly. Conclusions: Patients with acromegaly have an increased number of vascular branching points in the retina without an alteration of macroscopic vessel morphology. This is consistent with an angiogenic effect of GH/IGF-1 in humans. The prevalence of diabetic retinopathy was not increased in patients with acromegaly and diabetes.


Assuntos
Acromegalia/patologia , Vasos Retinianos/patologia , Acromegalia/complicações , Acromegalia/terapia , Adolescente , Adulto , Idoso , Arteríolas/patologia , Estudos de Casos e Controles , Estudos Transversais , Complicações do Diabetes/patologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Retinopatia Diabética/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/etiologia , Neovascularização Patológica/patologia , Prevalência , Estudos Retrospectivos , Vênulas/patologia , Adulto Jovem
5.
Endocrinol Metab Clin North Am ; 48(4): 779-793, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31655776

RESUMO

Hypertension is one of the most frequent complications in acromegaly, with a median frequency of 33.6% (range, 11%-54.7%). Although the pathogenesis has not been fully elucidated, it probably results from concomitant factors leading to expansion of extracellular fluid volume, increase of peripheral vascular resistance, and development of sleep apnea syndrome. Because the effect of normalization of growth hormone and insulinlike growth factor 1 excess on blood pressure levels is unclear, an early diagnosis of hypertension and prompt antihypertensive treatment are eagerly recommended, regardless of the specific treatment of the acromegalic disease and the level of biochemical control attained.


Assuntos
Acromegalia , Anti-Hipertensivos/uso terapêutico , Hipertensão , Acromegalia/complicações , Acromegalia/diagnóstico , Acromegalia/metabolismo , Acromegalia/terapia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/metabolismo , Hipertensão/terapia
6.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(3): 433-437, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31631614

RESUMO

Objective: To identify risk factors associated with thyroid nodular lesions in patients with acromegaly. Methods: Clinical and thyroid ultrasonography data of patients with acromegaly diagnosed in the West China Hospital of Sichuan University from May 2009 to January 2018 were reviewed and analyzed. Multivariate linear regression models were established to identify factors associated with thyroid volumes and size of thyroid nodules. Multivariate binary logistic regression models were established to determine risk factors associated with thyroid nodules in patients with acromegaly. Results: Of the 240 acromegaly patients, 70 received thyroid ultrasonography and 56 had thyroid nodules (56/70, 80%). The patients with thyroid nodules had a longer median duration of acromegaly than 14 patients who without thyroid nodules (8.0 years vs. 3.0 years, P<0.05), but had a similar mean age and female to male ratio with the latter. The risk of thyroid nodules increased with the duration of acromegaly (odds ratio=1.306, 95% confidence interval (1.010, 1.688), P=0.042). The level of random growth hormone was linearly correlated with thyroid volumes. Gender, age, and serum growth hormone were not predictors of thyroid nodules in patients with acromegaly. Conclusion: Duration of acromegaly is an independent predictor of thyroid nodules.


Assuntos
Acromegalia/complicações , Nódulo da Glândula Tireoide/complicações , China , Feminino , Humanos , Masculino , Fatores de Risco , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia
7.
Horm Metab Res ; 51(10): 649-654, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31487747

RESUMO

The purpose of the study was to compare serum visfatin levels between patients with acromegaly and healthy controls and to evaluate the relationships between visfatin levels and epicardial fat thickness (EFT), carotid intima media thickness (cIMT), and ankle brachial index (ABI). We conducted a cross-sectional case-control study of 54 patients with acromegaly (37 females and 17 males) and 34 healthy controls (22 females and 12 males). Serum visfatin was measured by ELISA. Acromegalic and control participants and those with active or controlled acromegaly were compared with respect to their serum visfatin, clinical and metabolic parameters, EFT, cIMT, and ABI. Linear correlation was used to identify associations between these parameters and visfatin in all participants. Serum visfatin and glycated hemoglobin (HbA1c) were higher in the acromegaly group than in the control group (p<0.001 and p=0.007, respectively). There was no difference in visfatin between the active and controlled acromegaly groups, but HbA1c was higher in the active than the controlled acromegaly group (p<0.04). EFT, cIMT, and ABI were similar between the acromegaly and control groups and between the active and controlled acromegaly groups. Serum visfatin positively correlated with HbA1c, growth hormone (GH), and insulin-like growth factor-1 (IGF-1)/upper limit of normal ratio (r=0.245, p=0.024; r=0.259, p=0.017; and r=0.282, p=0.009, respectively). This study has revealed that a high visfatin level is associated with glycemic dysregulation and higher levels of GH and IGF-1 in acromegalic patients.


