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1.
Arq. bras. med. vet. zootec. (Online) ; 73(5): 1099-1104, Sept.-Oct. 2021. tab, ilus
Article in English | ID: biblio-1345269

ABSTRACT

A senile male captive bush dog (Speothos venaticus) presented a small perianal cutaneous nodule. Histologically, there was an ulcerated round cell tumor composed of well differentiated mast cells with abundant intracytoplasmic purple Giemsa-positive granules, with a diffuse eosinophilic infiltrate. Immunohistochemistry revealed that 30% of the neoplastic cells were positive for Kit in the cytoplasm and cell membrane, and all neoplastic cells were negative for MAC and CD3. Less than 10% of the neoplastic cells were positive for Ki67. At necropsy other primary tumors were identified in this animal, including an intestinal adenoma, an adrenal cortex adenoma and a testicular interstitial cell tumor.(AU)


Um cachorro-vinagre (Speothos venaticus) apresentou um nódulo cutâneo pequeno na região perianal. Histologicamente havia neoplasia cutânea de células redondas e ulcerada, constituída por mastócitos bem diferenciados, com abundantes grânulos citoplasmáticos metacromáticos na coloração de Giemsa e infiltrado eosinofílico difuso. A imuno-histoquímica demonstrou que 30% das células neoplásicas eram positivas para a proteína Kit no citoplasma e na membrana celular. As células foram negativas para MAC e CD3. Menos de 10% das células neoplásicas foram positivas para Ki67. Durante a necropsia, foram identificados outros tumores primários, como adenoma intestinal, adenoma cortical da adrenal e tumor de células intersticiais do testículo.(AU)


Subject(s)
Canidae , Mastocytoma, Skin/diagnosis , Mastocytoma, Skin/pathology , Adenoma/pathology , Animals, Zoo
2.
Rev. cuba. anestesiol. reanim ; 20(2): e657, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289357

ABSTRACT

Introducción: El adenoma del paladar blando es frecuente en mujeres, aunado a los cambios fisiológicos que suceden durante el embarazo, es de presumir que la gestante puede presentar una vía aérea difícil. Objetivo: Describir el abordaje de la vía aérea en una gestante con adenoma del paladar blando. Presentación del caso: Se trata de una gestante de 20 años de edad con antecedentes patológicos personales de asma bronquial, alergia a los anestésicos locales, que presenta un adenoma en el paladar blando que impide ver la estructura de la orofaringe, Mallampatti IV, anunciada para procedimiento quirúrgico de urgencia para realizarle cesárea segmentaria anterior. Conclusiones: La embarazada presenta mayor incidencia de vía aérea difícil comparado con la población general, debido a los cambios fisiológicos que presenta en este periodo, si a ello se le adiciona la presencia de un tumor oro faríngeo que imposibilita la manipulación de la vía aérea, la evaluación preoperatoria y trazar una estrategia multidisciplinaria, constituyen los pilares para evitar complicaciones potencialmente fatales(AU)


Introduction: Adenoma of soft palate is frequent in women, together with the physiological changes that occur during pregnancy. The pregnant woman is to be presumed to have a difficult airway. Objective: To describe the airway managment in a pregnant woman with adenoma of soft palate. Case presentation: This is a 20-year-old pregnant woman (Mallampati IV) with a personal pathological history of bronchial asthma and allergy to local anesthetics, who presents an adenoma of soft palate that avoids seeing the oropharynx structure, announced for emergency surgical procedure for an anterior segmental cesarean section. Conclusions: The pregnant woman has a higher incidence of difficult airway compared to the general population, due to the physiological changes that she presents in this period. If, apart from this situation, the presence is considered of an oropharyngeal tumor that makes it impossible to manipulate the airway, preoperative assessment and tracing a multidisciplinary strategy are the pillars to avoid potentially fatal complications(AU)


Subject(s)
Humans , Female , Pregnancy , Young Adult , Oropharynx , Palate, Soft , Surgical Procedures, Operative , Adenoma, Pleomorphic , Surgical Clearance , Adenoma/complications , Emergencies , Anesthetics, Local
3.
Rev. colomb. gastroenterol ; 36(supl.1): 26-29, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251542

ABSTRACT

Resumen Existen numerosas publicaciones sobre resección endoscópica de lesiones de la papila mayor, pero solo se han presentado series de casos individuales de resección de lesiones de la papila menor. En el presente artículo se describe el éxito técnico y la seguridad de la resección endoscópica de dos lesiones adenomatosas de la papila menor.


Abstract There are various publications on endoscopic resection of major papilla lesions, but only individual case series of resection of minor papilla lesions have been reported. This article describes the technical success and safety of endoscopic resection of two adenomatous lesions of the minor papilla.


