Tratamiento quirúrgico de los adenomas hipofisarios en el Noroeste Argentino / Surgical treatment of pituitary adenomas in the Argentine Northwest

Introducción: Los tumores de hipófisis representan aproximadamente un 10% de los tumores intracraneales. Los adenomas hipofisarios son ampliamente la lesión selar más frecuente. Es fundamental que se conformen equipos capaces de tratar holísticamente esta patología en las distintas regiones de nuestro vasto territorio. El propósito del presente trabajo es presentar nuestra experiencia en el manejo quirúrgico de los adenomas hipofisarios en el Noroeste Argentino. Materiales y métodos: Estudio retrospectivo de pacientes operados por adenomas selares, desde enero de 2013 hasta abril de 2019, en la provincia de Tucumán, por el autor Senior. Resultados: Se analizaron 211 pacientes operados de adenomas pituitarios. En el 75% (n=158) las resecciones fueron totales y en el 25% (n=53) fueron resecciones subtotales. De los 88 pacientes con macroadenomas no funcionantes y déficit visual, el 94% (n=83) presentó mejoría visual en el postoperatorio. De los 52 pacientes con acromegalia, un 75% (n=39) presentó remisión bioquímica completa postquirúrgica. De los 26 pacientes con enfermedad de Cushing, un 81% (n=21) presentó remisión bioquímica completa postquirúrgica. De los 21 pacientes con prolactinomas, un 71% (n=15) normalizaron los niveles de prolactina en el postoperatorio. Conclusión: Los resultados en el tratamiento quirúrgico de los adenomas hipofisarios de la presente serie son comparables a los reportados por centros especializados internacionales. Debemos formar equipos capaces de tratar esta patología en las distintas regiones de la Argentina.

Background: Pituitary tumors account for 10% of intracranial tumors. Pituitary adenomas are the most common selar lesion. It is essential that teams be formed capable of treating this pathology holistically in the different regions of our vast territory. The purpose of this article is to present our experience in the surgical management of pituitary adenomas in the Northwest of Argentine. Materials and methods: A retrospective analysis was done studding patients operated from pituitary adenomas, from January 2013 to April 2019, in Tucumán, by the Senior Author. Results: We analyzed 211 patients operated from pituitary adenomas, of which 75% (n=158) had gross total resections and 25% (n=53) had subtotal resections. Of the 88 patients with non-functioning macroadenomas and visual deficit, 94% (n=83) presented visual improvement after surgery. Of the 52 patients with acromegaly, 75% (n=39) presented complete biochemical remission after surgery. Of the 26 patients with Cushing's disease, 81% (n=21) presented complete biochemical remission after surgery. Of the 21 patients with prolactinomas, 71% (n=15) normalized prolactin levels after surgery. Conclusion: Our results in the surgical treatment of pituitary adenomas are comparable to those reported by international specialized centers. We must form teams capable of treating this pathology in the different regions of Argentina

"In x Out": Revisando o Viés de Grupo através da Perspectiva Biológica / "In x Out": Revisando el Sesgo de Grupo a través de la Perspectiva Biológica / "In x Out": Reviewing the Group Bias through the Biological Perspective

Os fatores subjacentes ao favorecimento do endogrupo e de indiferença/hostilidade ao exogrupo são amplamente estudados pela psicologia social, onde estudos reportam que, por exemplo, indivíduos confiam mais e associam palavras positivas aos membros do mesmo grupo. O estudo desses fatores pode ajudar na compreensão de fenômenos tais como preconceito e etnocentrismo. As perspectivas evolucionista e neuroendócrina vêm sendo extremamente relevantes nos últimos anos para o estudo do favoritismo ingroup. Todavia, uma busca sistemática nas bases de dados Lilacs, Scielo, Google Scholar e Web of Science por palavras-chave relacionadas ao viés de grupo demonstrou uma carência por publicações nesse tema no Brasil. Dos trabalhos recuperados, apenas um se enquadrava na perspectiva evolucionista e nenhum abordava os mecanismos neuroendócrinos do viés de grupo. Dessa forma, o objetivo do presente estudo é discutir o viés de grupo através de uma perspectiva biológica, explicitando as hipóteses para a evolução desses comportamentos, os métodos empregados para o estudo dos mesmos e as bases neuroendócrinas e os substratos neurais que os medeiam.