Assuntos
Acromegalia/sangue , Aterosclerose/diagnóstico , Biomarcadores/sangue , Citocinas/sangue , Hemoglobina A Glicada/análise , Hormônio do Crescimento Humano/sangue , Fator de Crescimento Insulin-Like I/análise , Nicotinamida Fosforribosiltransferase/sangue , Acromegalia/complicações , Adulto , Aterosclerose/sangue , Aterosclerose/etiologia , Glicemia/análise , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
8.
Neurol India ; 67(3): 757-762, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31347550

RESUMO

Objective: The natural history of glucose intolerance (GI) in patients with acromegaly undergoing surgical treatment has not been fully understood. This study was aimed to unravel the prevalence and predictors of recovery from GI in these patients in a prospective multivariate model. Materials and Methods: Patients with acromegaly treated between 2007 and 2016 were prospectively studied with respect to demographics, clinicoradiological features, comorbidities, and hormonal investigations before surgery and at regular follow-up. The independent predictors of recovery from diabetes were analyzed. Results: There were a total of 151 patients with active acromegaly included in the study. The median baseline growth hormone (GH) and insulin-like growth factor (IGF)-1 levels were 25 and 811 ng/mL, respectively. Diabetes mellitus (DM) and pre-diabetes were noted in 93 (61.6%) and 20 (13.2%) patients, respectively. Following surgical treatment, the median HbA1c decreased significantly from 6.4% to 5.5% (P < 0.001), with 46.8% having complete recovery from DM or pre-diabetes. This glycemic recovery had significant association with both biochemical (P = 0.001) and radiological remission (P = 0.01). The recovery from DM had a greater association with post-operative IGF-1 than GH, especially among those with discordant GH and IGF-1 levels (60% in normal IGF-1 and high GH vs. 20% in high IGF-1 and normal GH). Post-operative IGF-1 had a significant impact on recovery from DM (P = 0.01) independent of age, body mass index, duration of DM, and pre-operative HbA1c. Conclusion: Nearly half of the patients with acromegaly with DM or pre-diabetes had glycemic recovery, influenced by biochemical and radiologic remission. Post-operative IGF-1 appears to be the strongest independent determinant of recovery from DM.


Assuntos
Acromegalia/cirurgia , Complicações do Diabetes/diagnóstico , Acromegalia/complicações , Adolescente , Adulto , Idoso , Criança , Complicações do Diabetes/etiologia , Feminino , Intolerância à Glucose/etiologia , Hormônio do Crescimento Humano/análise , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Prognóstico , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
9.
Pan Afr Med J ; 33: 5, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303950

RESUMO

Acromegaly is a rare disease that can have serious consequences. This disease is not widely known by stomatologists, although cranio-facial manifestations are important and rapid changes in the oral cavity are frequent and sometimes dramatic. The prosthetic management of patients with acromegaly is not easy because it is necessary to wait for the stabilization of the disease. If this is not the case, the bone changes prevent the stability of prostheses over time. Moreover, because of bone remodeling, some treatments are contra-indicated, which limits our therapeutic choices. Through this clinical case, we will focus on the oral manifestations of patients with acromegaly and the method of prosthetic management.


Assuntos
Acromegalia/complicações , Prótese Dentária , Reabilitação Bucal/métodos , Humanos , Masculino , Pessoa de Meia-Idade
10.
Endokrynol Pol ; 70(4): 305-312, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274183

RESUMO

INTRODUCTION: Long-acting repeatable (LAR) octreotide i.m. is a potent, synthetic somatostatin analogue (SSA) that requires less frequent dosing and offers quality of life (QoL) benefits in acromegaly patients compared to its shorter-acting predecessor. This study investigated the efficacy and safety of high-dose Sandostatin® LAR® as monotherapy or in combination with pegvisomant or cabergoline in acromegalic patients with pituitary adenomas following previous failure of conventional SSA treatment. MATERIAL AND METHODS: After three months of high-dose Sandostatin® LAR® monotherapy (40 mg), patients who achieved biochemical control (n = 7) continued to receive the same treatment for an additional four months, whereas uncontrolled patients were randomised to receive high-dose Sandostatin® LAR® in combination with pegvisomant (n = 31) or cabergoline (n = 32). Outcomes included biochemical response at eight months, QoL, and safety. RESULTS: After three months, 3 of 68 (4.4%) evaluable patients achieved a biochemical control (BC) as assessed by levels of growth hormone and insulin-like growth factor-1. At eight months, 4 of 67 (6.0%) patients achieved BC, including one receiving monotherapy and three receiving Sandostatin® LAR® plus cabergoline. Partial response rate, improvements in acromegaly signs and symptoms, and changes in QoL were similar for all three groups. All treatments were well tolerated with a slight excess of adverse events in the combination arms. There were no deaths or serious adverse events leading to treatment discontinuation. CONCLUSION: These data demonstrate that high-dose Sandostatin® LAR® as monotherapy or in combination with pegvisomant or cabergoline is a feasible salvage option in patients with pituitary adenomas not adequately controlled on conventional SSA regimens.


