ABSTRACT
La infección por SARS-CoV-2 podría gatillar la ocurrencia de numerosas patologías, algunas de ellas de tipo endocrinológico. Se presenta una revisión narrativa sobre la asociación entre COVID-19 y tiroiditis subaguda, en la que se describen aspectos epidemiológicos, fisiopatológicos, manifestaciones clínicas y de laboratorio, tratamiento y pronóstico. La prevalencia de alguna disfunción tiroidea en pacientes COVID-19 fluctúa entre 13 y 64%, específicamente en relación con tiroiditis subaguda se describe un cambio en la prevalencia de 0,5% a 10% entre los años 2019 y 2020. La tiroiditis subaguda se produce por la unión del virus SARS-CoV-2 con la enzima convertidora de angiotensina 2 (ACE-2) ampliamente expresada en la glándula tiroides, generando manifestaciones clínicas tipo tirotoxicosis, aunque la presentación de la tiroiditis subaguda asociada a COVID-19 puede ser atípica. Los elementos centrales del tratamiento son similares a los empleados ante cualquier tiroiditis subaguda. Se concluye la necesidad de considerar esta entidad en el diagnóstico diferencial de pacientes actual o previamente infectados por SARS-CoV-2 que presenten síndrome febril, elevación de parámetros inflamatorios o taquicardia persistente, sin etiología precisada.
SARS-CoV-2 infection can trigger the occurrence of numerous pathologies, some of them endocrinological. The present narrative review works on the association between COVID-19 and subacute thyroiditis, which describes epidemiological and pathophysiological aspects, clinical and laboratory manifestations, treatment, and prognosis. The prevalence of thyroid dysfunction in COVID-19 patients fluctuates between 13 and 64%, explicitly concerning subacute thyroiditis; it has been described as a change in prevalence from 0.5% to 10% between 2019 and 2020. The binding of the SARS-CoV-2 virus with the angiotensin-converting enzyme 2 receptor (ACE-2) widely expressed in the thyroid gland causes subacute thyroiditis, generating thyrotoxicosis-like clinical manifestations. However, the presentation of subacute thyroiditis associated with COVID-19 may be atypical. The central elements of the treatment are similar to those used in any subacute thyroiditis. We conclude that this entity must be considered in differential diagnoses of patients currently or previously infected with SARS-CoV-2 that present a febrile syndrome, elevated inflammatory parameters, or persistent tachycardia without a specified aetiology.
ABSTRACT
Neuroendocrine Tumors (NETs) encompass a wide variety of tumors arising from neuroendocrine cells, which produce bioactive substances. The incidence of NETs increased significantly lately, becoming one of the most common tumors of the digestive tract. Their clinical presentation is as diverse as their capacity for hormone production. Carcinoid syndrome is the most common hormonal syndrome produced by NETs and is characterized by diarrhea, flushing and cardiac valvular lesions. New research brought multiple changes in the classification of these neoplasms and a new understanding about their diagnosis and treatment, promoting a multidisciplinary approach. Somatostatin analogues, radiation, biological, and cytotoxic drugs have improved the prognosis of these patients, which entails a great challenge for healthcare providers.
