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1.
J Surg Res ; 245: 64-71, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31401249

RESUMO

BACKGROUND: The American Thyroid Association (ATA) issued specific preoperative preparatory guidelines for patients undergoing thyroidectomy for treatment of Graves' disease. Our goal is to determine if compliance with these guidelines is associated with better outcomes. METHODS: A retrospective review of a prospectively maintained database identified 228 patients with Graves' disease who underwent total thyroidectomy between August 2007 and May 2015. Patients treated in compliance with ATA guidelines were compared with those not in full compliance with the current preparatory guidelines. RESULTS: At the time of surgery, 52% of all patients followed ATA guidelines. Patients who were prepped per ATA guidelines had fewer episodes of intraoperative tachycardia (0.3 versus 4.5, P = 0.04) but had no difference in peak systolic blood pressure or in number of episodes of systolic blood pressure > 180 mmHg. ATA prepped and nonprepped patients had similar mean operating room time and length of stay. ATA prepped and nonprepped patients had similar complication rates, including transient hypocalcemia (30.4% versus 25.5%, P = 0.45), prolonged hypoparathyroidism (0.98% versus 4.3%, P = 0.15), hoarse voice (10.8% versus 7.5%, P = 0.42), permanent recurrent laryngeal nerve paralysis (2.9% versus 2.1%, P = 0.71), and hematoma (2.9% versus 0%, P = 0.09). CONCLUSIONS: Our data suggest that compliance with ATA guidelines for thyroidectomy preparation is not essential for a successful surgical outcome. Although preparation per the guidelines decreased the frequency of intraoperative tachycardia, it did not impact intraoperative hypertension, operating room time, or postoperative complications.


Assuntos
Doença de Graves/cirurgia , Fidelidade a Diretrizes/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Tireoidectomia/normas , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Endocrinologia/normas , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Sociedades Médicas/normas , Tireoidectomia/efeitos adversos , Estados Unidos/epidemiologia , Adulto Jovem
2.
Intern Med J ; 49(5): 669-671, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31083806

RESUMO

Over careers spanning 35 years each, we have witnessed great advances in medicine especially in genetics, imaging, immunotherapies and targeted cancer therapies. Our respective specialties of endocrinology and medical oncology have come to overlap significantly necessitating better communication and skills across both specialties. We will highlight common scenarios that straddle endocrinology and medical oncology. The same broad issues apply to other closely related specialties, albeit with different clinical challenges. At present, we see expensive and inefficient cross-referrals to other subspecialists or sometimes no referral at all, leading to significant clinical omissions. Opportunities for dual advanced training, or for more comprehensive single advanced training could more efficiently lead to enhanced patient care and communication.


Assuntos
Certificação , Endocrinologia/educação , Oncologia/educação , Encaminhamento e Consulta , Escolha da Profissão , Certificação/normas , Certificação/tendências , Endocrinologia/normas , Endocrinologia/tendências , Humanos , Oncologia/normas , Oncologia/tendências , Medicina/normas , Medicina/tendências , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/tendências
3.
J Pediatr Endocrinol Metab ; 32(5): 505-511, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31028713

RESUMO

Background A structured transition process for young adults with chronic medical conditions from pediatric to adult clinics is strongly promoted. However, the most appropriate transition model has not yet been determined. This study evaluated the effect of a "combined team" Endocrinology Transition Clinic model, including a joint meeting with the patient and pediatric and adult endocrinologists, regarding medical treatment, adherence to follow-up and patient satisfaction with the process. Methods Clinical and demographic data of patients admitted to the Endocrinology Transition Clinic were collected. The clinical impact of the transition meeting was evaluated based on treatment modifications and patient adherence to follow-up. Patient satisfaction was evaluated using a questionnaire. Results From September 2014 through November 2018, 107 patients attended the Endocrinology Transition Clinic, 85.0% were females, mean age 19.7 ± 2.2 years (range 16-29), 97.2% were unmarried. The most common endocrine disorders were obesity (41.1%), Hashimoto's thyroiditis (41.1%) and ovarian hyperandrogenism (38.3%). The Transition Clinic visit modified treatment and/or evaluation for 48 (44.8%) patients. Adherence to follow-up in the adult clinic was 82.9% and was not associated with gender (p = 0.366), ethnicity (p = 0.725), age at transition (p = 0.479) or obesity (p = 0.375). Overall satisfaction reported by 65/85 patients was high (86.8%), although higher among patients who were adherent to follow-up (89.4% vs. 65.6%, p = 0.006). Conclusions The "combined team" transition model in endocrinology requires relatively few resources and has considerable clinical impact, high adherence to follow-up and high patient satisfaction rate. Implementing this model at the interface of pediatric and adult endocrinology units, and possibly in other medical fields, is feasible and efficient.