Assuntos
Acromegalia/tratamento farmacológico , Adenoma/tratamento farmacológico , Cabergolina/uso terapêutico , Hormônio do Crescimento Humano/análogos & derivados , Octreotida/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Acromegalia/complicações , Adenoma/complicações , Adulto , Idoso , Antineoplásicos Hormonais/uso terapêutico , Quimioterapia Combinada , Feminino , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/complicações , Resultado do Tratamento
11.
Diabetes Metab Syndr ; 13(2): 901-903, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336543

RESUMO

Patients with acromegaly have soft tissue overgrowth that induced characteristic clinical presentation. A growth hormone-secreting adenoma of the anterior pituitary gland is the most common cause of acromegaly. Metabolic and somatic features of acromegaly caused by high serum concentrations of insulin-like growth factor-I (IGF-I) and excess growth hormone (GH) production. we present a case of 'pseudoacromegaly' with an acromegaloid features, suppressed IGF-I levels and marked elevation of serum insulin. Endocrinologists should consider this diagnosis when assessing patients with clinical features of acromegaly and insulin resistance, in the absence of elevated levels of GH and IGF-I.


Assuntos
Acromegalia/patologia , Hipoglicemiantes/efeitos adversos , Resistência à Insulina , Insulina/efeitos adversos , Acromegalia/induzido quimicamente , Acromegalia/complicações , Adulto , Feminino , Humanos , Prognóstico , Adulto Jovem
12.
Rev. chil. endocrinol. diabetes ; 12(3): 162-164, jul. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1006497

RESUMO

La acromegalia, originada por un exceso de producción de Hormona de crecimiento (Gh), se caracteriza por crecimiento somático exagerado, alto riesgo cardio-metabólico, así como reducción de la expectativa de vida. Tiene una incidencia de 3-4 casos por millón de habitantes. El diagnóstico se retrasa hasta 10 años aumentando la morbi-mortalidad. Las alternativas terapéuticas incluyen medicamentos y cirugía, que van encaminados a reducir los efectos de masa tumoral, normalizar los parámetros bioquímicos y resolver las manifestaciones clínicas. En casos muy infrecuentes, el tumor hipofisario que la origina se asocia a silla turca vacía.


Acromegaly, caused by an excess production of growth hormone (Gh), it is characterized by exaggerated somatic growth, high cardio-metabolic risk, as well as reduction of life expectancy. It has an incidence of 3-4 cases per million population. The diagnosis is delayed up to 10 years increasing morbidity and mortality. The therapeutic alternatives include medications and surgery, which are aimed at reduce the effects of tumor mass, normalize biochemical parameters and resolve clinical manifestations. In very infrequent cases, the pituitary tumor that originates it is associated with empty sella syndrome. Key words: Acromegaly, Empty sella syndrome, Pituitary tumor.


Assuntos
Humanos , Feminino , Idoso , Neoplasias Hipofisárias/complicações , Acromegalia/complicações , Acromegalia/diagnóstico , Síndrome da Sela Vazia/complicações , Sela Túrcica/patologia , Fator de Crescimento Insulin-Like I/análise , Hormônio do Crescimento/análise , Imagem por Ressonância Magnética , Teste de Tolerância a Glucose
13.
Ann Endocrinol (Paris) ; 80(4): 196-201, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31227172

