ABSTRACT
La aparición de nódulos tiroideos en las personas con acromegalia es una consecuencia de la elevación crónica de la hormona de crecimiento y el factor de crecimiento similar a la insulina tipo 1. Su naturaleza varía según la zona geográfica, suficiencia de yodo y antecedentes patológicos familiares, entre otros factores. No se han publicado estudios cubanos sobre la enfermedad nodular tiroidea en estas personas. Objetivos: Describir las características clínicas, bioquímicas y ultrasonográficas de la glándula tiroidea, según la presencia o no de la enfermedad nodular tiroidea. Métodos: Estudio observacional descriptivo, transversal, que incluyó 73 pacientes con acromegalia entre enero de 2003 y diciembre de 2017. Se estudiaron las variables: edad, sexo, color de la piel, antecedentes familiares de la enfermedad nodular tiroidea, niveles de la hormona de crecimiento, hormona estimulante del tiroides, T4 libre, anticuerpos contra la peroxidasa tiroidea y contra la tiroglobulina, volumen tiroideo, patrón ecográfico nodular y estudio citológico. Resultados: La enfermedad nodular tiroidea se presentó en el 75,3 por ciento de los casos, con predominio del bocio multinodular. La edad al diagnóstico fue menor en los pacientes con la enfermedad (43,53 ± 9,67), que en los que no la tenían (49,33 ± 6,96 años) (p = 0,02). La hormona de crecimiento al diagnóstico de acromegalia, resultó menor en los pacientes con este padecimiento (18,73 ± 11,33 µg/L vs. 35,91 ± 21,68 µg/L; (p = 0,00). El volumen tiroideo mostró diferencias significativas entre ambos grupos (14,2 ± 4,5 mL en los casos positivos de la enfermedad nodular tiroidea y 10,5 ± 2,8 mL en los casos negativos; p = 0,002), siendo el nódulo de baja sospecha de malignidad el más frecuente. El resto de las variables resultaron similares entre los pacientes con y sin la enfermedad. La citología se informó como benigna en el 75 por ciento en los nódulos únicos, el 80 por ciento de los bocios nodulares y el 90 por ciento de los bocios multinodulares (p = 0,51). Conclusiones: La enfermedad nodular tiroidea fue frecuente en los casos de acromegalia, y se asoció a la menor edad y los niveles inferiores de la hormona de crecimiento al diagnóstico. El bocio multinodular constituyó la forma clínica más frecuente y los parámetros hormonales y de autoinmunidad no se asociaron al tipo de la enfermedad nodular tiroidea(AU)
The appearance of thyroid nodules in people with acromegaly is a consequence of chronic elevation of growth hormone (GH) and insulin-like growth factor type 1 (IGF-1). Its nature varies according to the geographical area, the iodine sufficiency and family pathological history, among other factors. No Cuban studies on thyroid nodular disease (TND) in these people have been published. Objectives: Describe some clinical characteristics, as well as biochemical and ultrasonographic ones related to the thyroid gland, according to the presence or not of TND, and to identify the possible association of clinical, biochemical, ultrasonographic and cytological factors with the different types of TND in patients with acromegaly. Methods: A descriptive, cross-sectional observational study that included 73 patients with acromegaly between January 2003 and December 2017. The following variables were studied: age, sex, skin color, family history of TND, GH levels, thyroid stimulating hormone, free T4, antibodies against thyroid peroxidase and thyroglobulin, thyroid volume, nodular ultrasound pattern and cytological study. Results: TND occurred in 75.3 percent of cases, with a predominance of multinodular goiter. The age at diagnosis time was lower in patients with TND (43.53 ± 9.67) than in those who did not have it (49.33 ± 6.96 years) (p=0.02). GH at diagnosis time of acromegaly was lower in patients with TND (18.73±11.33µg/L vs 35.91±21.68µg/L; (p=0.00). The thyroid volume showed significant differences between both groups (14.2±4.5mL in positive cases of TND and 10.5±2.8mL in negative cases; p=0.002), being the most frequent the nodule with low suspicion of malignancy. The rest of the variables were similar between patients with and without TNDs. Cytology was reported as benign in 75 percent in single nodules, 80 percent of nodular goiters and 90 percent of multinodular goiters (p=0.51). Conclusions: TND was frequent in cases of acromegaly, and was associated with lower age and lower GH levels at diagnosis time. Multinodular goiter was the most frequent clinical form and hormonal and autoimmunity parameters were not associated with the type of TND(AU)
Subject(s)
Humans , Acromegaly/diagnosis , Insulin-Like Growth Factor I/adverse effects , Thyroid Nodule/diagnostic imaging , Human Growth Hormone , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as TopicABSTRACT
RESUMEN Objetivo El objetivo de esta guía es formular pautas para el diagnóstico de acromegalia adecuadas a los parámetros internacionales y a los recursos disponibles en Argentina. Participantes El grupo de trabajo propuesto por la Federación Argentina de Sociedades de Endocrinología (FASEN) incluyó un equipo multidisciplinario compuesto por 5 médicos endocrinólogos (4 especialistas y una profesional joven), un neurocirujano y una bioquímica, expertos en el tema. Evidencia Esta guía basada en la evidencia se desarrolló utilizando la metodología AGREE para describir tanto las recomendaciones como la calidad de las pruebas. Los borradores de esta guía fueron revisados por un grupo multidisciplinario de especialistas reconocidos en acromegalia. Conclusiones Utilizando un enfoque basado en la evidencia, esta guía aborda la evaluación diagnóstica de la acromegalia en Argentina.
