Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

A importância da prática de alimentação, higiene bucal e fatores sócio-econômicos na prevalência da cárie precoce da infância em pré-escolares de Itatiba-SP / The importance of feeding practices, oral hygiene and socioeconomic factors in the early childhood caries prevalence in preschool children from Itatiba-SP

Objetivo: Verificar se a dieta, incluindo hábitos de aleitamento, a higiene bucal e os fatores sócio-econômicos podem ser considerados indicadores de risco para a cárie precoce da infância (CPI) em pré-escolares de Itatiba-SP. Material e método: A amostra foi constituída por 288 crianças, de 3 a 4 anos, que freqüentavam pré-escolas públicas do município de Itatiba-SP. Uma cirurgiã-dentista calibrada (Kappa=0,78) realizou exame físico para a determinação da presença de biofilme dentário e do índice de cárie. Para a avaliação da dieta foi empregado um diário alimentar, enquanto hábitos de aleitamento, higiene bucal, etnia, renda familiar e escolaridade materna foram avaliados por um questionário. Os dados foram analisados pelo teste qui-quadrado/exato de Fisher, seguido de regressão logística múltipla (alfa=0,05) expressa por razão de chances (odds ratio -OR). Resultados: A ingestão de açúcar na forma sólida 3 ou mais vezes ao dia (OR=4,5), a amamentação não exclusiva no peito por 12 meses ou mais (OR=2,0), a presença de biofilme dentário nos incisivos superiores (OR=3,1) e o fato de levar lanche para consumir na escola (OR=2,1), além da merenda, apresentaram associação significativa com a CPI (<0,05). Já os fatores etnia, escolaridade, renda familiar e freqüência de higiene bucal não se mostraram estatisticamente significativos (p>0,05). Conclusão: Os resultados sugerem que a exposição frequente aos açúcares na forma sólida, a presença de biofilme dentário e o fato de levar lanche para escola, principalmente os cariogênicos, são indicadores de risco expressivos para a cárie precoce da infância na população estudada.

Purpose: This study aimed to verify if the cariogenic diet, including nursing habits, the oral hygiene and the socioeconomic factors could be considered risk indicators for early childhood caries (ECC) in preschool children from Itatiba-SP. Methods: The sample was composed of 288 children, 3 to 4 years old, who attended public preschools from Itatiba-SP. Clinical examinations were conducted by one calibrated dentist (Kappa=0.78) for biofilm presence and caries index determination. For the diet evaluation, a diet chart was used, whereas the nursing habits, oral hygiene, ethnicity, family income and mothers´ level of education were evaluated by a questionnaire. Data were analyzed by chi-square/fisher´s exact test and multiple logistic regression (alfa=0.05) expressed by odds ratios (OR). Results: Sugar consumption in the solid form three or more times a day (OR=4.5), non-exclusive breast-feeding for 12 months or more (OR=2.0), presence of biofilm on the maxillary incisors (OR=3.1) and intake of snacks or drinks at school (OR=2.1), in addition to school meals were significantly associated with ECC (p<0.05). Besides, the factors ethnicity, level of education, family income and oral hygiene frequency did not show statistical significance (p>0.05). Conclusion: The results suggest that frequent exposure to solid sugar, biofilm presence and snacks as complement to school meals, particularly the cariogenic ones, are expressive risk indicators for early childhood caries in the population studied.