RESUMO

PURPOSE: Acromegaly causes multiple comorbidities, including gastrointestinal disorders. The present study evaluated the frequency of hiatal hernia and other upper gastrointestinal pathologies in patients with acromegaly, given that visceromegaly and reduced nitric oxide levels in acromegaly may impact diaphragm and lower esophageal sphincter function and thus possibly the development of hiatal hernia. METHODS: Thirty-nine acromegaly patients followed our center for the previous 6months were recruited. Upper gastrointestinal endoscopy was performed once in all patients to evaluate hiatal hernia, esophagitis, gastroduodenitis and ulcer. RESULTS: Twenty-three patients were male and 16 female. Upper gastrointestinal endoscopy found hiatal hernia, esophagitis and gastroduodenitis or gastric ulcer in 3 (7.6%), 2 (1.7%) and 31 (79.4%) patients, respectively. Pathologic examination of gastric antrum biopsy found intestinal metaplasia in 12 (30.7%) patients, and Helicobacter pylori was positive in 13 (33.3%). There were no significant correlations between age, gender, disease duration or preoperative adenoma size on the one hand and hiatal hernia or other endoscopic findings on the other. Similarly, neither surgical success nor recurrence was associated with endoscopic findings. CONCLUSIONS: The study showed that prevalence of gastritis, duodenitis, peptic ulcer and intestinal metaplasia is higher and prevalence of hiatal hernia lower in acromegaly patients than in the healthy population. Various unknown disease-related pathophysiological conditions may play a role; there is a need for further studies.


Assuntos
Acromegalia/complicações , Acromegalia/epidemiologia , Gastroenteropatias/epidemiologia , Trato Gastrointestinal Superior/patologia , Acromegalia/patologia , Adulto , Endoscopia Gastrointestinal , Esofagite/complicações , Esofagite/diagnóstico , Esofagite/epidemiologia , Feminino , Gastrite/complicações , Gastrite/diagnóstico , Gastrite/epidemiologia , Gastroenteropatias/complicações , Gastroenteropatias/diagnóstico , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Hérnia Hiatal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Úlcera Péptica/diagnóstico , Úlcera Péptica/epidemiologia , Prevalência , Trato Gastrointestinal Superior/diagnóstico por imagem
14.
Artigo em Inglês | MEDLINE | ID: mdl-31212352

RESUMO

Two intact bitches aged 9 and 11 years were referred due to chronic polyuria, polydipsia, vomiting, anorexia and progressive lethargy. On clinical examination, signs of tissue overgrowth (large paws, widened interdental space, pharyngeal stridor) were noticed. Diabetes mellitus (DM) was diagnosed in one dog (case 1) and diabetic ketoacidosis (DKA) in the other (case 2). There were increased IGF-1 values suggestive of hypersomatotropism. Progesterone values and pathological findings of the ovaries and uterus indicated diestrus. Diagnosis of diestrus-induced hypersomatotropism was made and ovariohysterectomy was performed in both dogs. Dog 1 also had multiple mammary neoplasms treated with bilateral mastectomy. Treatment resulted in diabetic remission in case 1 and improved glycaemic control in case 2. Overall, diestrus-induced hypersomatotropism is rare but should be considered in any intact diabetic bitch with acromegalic features. Ovariohysterectomy is recommended and associated with a fair to good prognosis.


Assuntos
Acromegalia , Complicações do Diabetes/complicações , Diestro/fisiologia , Doenças do Cão , Acromegalia/complicações , Acromegalia/diagnóstico , Acromegalia/terapia , Acromegalia/veterinária , Animais , Doenças do Cão/diagnóstico , Doenças do Cão/terapia , Cães , Feminino , Histerectomia , Mastectomia
15.
J Formos Med Assoc ; 118(11): 1488-1493, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31147197

RESUMO

BACKGROUND/PURPOSE: The objectives of this study were to evaluate the associations between clinical parameters and quality of life (QOL) of patients with acromegaly in Taiwan and to identify the impacts of hormone control, regimens, or co-morbidities on acromegalic patients' daily life. METHODS: From 2013 to 2015, subjects with acromegaly were recruited through five medical centers. Clinical data were recorded. The QOL of enrolled patients were assessed by using Acromegaly Quality of Life Questionnaire (AcroQoL). RESULTS: This study enrolled 272 acromegalic subjects (117 males, 155 females). Remission, defined by normalization of IGF-1, had significant positive association with QOL scores in psychological/appearance (PSY/APP) dimension (ß = 6.760, p = 0.023). Somatostatin analogues therapy had negative associations with total score and score in psychological (PSY) dimension (ß = -4.720, p = 0.046 and ß = -5.388, p = 0.035, respectively). Diabetes mellitus had negative associations with score in PSY dimension and psychological/personal relations (PSY/PER) dimensions (ß = -5.839, p = 0.034 and ß = -7.516, p = 0.013, respectively). Cerebral vascular accident (CVA) had significant negative associations with total score and scores in physical (PHY), PSY, and PSY/PER dimensions (ß = -26.632, p = 0.013; ß = -28.353, p = 0.024; ß = -25.648, p = 0.026; and ß = -34.586, p = 0.006, respectively). All these associations remained significant even after adjusted with sex and age. CONCLUSION: Our analysis suggested that not only hormone control but also therapeutic regimens and presence of co-morbidities might affect QOL of patients with acromegaly in some dimensions.


