Doenças associadas à resistência à insulina/hiperinsulinemia, não incluídas na síndrome metabólica / Insulin resistance/hyperinsulinemia associated diseases not included in the metabolic syndrome

Nos últimos anos, no Brasil e em países do mundo desenvolvido, a obesidade se tornou um problema de saúde pública mais importante que a desnutrição. Com o aumento de prevalência de obesidade, identificou-se que, além do DM2 e da síndrome metabólica, outras entidades clínicas também estavam associadas à resistência à insulina. Nesta revisão, abordaremos algumas destas alterações, com destaque para a doença hepática gordurosa não alcoólica, mas incluindo também a SOP, a hiperuricemia, a doença renal crônica, a insuficiência cardíaca, alterações cognitivas e câncer.

In the past years, in Brazil and in developed countries, obesity has become a major public health problem. It was identified that besides DM2 and metabolic syndrome other clinical entities were associated with insulin resistance. In this review we describe some of these alterations emphasizing nonalcoholic fatty liver disease, but also including polycistic ovary disease, hyperuricemia, chronic renal failure, heart failure, cognitive decline and cancer.

Late-life depression, heart failure and frontal white matter hyperintensity: a structural magnetic resonance imaging study

The relevance of the relationship between cardiac disease and depressive symptoms is well established. White matter hyperintensity, a bright signal area in the brain on T2-weighted magnetic resonance imaging scans, has been separately associated with cardiovascular risk factors, cardiac disease and late-life depression. However, no study has directly investigated the association between heart failure, major depressive symptoms and the presence of hyperintensities. Using a visual assessment scale, we have investigated the frequency and severity of white matter hyperintensities identified by magnetic resonance imaging in eight patients with late-life depression and heart failure, ten patients with heart failure without depression, and fourteen healthy elderly volunteers. Since the frontal lobe has been the proposed site for the preferential location of white matter hyperintensities in patients with late-life depression, we focused our investigation specifically on this brain region. Although there were no significant group differences in white matter hyperintensities in the frontal region, a significant direct correlation emerged between the severity of frontal periventricular white matter hyperintensity and scores on the Hamilton scale for depression in the group with heart failure and depression (P = 0.016, controlled for the confounding influence of age). There were no significant findings in any other areas of the brain. This pattern of results adds support to a relationship between cardiovascular risk factors and depressive symptoms, and provides preliminary evidence that the presence of white matter hyperintensities specifically in frontal regions may contribute to the severity of depressive symptoms in cardiac disease.

Falla hepatica fulminante: forma atipica de presentacion de insuficiencia cardiaca / Fulminant hepatic failure: atypical form of cardiac failure presentation

La insuficiencia cardíaca puede presentar como manifestación clínica la enfermedad hepática congestiva. En el shock cardiogénico puede aparecer falla hepática aguda por isquemia hepática. Presentamos una paciente que con antecedentes de insuficiencia cardíaca crónica ingresa a nuestro servicio por presentar mal estado general asociado a deterioro progresivo del hepatograma, del tiempo de protrombina y de la función renal. Las serologías virales y los autoanticuerpos fueron negativos. No tenía antecedentes de contacto con hepatotóxicos. En su evolución presentó encefalopatía sin evidencias iniciales de shock. Al cuarto día de internación presenta shock cardiogénico, con manifestaciones del laboratorio compatibles con isquemia y congestión hepáticas. La paciente fallece 24 horas después. La histología demostró cambios compatibles con isquemia hepática. Se han descripto varios casos de hepatopatías crónicas sin causa evidente que resultaron ser manifestaciones secundarias a enfermedades cardiológicas, especialmente pericarditis constrictiva o miocarditis restrictivas. En este caso la paciente presentó falla hepática aguda sin evidencia inicial de mayor deterioro de su cardiopatía previa. Con este caso queremos destacar la importancia de las causas cardiológicas como probables etiologías de hepatopatías sin causa aparente.