Assuntos
Instituições de Assistência Ambulatorial/normas , Doenças do Sistema Endócrino/terapia , Endocrinologia/normas , Cooperação do Paciente/estatística & dados numéricos , Satisfação do Paciente , Transição para Assistência do Adulto/normas , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Cooperação do Paciente/psicologia , Prognóstico , Inquéritos e Questionários , Adulto Jovem
4.
J Endocrinol Invest ; 42(10): 1149-1164, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30980341

RESUMO

BACKGROUND: Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm, and humerus. Over recent decades, it has evolved from being viewed as an inevitable consequence of ageing, to being recognised as a serious and eminently treatable disease. MATERIALS AND METHODS: In this article, we review the literature pertaining to the epidemiology of osteoporosis, associated health burden, approaches to risk assessment and treatment. RESULTS: Although there is some evidence that fracture incidence has reached a plateau, or even started to decline, in the developed world, an ageing population and adoption of westernised lifestyles in transitioning populations is leading to an increasing burden of osteoporosis across the world. Whilst the clinical definition of osteoporosis has been based solely on bone mineral density, the prediction of fracture at the individual level has been improved by consideration of clinical risk factors in tools such as FRAX®, derived from a greater understanding of the epidemiology of osteoporosis. Such advances in approaches to primary and secondary prevention of fractures, coupled with elucidation of the underlying biology, and the development of a range of highly effective antiosteoporosis medications, have enabled a step change in our ability to prevent osteoporosis-related fractures. However, there remains a substantial disparity between the number of individuals at high fracture risk and number treated globally. CONCLUSION: Urgent work is needed at the level of health care systems, national and international policy, and in communication with patients and public, to ensure that all patients who should receive treatment for osteoporosis actually do so.


Assuntos
Endocrinologia/normas , Osteoporose/diagnóstico , Osteoporose/terapia , Densidade Óssea , Endocrinologia/tendências , Humanos , Osteoporose/complicações , Osteoporose/epidemiologia , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Medição de Risco , Fatores de Risco
5.
Cardiovasc Diabetol ; 18(1): 30, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-30857522

RESUMO

The 4th Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD Study Group was held in Munich on 25-26 October 2018. As in previous years, this summit served as a reference meeting for in-depth discussions on the topic of recently completed and presented CVOTs. This year, focus was placed on the CVOTs CARMELINA, DECLARE-TIMI 58 and Harmony Outcomes. Trial implications for diabetes management and the impact of the new ADA/EASD consensus statement treatment algorithm were highlighted for diabetologists, cardiologists, endocrinologists, nephrologists and general practitioners. Discussions evolved from CVOTs to additional therapy options for heart failure (ARNI), knowledge gained for adjunct therapy of type 1 diabetes and, on the occasion of the 10 year anniversary of the FDA's "Guidance for Industry: "should CVOTs be continued and/or modified?" The 5th Cardiovascular Outcome Trial Summit will be held in Munich on 24-25 October 2019 ( http://www.cvot.org ).


Assuntos
Pesquisa Biomédica/métodos , Cardiologia/métodos , Doenças Cardiovasculares/terapia , Ensaios Clínicos como Assunto/métodos , Diabetes Mellitus/tratamento farmacológico , Endocrinologia/métodos , Hipoglicemiantes/uso terapêutico , Pesquisa Biomédica/normas , Cardiologia/normas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Ensaios Clínicos como Assunto/normas , Comportamento Cooperativo , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Endocrinologia/normas , Humanos , Hipoglicemiantes/efeitos adversos , Comunicação Interdisciplinar , Guias de Prática Clínica como Assunto , Resultado do Tratamento
8.
Endocr Rev ; 40(1): 97-117, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30307546

RESUMO

Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair. Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population.


