Problemas gastrointestinales, nutricionales, endocrinológicos y de microbiota en el trastorno del espectro autista / Gastrointestinal, nutritional, endocrine, and microbiota conditions in autism spectrum disorder

Los problemas médicos gastrointestinales, nutricionales, metabólicos, endocrinológicos y de microbiota en los pacientes pediátricos con diagnóstico de trastorno del espectro autista (TEA) son parte de los problemas médicos concomitantes al diagnóstico. La prevalencia alcanza a más del 91 % en el caso de los problemas gastrointestinales, hasta el 89 % para los nutricionales y metabólicos, más del 50 % de disfunción tiroidea y hasta el 100 % para los relacionados con la microbiota.Es urgente actualizar la práctica médica para incluir la evaluación, testeo, diagnóstico y tratamiento de estos problemas médicos concomitantes al diagnóstico de TEA en la población pediátrica, adolescente y adulta. El tratamiento riguroso de dichos problemas genera cambios positivos en la calidad de vida y en la sintomatología bajo la cual el TEA se diagnostica en muchos casos. Debe basarse en evidencia científica de alta calidad, con control y cuidado médico adecuado

Gastrointestinal, nutritional, metabolic, endocrine, and microbiota medical problems in pediatric patients diagnosed with autism spectrum disorder (ASD) are some of the coexisting medical conditions in ASD diagnosis. Their prevalence reaches more than 91 % for gastrointestinal problems, up to 89 % for nutritional and metabolic disorders, more than 50 % for thyroid dysfunction, and up to 100 % for microbiota-related conditions.There is an urgency for medical practice to be updated and to include the assessment, testing, diagnosis, and treatment of these coexisting medical conditions in ASD diagnosis in the pediatric, adolescent, and adult population. A strict management of such conditions results in positive changes in the quality of life and symptoms based on which ASD is diagnosed many times. It should be based on high-quality scientific evidence with an adequate medical care and control

Endothelial dysfunction in cardiovascular and endocrine-metabolic diseases: an update

The endothelium plays a vital role in maintaining circulatory homeostasis by the release of relaxing and contracting factors. Any change in this balance may result in a process known as endothelial dysfunction that leads to impaired control of vascular tone and contributes to the pathogenesis of some cardiovascular and endocrine/metabolic diseases. Reduced endothelium-derived nitric oxide (NO) bioavailability and increased production of thromboxane A2, prostaglandin H2 and superoxide anion in conductance and resistance arteries are commonly associated with endothelial dysfunction in hypertensive, diabetic and obese animals, resulting in reduced endothelium-dependent vasodilatation and in increased vasoconstrictor responses. In addition, recent studies have demonstrated the role of enhanced overactivation ofβ-adrenergic receptors inducing vascular cytokine production and endothelial NO synthase (eNOS) uncoupling that seem to be the mechanisms underlying endothelial dysfunction in hypertension, heart failure and in endocrine-metabolic disorders. However, some adaptive mechanisms can occur in the initial stages of hypertension, such as increased NO production by eNOS. The present review focuses on the role of NO bioavailability, eNOS uncoupling, cyclooxygenase-derived products and pro-inflammatory factors on the endothelial dysfunction that occurs in hypertension, sympathetic hyperactivity, diabetes mellitus, and obesity. These are cardiovascular and endocrine-metabolic diseases of high incidence and mortality around the world, especially in developing countries and endothelial dysfunction contributes to triggering, maintenance and worsening of these pathological situations.

Disfunçäo endócrina reprodutiva e as epilepsias / Reproductive endocrine dysfuction and epilepsy

Recentemente, têm sido relatadas síndromes endócrinas em mulheres epilépticas, relacionando-se estas síndromes à reduçäo da fertilidade. Em particular, a síndrome do ovário policístico é observada com maior frequência em mulheres epiléticas, em comparaçäo à populaçäo geral. Alguns fatores podem ser considerados na tentativa de explicaçäo deste fenômeno. Em primeiro lugar, é possível que a atividade epilética, através de descargas paroxísticas atingindo o hipotálamo, interfira na atividade funcional hormonal, em particular no pulso gerador do hormônio liberador da gonadotropina (GnRH). Por outro lado, alteraçöes endócrinas decorrentes de ciclos anovulatórios poderiam estar relacionadas ao desencadeamento de descargas epiléticas, talvez por açäo direta dessa concentraçäo hormonal anormalmente elevada nas estruturas límbicas. O objetivo deste trabalho é estudar, à luz da literatura disponível, a possível relaçäo entre crises epiléticas originadas no lobo temporal e síndrome de disfunçöes hormonais sexuais, em especial a síndrome do ovário policístico.

Mecanismos moleculares de açäo hormonal / Molecular mechanisms of hormonal action

A característica principal dos hormônios é a sua habilidade em interagir com receptores altamente seletivos e ativar vias intracelulares do sinalizaçäo nos órgaos específicos. Após a interaçäo dos hormônios com seus receptores, uma seqüência de reaçöes pode levar ao aumento ou diminuiçäo na atividade de determinadas enzimas que, por sua vez, produzem a resposta fisiológica. Os hormônios säo bioquimicamente classificados em esteróides, peptídeos ou aminas e seus receptores diferem, basicamente, por sua localizaçäo, intra ou extracelular. No presente trabalho, o mecanismo molecular de açäo dos hormônios peptídicos (hidrofílicos) e esteróides (lipofílicos) é discutido.

Ovarian activity before and after gonadal suppression by GnRH-a in patients with polycystic ovary syndrome, hyperandrogenism, hyperinsulinism and acanthosis nigricans

Objective. To investigate the ovarian activity before and after gonadal suppression with GnRH-analog in patients with PCO, hyperandrogenism, hyperinsulinism and ancathosis nigricans. Design: Controlled clinical study. Setting: Tertiary academic medical center. Patients: Six patients with clinical findings of PCO, hirsutism and acanthosis nigricans. Interventions. Morning blood samples in the follicular phase to determine the seteroid levels, glucose and insulin curve, comparing to a control group. Administration for 2 consecutive months of a GnRH-analog, comparing, in the study group, the free testosterone levels before and after ovarian suppression. Main Outcome Measure. Determination of insulin levels in PCO, hirsutism and acanthotic patients and the free-testosterone levels before and after gonadal suppression. Results. Insulin levels were significantly higher in the study group when compared to normal women during the glycemic test. We also found a significant decrease in the free-testosterone levels after 2 months of gonadal suppression with GnRH-analog when compared to the initial time. Conclusions. Patients with PCO, hirsutism and acanthosis nicrigans present high levels of in sulin, suggesting an ovarian hyperesponsiveness, which is not sustained when gonadotrophic blockage was achieved.