Subject(s)
Humans , Male , Female , Aged , Therapeutics , Adenoma , Endoscopy, Digestive System
4.
Rev. méd. Urug ; 37(1): e702, mar. 2021. graf
Article in Spanish | LILACS, BNUY | ID: biblio-1180966

ABSTRACT

Resumen: Introducción: el hiperparatiroidismo primario por un adenoma gigante de paratiroides es infrecuente. Los adenomas de mayor tamaño reportados ocurrieron sobre paratiroides ectópicas (mediastinales). Comparte con el carcinoma su gran tamaño y elevadas cifras de calcemia y de hormona paratiroidea, hecho que dificulta el diagnóstico. Su tratamiento quirúrgico es la paratiroidectomía mediante una cervicotomía transversa centrada en la región infrahioidea. Objetivo: presentar un caso clínico de hiperparatiroidismo primario por un adenoma gigante de paratiroides tratado quirúrgicamente mediante un abordaje selectivo. Caso clínico: paciente de 53 años, sexo femenino, con antecedentes de litiasis ureteral, dolores óseos y tumoración infrahiodea de 4 cm de diámetro que imagenológicamente presentó las características de un adenoma paratiroideo inferior izquierdo. La valoración funcional confirmó hiperparatiroidismo. Con diagnóstico de hiperparatiroidismo primario por adenoma gigante se trató quirúrgicamente a través de una incisión pequeña y centrada en la tumoración, realizándose la paratiroidectomía inferior izquierda con la cual remitió la sintomatología y normalizó la funcionalidad paratiroidea. Discusión: el hiperparatiroidismo primario por adenoma gigante de paratiroides tiene indicación quirúrgica y es curativo. El caso presentado demuestra la factibilidad y seguridad de un abordaje selectivo a lo que suma una menor afectación cosmética, dejando indemne la logia tiroidea contralateral ante futuras cirugías sobre ésta.


Summary: Introduction: primary hyperparathyroidism caused by giant parathyroid adenoma is a rather unusual condition. Reported large adenomas occurred in ectopic parathyroid glands (mediastinal). Just like carcinomas, they are large, present high calcemia and parathyroid hormone values, what complicates diagnosis. Surgical treatment consists in parathyroidectomy by means of transversal cervicotomy around the infrahyoid region. Objective: the study presents the clinical case of primary hyperparathyroidism caused by giant parathyroid adenoma that was treated by selective surgery approach. Clinical case: 53 year-old female patient with a history of uretheral lithiasis, bone pain and 4-cm-diameter infrahyoid tumor. Imagenology studies revealed the characteristics of lower left parathyroid adenoma. Functional assessment confirmed hyperparathyroidism. Upon the diagnosis of primary hyperparathyroidism caused by giant parathyroid adenoma it was surgically addressed by means of a small cut around the tumour and performing a lower left parathyroidectomy, what resulted in the remission of symptoms and normalized parathyroid functionality. Discussion: primary hyperparathyroidism caused by giant parathyroid adenoma has an indication for surgery and is therapeutic. The case presented shows the feasibility and safety of a selective approach, as well as its smaller cosmetic harm, managing to keep the contralateral thyroid loggia intact, in view of future surgeries involving it.


Resumo: Introdução: o hiperparatireoidismo primário devido a adenoma de paratireoide gigante é raro. Os maiores adenomas relatados ocorreram em paratireoides ectópicas (mediastinais). Compartilha com o carcinoma seu grande tamanho e altos níveis de cálcio e hormônio da paratireoide, o que torna o diagnóstico difícil. Seu tratamento cirúrgico é a paratireoidectomia por meio de cervicotomia transversa com foco na região infra-hióidea. Objetivo: apresentar um caso clínico de hiperparatireoidismo primário por adenoma gigante da paratireoide tratado cirurgicamente por abordagem seletiva. Caso clínico: paciente do sexo feminino, 53 anos, com história de litíase ureteral, dor óssea e tumor infra-hióideo de 4 cm de diâmetro que apresentava características de imagem de adenoma de paratireoide inferior esquerdo. A avaliação funcional confirmou hiperparatireoidismo. Com diagnóstico de hiperparatireoidismo primário por adenoma gigante, foi tratada cirurgicamente por meio de pequena incisão focada no tumor, realizando paratireoidectomia inferior esquerda com remissão dos sintomas e normalização da funcionalidade da paratireoide. Discussão: o hiperparatireoidismo primário devido ao adenoma gigante da paratireoide tem indicação cirúrgica e é curativo. O caso apresentado demonstra a viabilidade e segurança de uma abordagem seletiva que apresenta um menor envolvimento estético, deixando o espaço contralateral da tireoide sem danos para futuras cirurgias.


Subject(s)
Parathyroid Neoplasms , Adenoma , Parathyroidectomy , Hyperparathyroidism, Primary/surgery
5.
Medicina (B.Aires) ; 81(1): 99-102, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287247

ABSTRACT

Resumen La resección transmural endoscópica es una técnica que permite la resección en bloque de lesiones colónicas en pacientes en los cuales han fracasado los métodos endoscópicos convencionales como la resección mucosa endoscópica o la disección submucosa endoscópica. Presentamos el caso de un hombre de 75 años con antecedentes de adenoma de colon con fibrosis debido a dos intentos previos fallidos de resección endoscópica en otra institución. Realizamos con éxito el procedimiento de resección transmural endoscópica evitando así una cirugía.