Assuntos
Endocrinologia , Disforia de Gênero/tratamento farmacológico , Hormônios Esteroides Gonadais , Procedimentos de Readequação Sexual , Pessoas Transgênero , Transexualismo/tratamento farmacológico , Adolescente , Adulto , Endocrinologia/métodos , Endocrinologia/normas , Feminino , Hormônios Esteroides Gonadais/administração & dosagem , Hormônios Esteroides Gonadais/efeitos adversos , Hormônios Esteroides Gonadais/antagonistas & inibidores , Humanos , Masculino , Procedimentos de Readequação Sexual/efeitos adversos , Procedimentos de Readequação Sexual/métodos , Procedimentos de Readequação Sexual/normas
9.
Thyroid ; 29(2): 278-289, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30444186

RESUMO

BACKGROUND: The reported prevalence of thyroid disease in pregnancy varies widely through the published literature. These discrepancies are due to differences in criteria for euthyroidism, nationality, iodine status, and gestational age at screening. As a result, currently, an accepted rate of prevalence does not exist for the various thyroid diseases in pregnancy. Understanding the true prevalence rates of these disorders has important implications for clinical management and the ongoing discussion regarding universal screening. The aims of this study were to assess (i) the true prevalence of thyroid disorders in pregnancy and (ii) the impact of diagnostic methodology on these rates. METHODS: A systematic review was conducted of the existing literature, including the Pubmed database and references from relevant review articles. Sixty-three studies reporting prevalence of overt hypothyroidism, subclinical hypothyroidism, isolated hypothyroxinemia, subclinical hyperthyroidism, and overt hyperthyroidism in pregnant women were included. Studies were further classified by thyrotropin (TSH) cutoff for diagnosis in hypothyroid disease and timing of screening for hyperthyroid disease. Meta-analysis yielded pooled prevalence rates, with subgroup analyses for TSH cutoff and timing of screening. Analysis of studies using the 97.5th percentile TSH cutoff was assessed to yield the most accurate prevalence rates for hypothyroidism. RESULTS: Pooled prevalence rates for hypothyroidism calculated from studies using the 97.5th percentile as an upper limit for TSH were 0.50% for overt hypothyroidism, 3.47% for subclinical hypothyroidism, and 2.05% for isolated hypothyroxinemia. Pooled prevalence rates in the first and second trimesters for hyperthyroidism were 0.91% and 0.65%, respectively, for overt hyperthyroidism and 2.18% and 0.98%, respectively, for subclinical hyperthyroidism. CONCLUSION: Population-based, trimester-specific TSH cutoffs for diagnosis of hypothyroid disease in pregnancy result in more accurate diagnosis and better estimates for prevalence of disease. Prevalence of hyperthyroidism in pregnancy varies depending on timing of screening. The prevalence rates reported in this study represent the best estimate to date of the true rates of thyroid disease in pregnancy.


Assuntos
Endocrinologia/normas , Complicações na Gravidez/diagnóstico , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/epidemiologia , Feminino , Humanos , Hipertireoidismo/sangue , Hipertireoidismo/complicações , Hipertireoidismo/diagnóstico , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Gravidez , Prevalência , Doenças da Glândula Tireoide/complicações , Testes de Função Tireóidea , Tireotropina/sangue , Tiroxina/sangue
13.
J Clin Endocrinol Metab ; 103(11): 4324-4331, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30289543

RESUMO

Context: Adrenoleukodystrophy (ALD) is a peroxisomal disorder associated with neurologic decompensation and adrenal insufficiency. Newborn screening for ALD has recently been implemented in five states with plans to expand to all 50 states in the United States. Adrenal insufficiency ultimately develops in most males with ALD, but the earliest age of onset is not well established. Objective: These clinical recommendations are intended to address screening for adrenal insufficiency in boys identified to have ALD by newborn screen. Participants: Seven members of the Pediatric Endocrine Society Drug and Therapeutics/Rare Diseases Committee, with clinical experience treating children with ALD and adrenal insufficiency, and a pediatric endocrinologist and laboratory director were selected to be on the working committee. Consensus Process: The authors comprised the working group and performed systematic reviews of the published literature regarding adrenal insufficiency and ALD. The recommendations were reviewed and approved by the larger Pediatric Endocrine Society Drug and Therapeutics/Rare Diseases Committee and then by the Pediatric Endocrine Society Board of Directors. Conclusions: There is limited literature evidence regarding monitoring of evolving adrenal insufficiency in male infants and children with ALD. The recommendations suggest initiating assessment of adrenal function at diagnosis with ALD and regular monitoring to identify boys with adrenal insufficiency in a timely manner and prevent life-threatening adrenal crisis. These recommendations are intended to serve as an initial guide, with the understanding that additional experience will inform future guidelines.