Los factores subyacentes al favorecimiento del endogrupo y a la indiferencia/hostilidad al exogrupo son ampliamente estudiados por la psicología social, donde estudios informan, por ejemplo, que los indivíduos confian más y asocian palabras positivas a los miembros del mismo grupo. El estúdio de esos factores puede ayudar en la comprensíon de fenómenos tales como el prejuicio y el etnocentrismo. Las perspectivas evolucionista y neuroendócrina han sido extremadamente relevantes en los últimos años para el estúdio del favoritismo ingroup. Sin embargo, una búsqueda sistemática en las bases de datos Lilacs, Scielo, Web of Science y Google Scholar por palabras claves relacionadas al sesgo de grupo demostró una carencia de publicaciones sobre ese tema en Brasil. De los trabajos recuperados sólo uno se ajustaba a la perspectiva evolucionista y ninguno abordaba los mecanismos neuroendocrino del sesgo de grupo. De esta manera, el objetivo del presente estudio es discutir el sesgo de grupo a través de una perspectiva biológica, explicando las hipótesis para la evolución de esos comportamientos, los métodos utilizados para el estúdio de ellos, las bases neuroendocrinas y los sustratos neurales que los median.

The factors underlying to the ingroup favoritism and outgroup indifference/hostility are broadly studied by social psychology, where studies report that, for example, individuals trust more and associate positive words to members of the same group. The study of these factors can help in understand phenomena such as prejudice and ethonocentrism. However, a systematic search in the databases Web of Science, Google Scholar, Scielo, and Lilacs for the keywords related to group bias showed a studies shortage for this topic in Brazil. Besides, in the studies retrieved, just one fitted into evolutionary perspective and no study has approached the neuroendocrine mechanisms of the group bias. Therefore, the objective of this study was to discuss the group bias through the biological perspective, explaining the evolutionary hypothesis to the evolution of these behaviors, the methods applied to study this topic, and the neuroendocrine basis and neural substrates mediating them.

Dehydroepiandrosterone Sulfate Level Varies Nonlinearly with Symptom Severity in Major Depressive Disorder

OBJECTIVE: The pathophysiology of major depressive disorder (MDD) is still not well understood. Conflicting results for surrogate biomarkers in MDD have been reported, which might be a consequence of the heterogeneity of MDD patients. Therefore, we aim to investigate how the severity of depression and various symptom domains are related to the levels of dehydroepiandrosterone sulfate (DHEA-s) in MDD patients. METHODS: We recruited 117 subjects from a general practice. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Depressive symptoms were divided into three subdomains according to BDI items; somatic symptoms, guilt and failure, and mood and inhibition. RESULTS: In subjects with very-mild-to-moderate depression, the DHEA-s level increased as BDI score did. However, the DHEA-s levels in the subjects with severe depression were significantly lower than in subjects with moderate depression (p=0.003). DHEA-s level was correlated with the BDI subscore for guilt and failure in very-mild-to-moderate depression (r=0.365, p=0.006). CONCLUSION: The DHEA-s level appears to be indicative of MDD severity with respect to depressive symptoms, especially regarding guilt and failure. Our findings suggest that the upregulation of DHEA-s may be a part of a compensatory process in very-mild-to-moderate depression, and the failure of this compensation mechanism may underlie the development of severe depression.

Factors Associated with Postoperative Diabetes Insipidus after Pituitary Surgery

BACKGROUND: Determining risk factors for diabetes insipidus (DI) after pituitary surgery is important in improving patient care. Our objective is to determine the factors associated with DI after pituitary surgery. METHODS: We reviewed records of patients who underwent pituitary surgery from 2011 to 2015 at Philippine General Hospital. Patients with preoperative DI were excluded. Multiple logistic regression analysis was performed and a predictive model was generated. The discrimination abilities of the predictive model and individual variables were assessed using the receiving operator characteristic curve. RESULTS: A total of 230 patients were included. The rate of postoperative DI was 27.8%. Percent change in serum Na (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.15 to 1.69); preoperative serum Na (OR, 1.19; 95% CI, 1.02 to 1.40); and performance of craniotomy (OR, 5.48; 95% CI, 1.60 to 18.80) remained significantly associated with an increased incidence of postoperative DI, while percent change in urine specific gravity (USG) (OR, 0.53; 95% CI, 0.33 to 0.87) and meningioma on histopathology (OR, 0.05; 95% CI, 0.04 to 0.70) were significantly associated with a decreased incidence. The predictive model generated has good diagnostic accuracy in predicting postoperative DI with an area under curve of 0.83. CONCLUSION: Greater percent change in serum Na, preoperative serum Na, and performance of craniotomy significantly increased the likelihood of postoperative DI while percent change in USG and meningioma on histopathology were significantly associated with a decreased incidence. The predictive model can be used to generate a scoring system in estimating the risk of postoperative DI.