ABSTRACT Objective The aim is to formulate guidelines for the clinical, biochemical and imaging diagnosis of acromegaly in accordance with international criteria and resources available in Argentina. Participants The task force selected by FASEN included a multidisciplinary team of 5 endocrinologists (4 senior and 1 junior), a neurosurgeon and a biochemist, experts in the field. Evidence This evidence-based guidelines were developed using the AGREE methodology to describe both the recommendations and the quality of evidence. The draft of these guidelines was reviewed by endocrinologists, biochemists and neurosurgeons experts in the field. Conclusions Using an approach based on evidence, these guidelines address the diagnosis of acromegaly in Argentina.
Subject(s)
Acromegaly/diagnosis , Acromegaly/blood , Acromegaly/diagnostic imaging , Insulin-Like Growth Factor I/adverse effects , Clinical Diagnosis , Human Growth Hormone/adverse effectsABSTRACT
The study aimed to quantify the concentrations of free IGF-I in serum and fluid of ovarian follicles in pre-pubertal gilts and describe the ovarian morphology by measuring the size of the ovaries and counting the number of surface follicles. Ovaries (n=1,000) from pre-pubertal gilts were obtained immediately after slaughter. A total of 10 samplings were performed, with ovaries obtained from 50 females for each collection. The follicles situated on the surface of each ovary were classified as small (SFs, 2 to 5mm in diameter) or large (LFs 6 to 10mm in diameter) and the follicular fluid was obtained by follicle aspiration. The collection of serum samples was performed after the gilts exsanguination using sterile tubes. From the pool of serum and follicular fluid obtained from 50 females, the concentration of free IGF-I was determined in each sample using an enzyme immunoassay kit (ELISA). The description of ovarian morphometry was performed in 100 ovaries from randomly selected gilts. The larger and smaller lengths of ovaries were measured, and the total number of SFs and LFs present on the surface of each ovary were also counted. The IGF-I concentration was greater (P<0.05) in LFs (170.92±88.29 ng/mL) compared with SFs (67.39±49.90ng/mL) and serum (73.48±34.63ng/mL). The largest and smallest length of the ovaries was 26.0±3.0 and 19.0mm ±2.0mm, respectively. The number of SFs (70.86±25.76) was greater (P<0.01) than LFs (6.54±5.26). The study concluded that LFs present greater levels of IGF-I when compared with SFs and blood, which is related to increased activity of the LFs and its differentiation to ovulation. In addition, ovaries of pre-pubertal gilts have a higher number of SFs compared to LFs. Therefore, our study demonstrated unique data regarding the physiological concentration of free IGF-I in ovarian follicles, that can be used in future research to evaluate the addition of this hormone in the in vitro production media of porcine embryos with the...