Assuntos
Insuficiência Adrenal/diagnóstico , Adrenoleucodistrofia/complicações , Endocrinologia/normas , Sociedades Médicas/normas , Insuficiência Adrenal/sangue , Insuficiência Adrenal/etiologia , Insuficiência Adrenal/prevenção & controle , Hormônio Adrenocorticotrópico/sangue , Adrenoleucodistrofia/sangue , Adrenoleucodistrofia/diagnóstico , Aldosterona/sangue , Técnicas de Diagnóstico Endócrino/normas , Endocrinologia/métodos , Humanos , Hidrocortisona/sangue , Recém-Nascido , Masculino , Triagem Neonatal , América do Norte , Valores de Referência
14.
J Clin Endocrinol Metab ; 103(12): 4333-4338, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30346542

RESUMO

Context: There has been a proliferation of clinical practice guidelines in endocrinology and a coincident increased interest in transparency regarding relationships between physicians and industry. Evidence Acquisition: We collected self-reported disclosures and Open Payments data for 169 authors of 26 clinical practice guidelines published between 2010 and 2017 by the Endocrine Society. Conflicts of interest in which pharmaceutical and device companies manufactured drugs or products pertinent to an author's specific clinical practice guideline(s) were deemed relevant. Open Payments data were grouped into research and nonresearch (consultancies, honoraria, travel, food) categories. Evidence Synthesis: We compared the policies of the Endocrine Society regarding seven conflict of interest recommendations issued by the National Academy of Medicine in 2011. Conclusion: Relevant nonresearch financial conflicts of interest were self-reported by 42% of authors of clinical practice guidelines. Open Payments were recorded for 74% (84 of 113) of US authors between 2013 and 2016. Payments to 84 US authors totaled $5.5 million for nonresearch activities and $30.9 million for research. The nonresearch payments were divided into consulting (46%), honoraria (26%), travel (25%), and food (3%). The Endocrine Society partially follows the National Academy of Medicine recommendations to limit conflicts of interest. Readers should be aware of how clinical practice guidelines are developed and the policies of the organizations and journals that publish them. Professional societies and journal editors should strive to ensure that their policies and practices promote objective and unbiased clinical practice guidelines.


Assuntos
Conflito de Interesses/economia , Endocrinologistas/ética , Políticas , Guias de Prática Clínica como Assunto , /normas , Revelação/ética , Revelação/estatística & dados numéricos , Endocrinologistas/economia , Endocrinologia/ética , Endocrinologia/normas , Humanos , Autorrelato/estatística & dados numéricos , Sociedades Médicas/ética , Sociedades Médicas/normas , Estados Unidos
17.
Presse Med ; 47(9): 769-774, 2018 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30274915

RESUMO

Total cardiovascular risk estimation using a system such as SCORE is recommended for adults>40years of age without evidence of cardiovascular disease, diabetes, chronic kidney disease, severe hypertension or familial hypercholesterolemia. Before treatment, a full lipid profile is recommended, fasting in French guidelines, fasting or non-fasting in European guidelines. LDL-C has to be used as the primary target for treatment. For patients with elevated triglycerides, non-HDL-C level is also recommended as the secondary goal for treatment. In patients at very high and high cardiovascular risk, LDL-C goals are respectively below<0.70g/L and<1.0g/L. For subjects at very high and high cardiovascular risk, French guidelines do not mention that a≥50% reduction in LDL-C should be achieved. Statins are the treatment of choice to reach LDL-C goals. If the goal is not reached on maximally tolerated dose of statin, combination with another LDL lowering drug, mainly ezetimibe, is recommended. Fibrates are mainly proposed for patients with severe hypertriglyceridemia (TG>5g/L after lifestyle changes).


Assuntos
Dislipidemias/terapia , Endocrinologia/normas , Guias de Prática Clínica como Assunto , Anticolesterolemiantes/uso terapêutico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Dislipidemias/epidemiologia , Europa (Continente)/epidemiologia , França/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Guias de Prática Clínica como Assunto/normas , Fatores de Risco
18.
Presse Med ; 47(9): 746-756, 2018 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30274916

RESUMO

Amiodarone, a benzofuranic iodine-rich pan antiarrhythmic drug, is frequently associated with thyroid dysfunction. This side effect is heterogeneous and unpredicted, motivating regular evaluation of thyroid function tests. In contrary to hypothyroidism, amiodarone-induced thyrotoxicosis (AIT) is a challenging situation owing to the risk of deterioration of the general and cardiac status of such debilitating patients. Classically, AIT is either an iodine-induced thyrotoxicosis in patients with an abnormal thyroid (type I), or due to a subacute thyroiditis on a "healthy" thyroid (type II). Even if many studies tried to better identify the types of AIT, the diagnostic dilemma of type of AIT could be present, and many patients are treated by an association of antithyroid drugs (useful for type I AIT) with corticoids (useful for type II AIT). Being the main etiological factor in AIT, amiodarone is supposed to be stopped, but it could remain the only anti-arrhythmic option that is needed to be either continued or reintroduced to improve the cardiovascular survival. Recently, many studies demonstrated that amiodarone could be continued or reintroduced in patients with history of type II AIT. Nevertheless, in the other patients, amiodarone maintenance complicates the therapeutic response to the antithyroid drugs and increases the risk of AIT recurrence. Thus, amiodarone therapy is preferred to be interrupted. In such patients, thyroid ablation is recommended once AIT is under control.


Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Tireotoxicose/induzido quimicamente , Tireotoxicose/terapia , Endocrinologia/métodos , Endocrinologia/normas , Humanos , Testes de Função Tireóidea , Tireoidectomia/estatística & dados numéricos
19.
J Clin Endocrinol Metab ; 103(11): 4043-4088, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30272171

RESUMO

Objective: To update the congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency clinical practice guideline published by the Endocrine Society in 2010. Conclusions: The writing committee presents updated best practice guidelines for the clinical management of congenital adrenal hyperplasia based on published evidence and expert opinion with added considerations for patient safety, quality of life, cost, and utilization.


Assuntos
Hiperplasia Suprarrenal Congênita/terapia , Endocrinologia/normas , Sociedades Médicas/normas , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/economia , Hiperplasia Suprarrenal Congênita/genética , Análise Custo-Benefício , Feminino , Terapias Fetais/economia , Terapias Fetais/métodos , Terapias Fetais/normas , Aconselhamento Genético/economia , Aconselhamento Genético/métodos , Aconselhamento Genético/normas , Glucocorticoides/uso terapêutico , Humanos , Recém-Nascido , Assistência de Longa Duração/economia , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Triagem Neonatal/economia , Triagem Neonatal/normas , Segurança do Paciente/normas , Qualidade de Vida , Terapias em Estudo/economia , Terapias em Estudo/métodos , Terapias em Estudo/normas
20.
J Clin Endocrinol Metab ; 103(11): 4097-4103, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30272185

RESUMO

Background: Individuals with congenital adrenal hyperplasia (CAH) require glucocorticoid therapy to replace cortisol and to control androgen excess. We sought to evaluate the effects of glucocorticoid therapy on cardiovascular and metabolic outcomes in individuals with CAH. Methods: We searched bibliographical databases through January 2016 for studies evaluating cardiovascular risk factors in individuals with CAH treated with glucocorticoids compared with controls without CAH. We used a random-effects model to synthesize quantitative data. Results: We included 20 observational studies (14 longitudinal, six cross-sectional) with a moderate to high risk of bias. The average dose of glucocorticoids (in hydrocortisone equivalents) was 9 to 26.5 mg/m2/d. In the meta-analysis (416 patients), compared with controls without CAH, individuals with CAH had increased systolic blood pressure [weighted mean difference (WMD), 4.44 mm Hg; 95% CI, 3.26 to 5.63 mm Hg], diastolic blood pressure (WMD, 2.35 mm Hg; 95% CI, 0.49 to 4.20 mm Hg), homeostatic model assessment of insulin resistance (WMD, 0.49; 95% CI, 0.02 to 0.96), and carotid intima thickness (WMD, 0.08 mm; 95% CI, 0.01 to 0.15 mm). No statistically significant differences were noted in fasting blood glucose, insulin level, glucose, or insulin level after 2-hour glucose load or serum lipids. Data on cardiac events were sparse, and most of the literature focused on surrogate outcomes. Conclusion: Individuals with CAH demonstrate a high prevalence of cardiovascular and metabolic risk factors. The current evidence relies on surrogate outcomes. Long-term prospective studies are warranted to assess strategies for reducing cardiovascular risk in individuals with CAH.


Assuntos
Hiperplasia Suprarrenal Congênita/complicações , Doenças Cardiovasculares/diagnóstico , Sistema Cardiovascular/efeitos dos fármacos , Glucocorticoides/efeitos adversos , Síndrome Metabólica/diagnóstico , Hiperplasia Suprarrenal Congênita/tratamento farmacológico , Hiperplasia Suprarrenal Congênita/metabolismo , Hiperplasia Suprarrenal Congênita/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Espessura Intima-Media Carotídea , Endocrinologia/métodos , Endocrinologia/normas , Humanos , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Síndrome Metabólica/fisiopatologia , Guias de Prática Clínica como Assunto , Prevalência , Fatores de Risco
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