A review on the diagnosis and treatment of patients with clinically nonfunctioning pituitary adenoma by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors’ experience. Arch Endocrinol Metab. 2016;60(4):374-90.

In the land of giants: the legacy of José Dantas de Souza Leite / Na terra de gigantes: o legado de José Dantas de Souza Leite

The authors describe the extraordinary contribution to science made by José Dantas de Souza Leite, who graduated from the Bahia School of Medicine and trained in Prof. Charcot’s Neurology Service under the supervision of Charcot’s most able pupil, Dr. Pierre Marie. Souza Leite presented his doctoral thesis on acromegaly, in Paris in 1890, and in the following year both him and Pierre Marie published a book on the subject, “Essays on Acromegaly”. This exceptional work established Souza Leite internationally as an important researcher, and the first Brazilian physician to contribute to the development of neuroendocrinology in an innovative way.

Os autores apresentam a extraordinária contribuição científica do Dr. José Dantas de Souza Leite, médico formado pela Faculdade de Medicina da Bahia, e interno do Serviço de Neurologia do Professor Charcot, onde estagiou sob supervisão do seu melhor discípulo, Pierre Marie. Souza Leite apresentou a sua tese de doutoramento em Paris sobre acromegalia, no ano de 1890. Um ano mais depois, publicou o livro “Essays on Acromegaly” em coautoria com Pierre Marie. Este trabalho excepcional consagrou Souza Leite como grande pesquisador no cenário internacional e o primeiro médico brasileiro a contribuir de maneira inovadora para o desenvolvimento da neuroendocrinologia mundial.

Reproducción Estacional en el Macho / Seasonal Reproduction in the Male

Hay una sorprendente relación entre el ambiente y adaptaciones de la conducta reproductiva, muy evidente en los reproductores estacionales que pueden reproducirse en días cortos o largos, de acuerdo a factores proximales, especialmente el fotoperiodo luminoso que provoca cambios fotoneuroendocrinos. Estos, involucran fotoreceptores, un reloj biológico y el aparato neuroendocrino. Las gonadotrofinas (GT), el desarrollo gonadal, la retroalimentación negativa de las GT por los esteroides sexuales, la intervención de las fibras retino-hipotalámico y los núcleos supraquiasmáticos así como la secreción de melatonina, intervienen en esta regulación. El pulso generador del hipotálamo (eminencia media) es importante en el control de la adenohipófisis respecto de la secreción de LH y FSH. En el testículo, las endocrinocitos intersticiales (de Leydig) (que secretan testosterona y también estrógenos), establecen un asa de retroalimentación con la adenohipófisis y el hipotálamo en un circuito de asa larga, corta y ultracorta, donde neuronas neuroendocrinas tienen un rol importante. Los sustentocitos (células de Sertoli) (intratubulares) son importantes por su rol mecánico, trófico y metabólico respecto a las células germinales y la secreción de activina e inhibina, que provoca o inhibe la secreción de FSH respectivamente. Los sustentocitos también secretan muchas proteínas específicas entre las cuales se encuentra la proteína que liga andrógenos (ABP), importante porque concentra 100 veces la testosterona en el parénquima testicular. La secreción tónica, por pulsos de GT, especialmente LH, es debida a actividad hipotalámica a través del control de generación de estos pulsos que se inicia en la pubertad. La reproducción en el potro y el toro se presentan como ejemplos.