Abstract Endoscopic full-thickness resection is a technique that allows in block resection of colonic lesions in patients in whom conventional endoscopic methods such as endoscopic mucosal resection or endoscopic submucosal dissection have failed. We present a case of a 75-year-old man with history of a difficult-to-resect colon adenoma. He had undergone two previous failed attempts of endoscopic mucosal resection due to non-lifting sign in another center. We successfully performed an endoscopic full-thickness resection procedure, avoiding unnecessary surgery.


Subject(s)
Humans , Male , Aged , Adenoma/surgery , Adenoma/diagnostic imaging , Colonic Neoplasms/surgery , Endoscopic Mucosal Resection , Fibrosis , Treatment Outcome
6.
Rev. medica electron ; 43(1): 2739-2747, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156771

ABSTRACT

RESUMEN Introducción: la citología con aguja fina se mantiene como el estudio fundamental ante un nódulo tiroideo, pero el diagnóstico de neoplasia folicular es aún su punto débil para definirlo. Se mantiene como conducta su extirpación quirúrgica para alcanzarlo. Objetivo: determinar la correlación citopatológica en las neoplasias foliculares del tiroides. Materiales y métodos: se realizó un estudio prospectivo y descriptivo que incluyó a 80 pacientes operados con diagnóstico citológico de neoplasia folicular del tiroides, en el Hospital "Comandante Faustino Pérez" de la ciudad de Matanzas, de marzo del 2012 a febrero del 2016. Se evaluaron las variables: edad, sexo, tamaño, localización, número de nódulos y diagnóstico histológico definitivo. Resultados: predominaron las lesiones benignas con 56 para el 70 % dentro de ellas, los bocios multinodulares con 33,75 % y los adenomas foliculares con el 31,25 %. Los tumores malignos ocuparon el 30 %. El carcinoma papilar, variedad folicular con 12 para el 15 %, seguido del carcinoma papilar clásico con 10 para el 12,50 %. Conclusiones: el porcentaje de malignidad de este estudio fue del 30 % con predominio del carcinoma papilar variedad folicular y el carcinoma papilar clásico. Entre las lesiones benignas predominaron los bocios multinodulares y los adenomas foliculares (AU).


ABSTRACT Introduction: fine needle cytology is still the main study against a thyroidal nodule, but the follicular neoplasia diagnosis is still its weak point to define it. The surgical removal keeps being used to reach it. Objective: to determine the cytopathological correlation in follicular thyroid neoplasia. Materials and methods: a prospective, descriptive study was carried out including 80 patient with diagnosis of follicular thyroid neoplasia in the Hospital "Comandante Faustino Pérez" of Matanzas, who underwent a surgery from March 2012 to February 2016. The assessed variables were age, sex, size, location, quantity of nodes and final histological diagnosis. Results: benign lesions predominated, with 56 for 70 %; among them, multinodular goiters with 33.75 % and follicular adenomas with 31.25 %. Malignant tumors were 30 %: papillary carcinoma, follicular variety with 12 for 15 %, followed by the classical papillary carcinoma with 10 for 12.50 % Conclusions: the malignity percent of this study was 30 % with the predominance of the papillary carcinoma, follicular variant and the classic papillary carcinoma. Multinodular goiters and follicular adenomas predominated among the benign lesions (AU).


Subject(s)
Humans , Thyroid Neoplasms/pathology , Adenoma , Carcinoma, Papillary, Follicular , Thyroid Neoplasms/surgery , Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/diagnostic imaging , Epidemiology, Descriptive , Prospective Studies , Goiter, Nodular
7.
Repert. med. cir ; 30(1): 13-21, 2021. Ilus., tab.
Article in English | LILACS, COLNAL | ID: biblio-1281415

ABSTRACT

El gen AIP (proteína moduladora de la actividad del receptor de aril hidrocarburos) se localiza en la región 11q13.2 y codifica para una proteína de 330 aminoácidos que interactúa con el factor de transcripción AhR (receptor para aril hidrocarburos). Las mutaciones en este gen se han asociado con adenomas pituitarios aislados de tipo familiar (APAF). Se caracterizan por una presentación temprana (alrededor de 20 años), por lo regular producen hormona de crecimiento y/o prolactina, tienen un comportamiento clínico agresivo y poca respuesta a análogos de somatostatina.


The AIP gene (aryl hydrocarbon receptor interacting protein) is located on chromosome 11q13.2 and encodes a 330 amino acid protein which interacts with the aryl hydrocarbon receptor (AHR) transcription factor. Mutations in the AIP gene have been associated with familial isolated pituitary adenomas (FIPA). They characterize by an early-onset (around the age of 20 years old) and for being aggressive, growth hormone and/or prolactin-secreting tumors, with poor response to somatostatin analogues.