Assuntos
Acromegalia/psicologia , Qualidade de Vida , Acromegalia/sangue , Acromegalia/complicações , Adulto , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/etiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Hormônios/uso terapêutico , Humanos , Fator de Crescimento Insulin-Like I/análise , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Somatostatina/análogos & derivados , Inquéritos e Questionários , Taiwan/epidemiologia
16.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-46578

RESUMO

Do ponto de vista histórico Associação Protectora dos Diabéticos de Portugal (APDP) foi fundada em 1926 para fornecer insulina a nível nacional aos pobres e carenciados com diabetes. Evoluiu para uma instituição de prestação de cuidados de saúde globais e de proteção às pessoas com diabetes, numa zona de influência correspondente ao território nacional e com ligações no campo assistencial, de investigação e formativo a várias instituições e organizações internacionais. É uma Instituição Particular de Solidariedade Social (IPSS) no âmbito da saúde reconhecida oficialmente de superior interesse nacional e dotada de autonomia técnica, administrativa e financeira. É a decana das Associações a nível mundial e está federada na Internacional Diabetes Federation (IDF). A APDP é parceira e participante ativa do Programa Nacional para a Diabetes. É desde 2009 o único centro nacional reconhecido pela IDF como Centre of Education of the International Diabetes Federation e, desde 2011, a nível europeu, é também reconhecida como clínica de referência para o tratamento de crianças e jovens – Centre of Reference for Pediatric Diabetes.


Assuntos
Diabetes Mellitus , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Diabetes Autoimune Latente em Adultos , Diabetes Gestacional , Neuropatias Diabéticas , Resistência à Insulina , Poliendocrinopatias Autoimunes , Síndrome de Cushing/complicações , Acromegalia/complicações , Feocromocitoma/complicações , Hemocromatose/complicações ,
17.
Arch Endocrinol Metab ; 63(3): 235-240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31038594

RESUMO

OBJECTIVE: To evaluate whether hormonal profile, arterial function, and physical capacity are predictors of fatigue in patients with acromegaly. Subjects and methods: This is a cross-sectional study including 23 patients. The subjects underwent a Modified Fatigue Impact Scale (MFIS) assessment; serum growth hormones (GH) and IGF-1 measurements; pulse wave analysis comprising pulse wave velocity (PWV), arterial compliance (AC), and the reflection index (IR1,2); dominant upper limb dynamometry (DYN); and the six-minute walking distance test (6MWT). Multiple linear regression models were used to identify predictors for MFIS. The coefficient of determination R2 was used to assess the quality of the models' fit. The best model was further analyzed using a calibration plot and a limits of agreement (LOA) plot. RESULTS: The mean ± SD values for the participants' age, MFIS, PWV, AC, IR1,2, DYN, and the distance in the 6MWT were 49.4 ± 11.2 years, 31.2 ± 18.9 score, 10.19 ± 2.34 m/s, 1.08 ± 0.46 x106 cm5/din, 85.3 ± 29.7%, 33.9 ± 9.3 kgf, and 603.0 ± 106.1 m, respectively. The best predictive model (R2 = 0.378, R2 adjusted = 0.280, standard error = 16.1, and P = 0.026) comprised the following regression equation: MFIS = 48.85 - (7.913 × IGF-I) + (1.483 × AC) - (23.281 × DYN). CONCLUSION: Hormonal, vascular, and functional variables can predict general fatigue in patients with acromegaly.