There is a surprising interrelationship between environments and adaptation of reproductive behaviour, very evident in seasonal breeders; which may reproduce in long or short days, according to proximal factors, mainly the light photoperiod which triggers photoneuroendocrine changes. These involve photoreceptors, a clock and the neuroendocrine apparatus. Gonadotropins (GT), gonadal development, negative feed back of GT done by sexual steroid, the intervention of the retino-hypothalamic fibers, and suprachiasmatics nucleus as well as melatonine secretion, intervene in this regulation. Of importance is the pulse generator of the hypothalamus (medial eminence) and its control of adenohypofisis for the secretion of LH and FSH. In the testis interstitial endocrine cells (Leydig)(secreting testosterone and also estrogens), establish a feed back loop with the adenohypofisis and hypothalamus in a circuit of long, short and ultra short circuit with neuroendocrine neurons playing a key role. Sustentocyte intratubular (Sertoli)are also important for their trophic, mechanic and metabolic relationships with the germ cells, and the secretions of activine and inhibine, which triggers or inhibits FSH secretions respectively. Sustentocyte also secrete many specifics proteins among which ABP (Androgen Binding Protein) is important because it concentrates 100 fold testosterone in the testicular parenchyme. Tonic secretion by pulses of GT, mainly LH, is due to hypothalamic activity with the control generation of these pulses by puberty. Reproduction in the stallion and the bull are presented as examples.

Impacto da terapia cognitivo-comportamental nos fatores neurobiológicos relacionados à resiliência / Impact of cognitive-behavior therapy on resilience-related neurobiological factors

A resiliência, como uma variável de desfecho, tem sido largamente negligenciada no campo terapêutico. Nosso objetivo foi investigar os efeitos da terapia cognitivo-comportamental (TCC) nos marcadores neurobiológicos de resiliência em pacientes com transtorno de estresse pós-traumático (TEPT). Nesta pesquisa experimental de caso único, foram acessadas variáveis fisiológicas (frequência cardíaca, frequência respiratória, tônus vagal cardíaco, balanço simpático e condutância da pele) e neuroendócrinas (cortisol e de-hidroepiandrosterona - DHEA) e medidas psicométricas de autorrelato (afeto negativo, resiliência, sintomas de TEPT, depressão, ansiedade e apoio social). Foram medidas as respostas fisiológicas, neuroendócrinas e psicométricas em repouso antes e após quatro meses de TCC. O paciente era um homem de 45 anos que sofreu dois assaltos com arma de fogo e não respondeu adequadamente ao tratamento farmacológico com paroxetina. A TCC levou a uma redução da frequência cardíaca, frequência respiratória, balanço simpático, condutância da pele e cortisol, bem como a um aumento no tônus vagal e DHEA. Além disso, a TCC promoveu redução na pontuação dos sintomas de TEPT, depressão, ansiedade e afeto negativo e aumento da pontuação de resiliência e apoio social. Nossos dados sugerem que a TCC aumenta os fatores relacionados à resiliência (DHEA, tônus vagal, autorrelato de resiliência e apoio social). Isso não é somente "antipatológico", mas também pode ser considerado "pró-bem-estar". Adicionalmente, nossos resultados mostram a relevância da investigação dos efeitos do tratamento psicológico em múltiplos sistemas neurobiológicos no mesmo paciente com TEPT, visando desvendar as bases neurobiológicas dos fatores de resiliência.

Resilience, as an outcome variable, has been largely neglected in the field of therapeutics. Our aim was to investigate the effects of cognitive behavioral therapy (CBT) on neurobiological markers of resilience in posttraumatic stress disorder (PTSD) patients. In this single-case experimental research, we assessed physiological (heart rate, respiratory rate, cardiac vagal tone, sympathetic balance and skin conductance) and neuroendocrine (cortisol and dehydroepiandrosterone - DHEA) variables; and psychometric self-report measures (negative affect, resilience, PTSD symptoms, depression, anxiety and social support). Physiological, neuroendocrine and psychometric responses at rest were measured before and after four months of CBT. The patient was a 45-year-old man who had suffered two armed robberies and failed to respond adequately to pharmacological treatment with paroxetine. CBT led to a reduction in heart rate, respiratory rate, sympathetic balance, skin conductance and cortisol. It also led to an increase in cardiac vagal tone and DHEA. Furthermore, CBT promoted reduction of PTSD symptoms, depression, anxiety and negative affect scores and enhancement of resilience and social support scores. CBT in this single case enhanced resilience-related factors such as DHEA, vagal tone, self-reported resilience and social support suggesting that this therapeutic strategy not only contributed to 'anti' pathology effects but to 'pro' well-being. Additionally, our results show the relevance of investigating the effects of psychological treatments in multiple neurobiological systems in the same PTSD patients to unveil the neurobiological underpinnings of resilience factors.