Subject(s)
Humans , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/therapy , Antineoplastic Agents/therapeutic use , Somatostatin/therapeutic use , DiarrheaABSTRACT
ABSTRACT Objective We aimed to describe the presentation of papillary microcarcinoma (PTMC) and identify the clinical and histological features associated with persistence/recurrence in a Latin American cohort. Subjects and methods Retrospective study of PTMC patients who underwent total thyroidectomy, with or without radioactive iodine (RAI), and who were followed for at least 2 years. Risk of recurrence was estimated with ATA 2009 and 2015 classifications, and risk of mortality with 7th and 8th AJCC/TNM systems. Clinical data obtained during follow-up were used to detect structural and biochemical persistence/recurrence. Results We included 209 patients, predominantly female (90%), 44.5 ± 12.6 years old, 183 (88%) received RAI (90.4 ± 44.2 mCi), followed-up for a median of 4.4 years (range 2.0-7.8). The 7th and 8th AJCC/TNM system classified 89% and 95.2% of the patients as stage I, respectively. ATA 2009 and ATA 2015 classified 70.8% and 78.5% of the patients as low risk, respectively. Fifteen (7%) patients had persistence/recurrence during follow-up. In multivariate analysis, only lymph node metastasis was associated with persistence/recurrence (coefficient beta 4.0, p = 0.016; 95% CI 1.3-12.9). There were no PTMC related deaths. Conclusions Our series found no mortality and low rate of persistence/recurrence associated with PTMC. Lymph node metastasis was the only feature associated with recurrence in multivariate analysis. The updated ATA 2015 and 8th AJCC/TNM systems classified more PTMCs than previous classifications as low risk of recurrence and mortality, respectively.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thyroid Neoplasms/surgery , Carcinoma, Papillary/surgery , Neoplasm Recurrence, Local , Prognosis , Thyroidectomy , Thyroid Neoplasms/radiotherapy , Carcinoma, Papillary/radiotherapy , Retrospective Studies , Risk Factors , Cohort Studies , Combined Modality TherapyABSTRACT
Recientemente se ha descubierto el gen de una nueva enzima convertidora de angiotensina I- homóloga a ECA y denominada ECA-2 que finalmente lleva a producir angiotensina 1-7. Esta segunda vía del sistema reninaangiotensina (SRA), con la ECA-2 tendría acciones opuestas a la ECA. Objetivo y Métodos: Determinar la actividad y expresión de la ECA2 en el tratamiento de la hipertrofia y fibrosis ventricular izquierda tardía post IAM en la rata. Se usaron ratas Sprague Dawley 200 +/- 10 g sometidas a ligadura de la coronaria izquierda. Como controles se usaron ratas sham (S). 48 hrs. post cirugía, un grupo de ratas IAM recibió enalapril (IAM-ENA; 10 mg/kg, gavage). A las 8 semanas post-operatorias se determinó la presión arterial sistólica (PAS), masa corporal(MC), masa cardíaca relativa (MCR, mg VI/100 g MC, expresión proteica de la cadena pesada de la miosina beta(betaMHC) por Western blot, mRNA por RT-PCR, las actividades enzimáticas de ECA y de ECA-2 por fluorimetría tanto circulante como en ventrículo izquierdo (VI), el contenido de colágeno total por rojo picrosirio y la actividad de metaloproteasa 2 (MMP-2) por zimografía. Conclusión: El aumento de la actividad y expresión de la ECA2 (a nivel circulante y tisular cardíaco) se asocia a menor fibrosis e hipertrofia ventricular izquierda, lo que podría aumentar en ese periodo - el efecto cardioprotector de Ang-(1-7).
Background. Recently the gene of a new angiotensin-1 converting homologous enzyme (ACE-2) which leads to the production of angiotensin 1-7 (Ang (1-7) has been reported. This new pathway of the renin-angiotensin system(RAS) is supposed to have opposite effects to those of ACE. Aim: To determine the activity and expression of ACE-2 in the development of left ventricular hypertrophy and fibrosis late after induced myocardial infarction (AMI) in rats. Methods: 200 +/- 10g Sprague-Dawley rats were submitted to left coronary artery ligation. Sham operated rats were used as controls. 48 hr after surgery, one group of AMI rats received enalapril (AMI-En), 10mg/Kg. 8 weeks after surgery the systolic blood pressure (SBP), body mass (BM) and relative cardiac mass (RCM, mg/100g BM) were measured. The protein expression of heavy weight chain beta myosin (beta HCM) was determined by Western Blot, mRNA through RT-PCR, circulating and left ventricular ACE and ACE-2 activities through fluorometry, total collagen content by the pycrosirius red method and metaloproteinase-2 (MMP-2) through zymography were determined. Conclusion: The increased activity and expression of ACE-2 both in plasma and the LV is associated to less fibrosis and left ventricular hypertrophy after AMI. This could temporarily boost the cardioproctive effect of Ang (1-7).