Subject(s)
Humans , Animals , Male , Female , Child , Adolescent , Adult , Young Adult , Pituitary Neoplasms/genetics , Pituitary Neoplasms/metabolism , Adenoma/genetics , Adenoma/metabolism , Intercellular Signaling Peptides and Proteins/genetics , Intercellular Signaling Peptides and Proteins/metabolism , Pituitary Diseases/genetics , Pituitary Diseases/metabolism
8.
Actual. osteol ; 17(1): 45-56, 2021. ilus, graf, tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1292122

ABSTRACT

El hiperparatiroidismo primario (HPTP) es poco frecuente en niños y adolescentes. Hay escasos datos para el manejo de estos pacientes en pediatría. Las glándulas paratiroideas son glándulas endocrinas que secretan hormona paratiroidea (PTH) y regulan el metabolismo del calcio y del fósforo. La sobreexpresión de PTH se llama hiperparatiroidismo, que se clasifica en primario, secundario y terciario. En los adolescentes, 80 a 92% de los hiperparatiroidismos primarios se deben a adenoma paratiroideo. Presentamos el caso clínico de una adolescente con una primera manifestación atípica de HPTP, la presencia de un tumor pardo del paladar, presentación rara de adenoma paratiroideo, acompañado de hipercalcemia, marcada elevación de PTH y varias lesiones óseas. (AU)


Primary hyperparathyroidism (PHPT) in children and adolescents is uncommon. Guidelines for management in pediatric patients are limited. Parathyroid glands are endocrine glands that secrete parathyroid hormone (PTH) and regulate calciumphosphate metabolism. The overexpression of PTH is called hyperparathyroidism, and is classified as primary, secondary, and tertiary. In adolescents, 80 to 92% of PHPT cases are due to a parathyroid adenoma. We present here a case report of an adolescent with a brown tumor of the palate as the first manifestation of the disease, atypical and rare presentation of parathyroid adenoma in an adolescent. She had hypercalcemia, marked elevation of PTH and bone lesions. (AU)


Subject(s)
Humans , Female , Child , Parathyroid Neoplasms/diagnosis , Palatal Neoplasms/etiology , Adenoma/diagnosis , Hyperparathyroidism, Primary/complications , Parathyroid Neoplasms/surgery , Palatal Neoplasms/diagnostic imaging , Adenoma/surgery , Hyperparathyroidism, Primary/etiology
9.
Autops. Case Rep ; 11: e2021270, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249033

ABSTRACT

Background Hemangiomas are benign neoplasms of capillary proliferation that arise from a developmental anomaly where angioblastic mesenchyme fails to form canals. Most hemangiomas arise in the head and neck region, either superficially in the skin or deeper within endocrine organs such as the parotid gland. Parathyroid hemangiomas, however, are extremely rare, with only five cases previously reported in the literature. Case presentation Herein, we present a case of a 68-year-old man with a hemangioma almost completely replacing the right upper parathyroid gland, grossly measuring 1.3 × 1.3 × 1.2 cm and weighing 700 mg, associated with primary hyperparathyroidism. Conclusions Parathyroid gland enlargement due to vascular neoplasms such as hemangiomas can mimic, both clinically and radiographically, hyperplasias and/or adenomas. Surgeons need to be aware of the presence of this entity and should consider it in the differential diagnosis of hyperparathyroidism or parathyroid gland enlargement.


Subject(s)
Humans , Male , Aged , Parathyroid Neoplasms/pathology , Adenoma/pathology , Hemangioma/pathology , Parathyroid Diseases/complications , Diagnosis, Differential
10.
Autops. Case Rep ; 11: e2020228, 2021. graf
Article in English | LILACS | ID: biblio-1142405

ABSTRACT

Tuberculosis is an infectious disease that involves any organ. However, the primary pituitary tuberculosis is an extremely rare disease. Intracranial tuberculomas account for 0.15-5% of intracranial space-occupying lesions, of which, pituitary as the primary site is unusual, and easily misdiagnosed as pituitary adenoma. In this setting, the late diagnosis can result in permanent endocrine dysfunction. We report the case of a 50-year-old woman who presented to the neurosurgery outpatient department with complaints of progressively increasing headache and diminished vision over the last year. On the clinical examination, the patient was conscious and oriented. The routine hematological and biochemical workup showed an increased erythrocyte sedimentation rate (ESR) and increased prolactin levels. The radiological working diagnosis was consistent with pituitary macroadenoma. No other radiological and/or clinical clue that could elicit the suspicion of pulmonary or extrapulmonary lesions of tuberculosis was found. The transsphenoidal endonasal tumor excision was done. The histopathology showed numerous epithelioid cell granulomas, Langhans giant cells along with scant necrosis. Ziehl Neelsen staining demonstrated acid-fast bacilli, and the final diagnosis of pituitary tuberculoma was made. We report this rare case of pituitary lesion that may be included in the differential diagnosis of sellar lesions to avoid unnecessary surgical interventions, especially in regions where the disease is endemic.