Depressão, cortisol urinário e perfil sócio-demográfico de portadores de diabetes mellitus tipo 2 / Depresion, el cortisol urinario y perfil sociodemografico em portadores de diabetes mellitus tipo 2 / Depression, urinary cortisol and social demographics characteristics in subjects with type 2 diabetes mellitus

O objetivo deste estudo foi investigar a relação entre indicadores de depressão e perfil sócio-demográfico de portadores de Diabetes Mellitus tipo 2 (DM2).A avaliação sócio-demográfica foi conduzida em amostra composta por 40 pacientes na Liga de Diabetes (HC-FMUSP).Os indicadores de depressão foram investigados a partir do Inventário de Depressão de Beck (IBD) em associação com cortisol urinário (CORT).Os resultados mostraram que indivíduos portadores de DM2 com alta escolaridade, baixo poder aquisitivo individual e familiar e com história de rompimento de relação conjugal estável estão mais propensos a sintomas de depressão.

The objective this study was investigate the relationship between depression indicators and social-demographics characteristics in subjects with Type 2 Diabetes Mellitus (DM2). The socio-demographic evaluation was conducted in a sample composed of 40 patients with DM2 from Diabetes League (HCFM-USP).Depression indicators were evaluated through the Beck Depression Inventory (BDI) in addition to urinary cortisol (CORT).The results showed that individuals with high education level,poor individual and familiar economic status in addition to history of broken stable relationship are more likely to depressive symptoms.

Lo objective deste estudo fue investigar la relación entre la depresión y los indicadores de perfil socio-demográfico de los pacientes con diabetes mellitus tipo 2 (DM2). Evaluación socio-demográficos se llevó a cabo en una muestra de 40 pacientes en la Liga de la Diabetes (HC-FMUSP). Indicadores de la depresión se han investigado en el Beck Depression Inventory (BDI),en asociación con el cortisol urinario (CORT).Resultados muestraron que los pacientes con DM2 con alto nivel de educación,las personas de bajos ingresos y familias con historia de interrupción de los matrimonios estables son más propensos a tener síntomas de la depresión.

Fatores ambientais, comportamentais e neuroendocrinológicos envolvidos na gênese da epidemia da obesidade: [revisão] / Environmental, comportamental and neuroendocrinological factors involved in obesity epidemic genesis: [review]

A obesidade constitui hoje um preocupante problema de saúde mundial, pois, além de prejudicar o bem estar físico de seu portador, traz consigo comorbidades associadas que aumentam as taxa de morbi-mortalidade. Entre elas incluem-se hipertensão arterial, diabetes mellitus, síndrome da apnéia obstrutiva do sono, osteoartrose, síndrome metabólica e outras. Os recentes avanços alcançados por importantes pesquisas na área molecular conseguiram elucidar grande parte dos mecanismos de controle central do peso corporal, expondo mais um possível sítio para a ação de drogas antiobesidade. A despeito dessas atualidades, o ambiente em que vivemos e determinados comportamentos que seguimos também apresentam forte influência sobre nosso balanço energético e peso corporal, tornando impossível tratar a obesidade por apenas uma frente de ataque. A atividade física e as mudanças no estilo de vida continuam sendo as medidas iniciais da terapêutica e, após estabelecerem-se estas condutas, as recentes descobertas na terapêutica medicamentosa passam a ter valia na tentativa de conter esta epidemia.

Presently the obesity is a serious health problem in the world because, in addition to the damage to the patients, cause co morbidities like hypertension, diabetes mellitus, osteoartrosis, metabolic syndrome, sleep obstructive apnéia syndrome and others increasing the morbid-mortality taxes. The recent findings achieve by important studies in the molecular area obtained succeed in expose a big part of neural control mechanism of body weight, showing another possible place for antiobesity drugs. In the spite of this, some behaviors that we have and the environment where we live also have a big importance in our energy balance and body weight, making impossible to treat the obesity only by one focus. The physical activity and changes in life style are the first step in the therapeutic and, after this, the recent findings in drugs therapeutic start to have value in the tentative of stopping the epidemic of obesity.