Objetivou-se quantificar as concentrações do IGF-I livre no soro e no fluido de folículos ovarianos de fêmeas suínas pré-púberes e descrever a morfologia ovariana, por meio da mensuração das dimensões dos ovários e da contagem do número de folículos superficiais. Ovários (n=1.000) foram obtidos de fêmeas pré-púberes imediatamente após o abate. Foi realizado um total de 10 coletas, sendo em cada, obtidos ovários de 50 fêmeas. Os folículos localizados na superfície de cada ovário foram classificados em pequenos (FPs, 2-5mm de diâmetro) ou grandes (FGs, 6-10mm de diâmetro) e o fluido folicular foi obtido por aspiração dos folículos. A coleta do soro foi realizada após a exsanguinação das fêmeas com o uso de tubos estéreis. A partir do pool de fluido folicular e do soro obtido das 50 fêmeas, determinou-se a concentração de IGF-I livre em cada amostra por meio de kit de ensaio imunoenzimático (ELISA). A descrição da morfometria ovariana foi realizada em 100 ovários provenientes de fêmeas escolhidas aleatoriamente. Foi mensurado o comprimento maior e menor dos ovários e, também, contabilizado o número total de FPs e FGs presentes na superfície de cada ovário. A concentração de IGF-I foi superior (P<0,05) nos FGs (170,92±88,29ng/mL) em comparação com os FPs (67,39±49,90ng/mL) e o sérico (73,48±34,63ng/mL). O comprimento maior e menor dos ovários foi de 26,0±3,0mm e 19,0±2,0 mm, respectivamente. O número de FPs (70,86±25,76) foi maior (P<0,01) em comparação com os FGs (6,54±5,26). Conclui-se que FGs apresentam níveis de IGF-I superiores aos FPs, e ao sangue, sendo isso relacionado a maior atividade dos FGs e à diferenciação que os mesmos sofrem para a ovulação. Além disso, ovários de fêmeas suínas pré-púberes apresentam elevado número de FPs em comparação aos FGs. Portanto, nosso estudo demonstrou dados originais a respeito da concentração fisiológica de IGF-I livre em folículos ovarianos, que podem ser utilizados em futuras pesquisas para avaliar a adição de...
Subject(s)
Animals , Female , Insulin-Like Growth Factor I/adverse effects , Ovarian Follicle , Swine/growth & development , Enzyme-Linked Immunosorbent Assay/veterinaryABSTRACT
Growth hormone [GH], insulin-like growth factor-I [IGF-I], IGF-binding protein [GH/IGF/IGFBP] axis has been suggested both to maintain normal renal function and to play an important role in the development of diabetic nephropathy [DN], in patients with type 1 diabetes [T1D]. Nephromegaly [NM] and microalbuminuria [MA] are early markers of DN. Study the role of urinary concentrations of GH and IGF-I in the development of DN, in children and adolescents suffering T1D, A total of 50 children and adolescents with T1D of 6-14 years old were recruited from the Pediatric Diabetes Clinic at King Abdulaziz University Hospital, 23 were males and 27 were females. Subjects were divided into two groups; 20 with early-onset diabetes and 30 with long-term diabetes. Both groups were subjected to history-taking, clinical examination including body mass index [BMI], pubertal staging according to the rating of Tanner[1], assessment of glycemic control, measurement of kidney volume [KV], as a marker of glomerular hypertrophy, by ultrasonography [U/S]. The overall rate of MA and NM accounted for 20% [10/50] and 26% [13/50], respectively, being more detected in long-term diabetics than that in patients with early-onset diabetes, with significant difference. Long-term diabetics had significantly higher albumin excretion rate [AER] and urinary GH and IGF-I concentrations than that in early-onset diabetics. The mean BMI, pubertal duration, urinary GH and urinary IGF-I were significantly higher among diabetics positive for MA than that among diabetics negative for MA. our data, which reflect increased mean urinary GH / IGF-I production, strengthen the evidence of an association between GH and MA and NM and also implicate urinary GH/ IGF-I in DN, particularly in children and adolescents with long-term diabetes, increased pubertal duration and poor glycemic contro
Subject(s)
Humans , Male , Female , Growth Hormone/adverse effects , Insulin-Like Growth Factor I/adverse effects , Diabetic Nephropathies/complications , ChildABSTRACT
Os IGFs( insulin-like growth factors 1 e 2) ou somastomedinas (A e C)sa peptideos de estrutura e funcao semelhante a insulina.Esses peptideos atuam na captacaode glicose e aminoacidos para as celulas,sendo que uma maior secrecao de IGF-1 estimula a sintese proteica e/ou dimiui a degradacao de proteinas em estado catabolico.Alem disso agem como mediadores do hormonio de crescimento(GH)promovendo o crescimento corporal atraves da diferenciacao celular de condroblastos,fibroblastos e mioblastos.A atividade fisica parece influenciar nos niveis plasmaticos e musculares de IGF-1 de acordo com a idade,a dieta,o tipo e a intensiadde do exercicio praticado.As proteinas tranportadoras dos IGFs(IGFBPs 1,2,3,4,5,6)assumen funcao reguladora sobre esses peptideos alem de os transportarem pela corrente sanguinea e tambem sao influencias pela atividade fisica