Assuntos
Acromegalia/complicações , Fadiga/diagnóstico , Fadiga/etiologia , Adulto , Brasil , Estudos Transversais , Tolerância ao Exercício , Feminino , Humanos , Fator de Crescimento Insulin-Like I/análise , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Análise de Onda de Pulso , Teste de Caminhada
18.
J Med Case Rep ; 13(1): 106, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31018862

RESUMO

BACKGROUND: Congestive heart failure is rarely observed in patients with acromegaly. Excessive growth hormone secretion and elevation of insulin-like growth factor 1 contribute to pathological changes in myocyte growth and structure, cardiac contractility, vascular function, and in later stage may progress to cardiac dysfunction. Early recognition of the condition is paramount, though the insidious progression of the disease commonly results in late diagnosis. Current standard regimens of pharmacological therapy, surgical treatment, radiotherapy are designed to normalize serum levels of both insulin-like growth factor 1 and growth hormone. In patients with late-stage heart failure due to acromegalic cardiomyopathy, cardiac resynchronization therapy might be a desirable treatment to help cardiac synchronization, improve symptoms, and eventually reduce hospital admissions together with mortality rates. CASE PRESENTATION: We describe a case of a 49-year-old man with a history of acromegaly who presented to our hospital with a diagnosis of decompensated systolic heart failure. Serial electrocardiograms showed wide (160-200 ms) QRS duration with left bundle branch block. Echocardiography showed severe left ventricular dysfunction that simultaneously achieved a left ventricular ejection fraction of 16%. Surgical indication was rarely assessed by neurosurgeons. Given that the stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects, cardiac resynchronization therapy was performed. Owing to biventricular synchronization and holding back reverse remodeling, the patient's symptoms were successfully alleviated, and he was discharged from the hospital. CONCLUSIONS: Congestive heart failure is a rare complication in acromegaly-induced cardiomyopathy (occurs in only 3% of patients). Early diagnosis and treatment with curative drugs more than cardiovascular implantable electronic devices might lead to better surgical outcomes in this group of patients.


Assuntos
Acromegalia/fisiopatologia , Terapia de Ressincronização Cardíaca , Cardiomiopatias/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Acromegalia/complicações , Acromegalia/terapia , Cardiomiopatias/congênito , Cardiomiopatias/terapia , Ecocardiografia , Insuficiência Cardíaca/congênito , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
J Craniofac Surg ; 30(6): 1806-1808, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31033754

RESUMO

INTRODUCTION: The McCune-Albright syndrome (MAS) is a complex congenital disorder caused by the embryonic post-zygotic somatic activating mutations in the GNAS1 gene. In such syndrome, phenotypes are heterogeneous and comprised polyostotic/monostotic fibrous dysplasia, café au lait macules, and hyperfunctioning endocrinopathies as the excess growth hormone. Likewise, acromegaly, as a manifestation of the endocrine hyperfunction, is unusual and affects about 20% of patients with MAS. CASE PRESENTATION: This research study describes a case of a 31-year-old female subject presenting polyostotic fibrous dysplasia with severe facial involvement, along with acromegaly and the MAS. The case was satisfactorily managed by surgical re-alignment and presented no clinical signs of relapse in a 12-year follow-up period. Finally, a literature review was conducted to discuss the standard protocols and the controversies when treating such cases. CONCLUSION: Patients with craniomaxillofacial fibrous dysplasia associated with acromegaly may present significant facial deformities that can be satisfactorily treated by cosmetic treatment, especially in patients with psychological problems and severe social acceptance.


Assuntos
Acromegalia/cirurgia , Manchas Café com Leite/cirurgia , Displasia Fibrosa Monostótica/cirurgia , Displasia Fibrosa Poliostótica/cirurgia , Acromegalia/complicações , Adulto , Manchas Café com Leite/complicações , Feminino , Displasia Fibrosa Monostótica/complicações , Displasia Fibrosa Poliostótica/complicações , Humanos
20.
Endocrinol Metab (Seoul) ; 34(1): 53-62, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30912339

RESUMO

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and the Korean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment of acromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.


Assuntos
Acromegalia/tratamento farmacológico , Neuroendocrinologia/organização & administração , Somatostatina/análogos & derivados , Acromegalia/complicações , Acromegalia/epidemiologia , Acromegalia/fisiopatologia , Acromegalia/cirurgia , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Hormonais/uso terapêutico , Atitude , Consenso , Tomada de Decisões , Prova Pericial/métodos , Humanos , Injeções Intramusculares , Seguro Saúde/normas , Octreotida/administração & dosagem , Octreotida/uso terapêutico , Peptídeos Cíclicos/administração & dosagem , Peptídeos Cíclicos/uso terapêutico , Guias de Prática Clínica como Assunto , Período Pré-Operatório , República da Coreia/epidemiologia , Somatostatina/administração & dosagem , Somatostatina/uso terapêutico
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