The neuroendocrinological sequelae of stress during brain development: the impact of child abuse and neglect

Severe stress during the sensitive periods of neurodevelopment, (which include the prenatal period, infancy, childhood and adolescence), has a long-lasting organizing effect on the brain and stress axes. Child abuse and neglect thus exert a cumulative harmful effect on neuroendocrinological development, which persists into adulthood. It is not merely the memory of the trauma which leaves a mark, but rather the effect on neurodevelopment which negatively influences the ability of adult survivors of childhood maltreatment to cope with current stressors. The victims of child abuse and neglect are likely to maltreat their own children and so perpetuate the intergenerational transmission of child maltreatment. In this paper relevant normal brain development is first summarized. Child abuse / neglect is next discussed with detailed reference to the aberrant neuroendocrinological development that is known to occur. We specifically examine effects on the hypothalamo-pituitary-adrenal and central noradrenergic-sympathoadrenomedullary stress axes and other neurotransmitter systems before turning to changes described in the cerebral volumes, corpus callosum and cortical hemispheres, prefrontal cortex and amygdalae, superior temporal gyrus, hippocampus as well as the cerebellar vermis

La distrofia adiposo genital o síndrome de Frohlich: su contribución al establecimiento de la neuroendocrinología / The adiposogenital distrophy or Frohlich syndrome and the beginning of the concept of neuroendocrinology

Hace casi un siglo Harvey Cushing llamó la atención médica mundial con motivo de un informe clínico consistente en el caso de obesidad e infantilismo sexual ocasionado por un tumor en la base del cráneo al cual se le dio el nombre de distrofia adiposo-genital o síndrome de Frohlich por haber sido quien lo describió por primera vez. El estudio de este síndrome permitió establecer la conexión entre la hipófisis y el hipotálamo que eran estructuras con funciones poco conocidas hasta ese momento. Así se fue gestando la neuroendocrinología clínica.

A century has passed since Harvey Cushing presented a syndrome characterized by obesity and sexual infantilism, caused by a tumour located in the base of the brain, and named it as Adiposogenital dystrophy or Frohlich's syndrome, on the name of its discoverer. Further study of this syndrome contributed to establish the hormonal connection between the brain and the anterior pituitary, and then the concept of neuroendocrinology.

Influência da infecção aguda pelo Trypanosoma cruzi sobre o eixo hipotálamo-hipófise-adrenal de camundongos / Influence of the acute infection for the Trypanosoma cruzi on the pituitary-adrenal system of mice

Atualmente, está bem estabelecida a existência de uma comunicação bidirecional existente entre os sistemas nervoso, endócrino e imune, a qual é relevante em termos de homeostasia. Essa homeostasia se mantém com a participação de receptores, hormônios e citocinas, formando uma linguagem comum dentro e entre os sistemas imune e neuroendócrino. Além do circuito de interação estabelecido entre esses sistemas, fatores extrínsecos, influenciam esses mesmos sistemas levando a alterações na função de seus diferentes tecidos, como por exemplo, o aumento nos níveis séricos de corticosterona em camundongos infectados pelo T. cruzi. No presente trabalho, investigamos as possíveis influências da infecção pelo Trypanosoma cruzi, o agente causador da Doença de Chagas, sobre o eixo hipotálamo-hipófise-adrenal (HPA). Ninhos de formas amastigotas do parasita foram detectadas nas adrenais, enquanto que o produto de amplificação do gene do T. cruzi foi detectado por PCR nas hipófises e adrenais de animais infectados. Análises imunohistológicas da hipófise e adrenais de animais infectados revelaram várias alterações morfológicas e estruturais tais como, estase vascular, aumento a expressão de proteínas de matriz extracelular (fibronectina e laminina), e presença de linfócitos T e macrófagos. Funcionalmente, observamos uma diminuição de hormônio liberador de corticotrofina, e um aumento de corticosterona no hipotálamo e soro respectivamente. Por outro lado, não detectamos alterações nas concentrações do hormônio adrenocortocotrófico (ACTH) no soro de animais infectados. Entretanto, observamos níveis elevados de IL-1b e IL-6 no soro desses animais. Em seguida, analisamos os efeitos in vitro da infecção pelo T. cruzi nas linhagens adenohipofisárias AtT-20, prdutora de ACTH, e GH3, produtora de prolactina e hormônio do crescimento. Quando infectadas, essas linhagens apresentaram aumento de moléculas de matriz extracelular. Culturas de células AtT-20 infectadas apresentaram baixos niv...