Subject(s)
Humans , Female , Middle Aged , Pituitary Gland/pathology , Pituitary Neoplasms , Tuberculosis/pathology , Adenoma/pathology , Epithelioid Cells , Giant Cells, Langhans , Rare Diseases , Diagnosis, Differential , Granuloma/pathology
11.
Arq. gastroenterol ; 57(4): 466-470, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142346

ABSTRACT

ABSTRACT BACKGROUND: The effectiveness of colonoscopy for colorectal cancer (CRC) screening depends on quality indicators, which adenoma detection rate (ADR) being the most important. Proximal serrated polyp detection rate (pSPDR) has been studied as a potential quality indicator for colonoscopy. OBJECTIVE: The aim is to analyze and compare the difference in ADR and pSPDR between patients undergoing screening colonoscopy and an unselected population with other indications for colonoscopy, including surveillance and diagnosis. METHODS: This is a historical cohort of patients who underwent colonoscopy in the digestive endoscopy service of a tertiary hospital. Out of 1554 colonoscopies performed, 573 patients were excluded. The remaining 981 patients were divided into two groups: patients undergoing screening colonoscopy (n=428; 43.6%); patients with other indications including surveillance and diagnosis (n=553; 56.4%). RESULTS: Adenoma detection rate of the group with other indications (50.6%) was higher than that of the screening group (44.6%; P=0.03). In regarding pSPDR, there was no difference between pSPDR in both groups (screening 13.6%; other indications 13.7%; P=0.931). There was no significant difference in the mean age (P=0.259) or in the proportion of men and women (P=0.211) between both groups. CONCLUSION: Proximal serrated polyp detection rate showed an insignificant difference between groups with different indications and could be used as a complementary indicator to adenoma detection rate. This could benefit colonoscopists with low colonoscopy volume or low volume of screening colonoscopies.


RESUMO CONTEXTO: A efetividade da colonoscopia no rastreamento do câncer colorretal (CCR) depende de indicadores de qualidade, sendo a taxa de detecção de adenoma (TDA) a mais importante. A taxa de detecção de pólipos serrilhados proximais (TDPSp) tem sido estudada como um potencial indicador de qualidade para a colonoscopia. OBJETIVO: O objetivo é analisar e comparar a diferença de TDA e TDPSp entre pacientes submetidos à colonoscopia de rastreamento e uma população não selecionada com outras indicações para colonoscopia, incluindo vigilância e diagnóstico. MÉTODOS: Esta é uma coorte histórica de pacientes submetidos à colonoscopia no serviço de endoscopia digestiva de um hospital terciário. Das 1554 colonoscopias realizadas, 573 pacientes foram excluídos. Os 981 pacientes restantes foram divididos em dois grupos: pacientes submetidos à colonoscopia de rastreamento (n=428; 43,6%); pacientes com outras indicações, incluindo vigilância e diagnóstico (n=553; 56,4%). RESULTADOS: A taxa de detecção de adenoma do grupo com outras indicações (50,6%) foi superior à do grupo de rastreamento (44,6%; P=0,03). Em relação ao TDPSp, não houve diferença entre os dois grupos (triagem 13,6%; outras indicações 13,7%; P=0,931). Não houve diferença significativa na idade média (P=0,259) ou na proporção de homens e mulheres (P=0,211) entre os grupos. CONCLUSÃO: A taxa de detecção proximal de pólipos serrilhados mostrou uma diferença insignificante entre os grupos com diferentes indicações para colonoscopia e poderia ser utilizada como um indicador complementar a TDA. Isso beneficiaria colonoscopistas com baixo volume de colonoscopias ou baixo volume de colonoscopias de rastreamento.


Subject(s)
Humans , Male , Female , Colorectal Neoplasms/diagnosis , Adenoma/diagnosis , Colonic Polyps/diagnosis , Retrospective Studies , Colonoscopy , Quality Indicators, Health Care , Early Detection of Cancer
12.
Rev. bras. oftalmol ; 79(6): 409-412, nov.-dez. 2020. graf
Article in Portuguese | LILACS | ID: biblio-1156156

ABSTRACT

Resumo Os tumores de hipófise representam aproximadamente 15% de todos os tumores cerebrais e dependendo do tamanho, pressionam o quiasma óptico, resultando em comprometimento da função visual que se manifesta como defeitos no campo visual, diminuição da acuidade visual e da visão das cores. O objetivo do presente estudo foi relatar um caso de macroadenoma de hipófise com compressão do quiasma óptico e defeito no campo visual, tratado inicialmente como glaucoma, levando a um diagnóstico e tratamento tardio.


Abstract Pituitary tumors represent approximately 15% of all brain tumors and depending on size, pressure optic chiasma, resulting in impaired visual func-tion that manifests itself as defective in the visual field, decreased acuity visual and color vision. The ob-jetive of the present study was to report a case of pitui-tary macroadenoma with compression of optical chiasma and visual field de-fect, initially treated as glaucoma, leading to a late diagnosis and treatment.


Subject(s)
Humans , Male , Adult , Optic Chiasm/physiopathology , Pituitary Neoplasms/diagnosis , Visual Acuity , Visual Fields , Adenoma/diagnosis , Color Vision
13.
Arq. gastroenterol ; 57(3): 316-322, July-Sept. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131664

ABSTRACT

ABSTRACT BACKGROUND: Rectal bleeding is the most important symptom of intestinal neoplasia; thus, tests of occult blood detection in stools are widely used for pre neoplastic lesions and colorectal cancer (CRC) screening. OBJECTIVE: Evaluate the accuracy of OC-Sensor quantitative test (Eiken Chemical, Tokyo, Japan) at cut-off 10 µg Hb/g feces (50 ng/mL) in a cohort of subjects that had to undergo diagnostic colonoscopy, and if more than one sample collected in consecutive days would improve the diagnostic accuracy of the test. METHODS: Patients (mean age 56.3±9.7 years) that underwent colonoscopy prospectively randomly received one (1-sample FIT, FIT 1) or two (2-sample FIT, FIT 2) collection tubes. They collected the stool sample before starting colonoscopy preparation. Samples were analyzed by the OC-Auto Micro 80 (Eiken Chemical, Tokyo, Japan). The performance of FIT 1 and FIT 2 were compared to the colonoscopy findings. RESULTS: Among 289 patients, CRC was diagnosed in 14 (4.8%), advanced adenoma in 37 (12.8%), early adenoma in 71 (24.6%) and no abnormalities in 141 (48.8%). For FIT 1, the sensitivity for CRC was 83.3% (95%CI 36.5-99.1%), for advanced adenoma was 24% (95%CI 10.1-45.5%), with specificity of 86.9% (95%CI 77.3-92.9%). For FIT 2, the sensitivity for CRC was 75% (95%CI 35.6-95.5%), for advanced adenoma was 50% (95%CI 22.3-77.7%), with specificity of 92.9% (95%CI 82.2-97.7%). The positive likelihood ratios were 1.8 (95%CI 0.7-4.4 for FIT 1) and 7.1 (95%CI 2.4-21.4 for FIT 2) for advanced adenoma, and 6.4 (95%CI 3.3-12.3, for FIT 1) and 10.7 (95%CI 3.8-29.8, for FIT 2) for CRC. The negative likelihood ratio were 0.9 (95%CI 0.7-1, for FIT 1) and 0.5 (95%CI 0.3-0.9, for FIT 2) for advanced adenoma, and 0.2 (0.03-1.1, for FIT 1) and 0.3 (0.08-0.9, for FIT 2) for CRC. The differences between FIT 1 and FIT 2 performances were not significant. However, the comparison of the levels of hemoglobin in feces of patients of FIT 1 and FIT 2 showed that the differences between no polyp group and advanced adenoma and CRC were significant. CONCLUSION: The accuracy of OCR Sensor with 10 µg Hb/g feces cut-off was comparable to other reports and two-sample collection improved the detection rate of advanced adenoma, a pre neoplastic condition to prevent CRC incidence.


RESUMO CONTEXTO: Sangramento retal é o sintoma mais importante de neoplasia intestinal; portanto, testes para detecção de sangue oculto nas fezes são amplamente usados para rastreamento de lesões pré-neoplásicas e de câncer colorretal (CCR). OBJETIVO: Avaliar a acurácia do teste quantitativo OC-Sensor (Eiken Chemical, Tokyo, Japan) com o valor de corte de 10 µg Hb/g fezes (50 ng/mL) numa coorte de indivíduos que se submeteram à colonoscopia diagnóstica, e se mais de uma amostra coletada em dias consecutivos melhoraria a acurácia diagnóstica do teste. MÉTODOS: Pacientes (idade média 56,3±9,7 anos) que se submeteram à colonoscopia prospectivamente, randomicamente, receberam tubos de coleta: um (1-amostra FIT, FIT 1), ou dois (2-amostra FIT, FIT 2). Eles coletaram as amostras de fezes antes de iniciar o preparo da colonoscopia. As amostras foram analisadas pelo OC-Auto Micro 80 (Eiken Chemical, Tokyo, Japan). As performances do FIT 1 e do FIT 2 foram comparadas com os achados da colonoscopia. RESULTADOS: Entre 289 pacientes, CCR foi diagnosticado em 14 (4,8%), adenoma avançado em 37 (12,8%), adenoma precoce em 71 (24,6%) e sem anormalidades em 141 (48,8%). Para FIT 1, a sensibilidade para CCR foi 83,3% (95%IC 36,5-99,1%), para adenoma avançado foi 24% (95%IC 10,1-45,5%), com especificidade de 86,9% (95%IC 77,3-92,9%). Para FIT 2, a sensibilidade para CCR foi 75% (95%IC 35,6-95,5%), para adenoma avançado foi 50% (95%IC 22,3-77,7%), com especificidade de 92,9% (95%IC 82,2-97,7%). A razão de verossimilhança positiva foi 1,8 (95%IC 0,7-4,4 para FIT 1) e 7,1 (95%IC 2,4-21,4 para FIT 2) para adenoma avançado, e 6,4 (95%IC 3,3-12,3, para FIT 1) e 10,7 (95%IC 3,8-29,8, para FIT 2) para CCR. A razão de verossimilhança negativa foi 0,9 (95%IC 0,7-1, para FIT 1) e 0,5 (95%IC 0,3-0,9, para FIT 2) para adenoma avançado, e 0,2 (0,03-1,1, para FIT 1) e 0,3 (0,08-0,9, para FIT 2) para CCR. As diferenças de performance entre FIT 1 e FIT 2 não foram significantes. Entretanto, a comparação dos níveis de hemoglobina nas fezes dos pacientes de FIT 1 e FIT 2 mostraram que as diferenças entre sem pólipo e adenoma avançado e CCR foram significantes. CONCLUSÃO: A acurácia do OCR Sensor com valor de corte de 10 µg Hb/g de fezes foi comparável a outras publicações e a coleta de duas amostras melhorou a taxa de detecção de adenoma avançado, lesão pré-neoplásica, para prevenir CCR.


Subject(s)
Humans , Aged , Colorectal Neoplasms/diagnosis , Adenoma , Colonoscopy , Early Detection of Cancer , Feces , Middle Aged , Occult Blood
14.
Rev. Assoc. Med. Bras. (1992) ; 66(9): 1190-1195, Sept. 2020. graf
Article in English | LILACS, SES-SP | ID: biblio-1136370

ABSTRACT

SUMMARY Tubulovillous adenomas of the duodenal ampulla are rare neoplasms. The present report describes a case with radiological-endoscopic and pathological correlation in which the patient underwent duodenal pancreatectomy with good postoperative progression. With advanced imaging methods, especially magnetic resonance and endoscopic ultrasound, locoregional aspects and extraluminal, lymphovascular, and metastatic invasion have been increasingly discussed as contributors to therapeutic decision making. This progression improves lesion staging and is especially useful in selecting eligible candidates for endoscopic treatment.


RESUMO Os adenomas túbulo-vilosos da ampola duodenal são neoplasias raras. Neste trabalho apresentamos um caso com correlação radiológico-endoscópica e patológica, tendo a paciente sido submetida à duodenopancreatectomia com boa evolução pós-operatória. Com os avanços dos métodos de imagem, em especial da ressonância magnética e ultrassonografia endoscópica, aspectos locorregionais, além da invasão extraluminal, linfovascular e metastática, têm sido discutidos de maneira crescente como contribuintes na decisão terapêutica. Essa evolução contribui para o melhor estadiamento destas lesões e é especialmente útil para selecionar candidatos elegíveis ao tratamento endoscópico.


Subject(s)
Humans , Adenoma/surgery , Radiography , Endosonography , Duodenal Neoplasms , Endoscopy
15.
Rev. cuba. med ; 59(3): e1324, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1139061

ABSTRACT

Introducción: El hiperparatiroidismo es una de las causas más frecuente de hipercalcemia. El 85 por ciento de los pacientes son mayores de treinta años, su frecuencia más alta se encuentra por encima de 60 años, a largo plazo puede producir una serie de complicaciones. Objetivo: Describir el caso clínico de hiperparatiroidismo primario que resultó negativa al estudio de gammagrafía con localización ectópica del adenoma. Caso Clínico: Paciente femenina de 20 años con antecedentes de litiasis renal y uretral de 7 años de evolución, la cual se sometió a 13 sesiones de litotricia y dos cirugías renales con recidivas, hace 6 meses se detectó cifras elevadas de calcio. Se realiza protocolo de estudio de hipercalcemia determinándose hiperparatiroidismo primario, ultrasonido y tomografía de cuello reportan lesión que podría corresponder a un adenoma paratiroideo paratraqueal; sin embargo, la gammagrafía con metoxi-isobutilisonitrilo y tecnecio 99 fue negativa. Se realizó cirugía de cuello convencional ya que la cirugía radioguiada no fue útil para la localización del adenoma paratiroideo intraoperatorio. Estudio histopatológico reportó adenoma paratiroideo. Conclusiones: En adenomas paratiroideo con gammagrafía negativa se puede hacer el diagnostico con estudios de imagen convencional. La localización ectópica del adenoma paratiroideo constituye una causa de gammagrafía negativa. La cirugía radioguiada no es útil en los adenomas paratiroides ectópicos con gammagrafía negativa(AU)


Introduction: Hyperparathyroidism is one of the most frequent causes of hypercalcemia. 85 percent of patients are older than thirty years, its highest frequency is over 60 years, in the long term it can produce a series of complications. Objective: To describe a clinical case of primary hyperparathyroidism that was negative in the scintigraphy study with ectopic location of the adenoma. Clinical case report: A 20-year-old female patient with a 7-year history of renal and urethral lithiasis, who had undergone 13 lithotripsy sessions and two recurrent kidney surgeries. Six months ago, elevated calcium levels were detected. A study protocol for hypercalcemia was carried out, determining primary hyperparathyroidism. Ultrasound and neck tomography report a lesion that could correspond to a paratracheal parathyroid adenoma; however, methoxy-isobutylisonitrile and technetium-99 scintigraphy was negative. Conventional neck surgery was performed since radioguided surgery was not useful for locating the intraoperative parathyroid adenoma. Histopathological study reported parathyroid adenoma. Conclusions: In parathyroid adenomas with negative scintigraphy, the diagnosis can be reached with conventional imaging studies. The ectopic location of the parathyroid adenoma is a cause of negative scintigraphy. Radioguided surgery is not helpful in scan-negative ectopic parathyroid adenomas(AU)


Subject(s)
Humans , Female , Adult , Adenoma/diagnostic imaging , Hyperparathyroidism, Primary/complications , Hyperparathyroidism, Primary/diagnostic imaging , Hypercalcemia/complications
16.
Rev. méd. Chile ; 148(6): 858-867, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1139382

ABSTRACT

Colorectal (CRC) is one of the most common types of cancer worldwide. Most tumors develop from an adenoma in a period of 10 to 15 years, but some may appear without previous adenomatous lesions. Seventy-five percent of colorectal cancers are sporadic, 20% have a family component (first or second-degree relatives with CRC) and 5% have a hereditary predisposition with a Mendelian pattern. The epidemiological evolution in the recent years in Chile has a worrisome evolution and the treatment costs of advanced stages are a burden for the healthcare system. We herein highlight the main Chilean medical and scientific contributions on the pathogenesis, early diagnosis, and treatment of CRC, which lead to its better understanding, and therefore better management, based on local evidence.


Subject(s)
Humans , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/genetics , Colorectal Neoplasms/epidemiology , Adenoma , Chile/epidemiology , Genetic Predisposition to Disease
17.
Medicina (B.Aires) ; 80(2): 181-184, abr. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1125063

ABSTRACT

La mayoría de los adenomas hipofisarios son esporádicos, pero un 3-5% puede ocurrir en un contexto familiar y hereditario. Este es el caso de la neoplasia endocrina múltiple de tipo 1 (NEM1), complejo de Carney (CNC) y adenomas hipofisarios aislados familiares (FIPA). El FIPA es una condición infrecuente, que ocurre en un contexto familiar, no asociada a NEM t ipo1 ni CNC. Los FIPA pueden ser homogéneos (todos los adenomas tienen el mismo fenotipo) o heterogéneos (diferente fenotipo tumoral). Describimos una familia congolesa en la que dos hermanas y una prima fueron diagnosticadas a los 29, 32 y 40 años, respectivamente, con un prolactinoma (FIPA homogéneo). Las pacientes presentaron macroadenomas no invasivos al momento del diagnóstico, con buena respuesta biológica y tumoral al tratamiento con cabergolina hasta una dosis máxima de 1.5 mg/semanal. De las dos hermanas, una cursó un embarazo sin complicaciones. Durante el seguimiento de 12 años, ninguna de ellas presentó elementos clínicos o biológicos compatibles con NEM1 o CNC, por lo que dichos genes no se estudiaron. El análisis genético en dos de las pacientes permitió descartar la posibilidad de una mutación germinal del gen aryl hydrocarbon receptor interacting protein (AIP). Se considera que el 80% de los pacientes con FIPA no presentan mutación del gen AIP, por lo que se requieren futuros estudios en este tipo de familias, para poder determinar otros genes afectados involucrados en su fisiopatología.


Most pituitary adenomas are sporadic, but 3-5% can occur in a family and hereditary context. This is the case of multiple endocrine neoplasia type 1 (MEN1), Carney complex (CNC) and familial isolated pituitary adenomas (FIPA). FIPA is an infrequent condition that occurs in a family context, not associated with MEN type1 or CNC. FIPA kindred can be homogeneous (all adenomas affected in the family having the same tumor phenotype) or heterogeneous (different tumor phenotypes in the affected members). We describe a Congolese family in which two sisters and a cousin were diagnosed with a prolactinoma (homogenous FIPA) at the ages of 29, 32 and 40 years, respectively. The patients presented with macroadenomas at the time of diagnosis, non-invasive tumors and good biological response to cabergoline treatment (maximum dose of 1.5 mg/weekly). Of these two sisters, one went through a pregnancy without complications. Because no MEN1 and CNC clinical and biochemical features were detected during the 12-year follow-up, these genes were not investigated. The genetic analysis of the aryl hydrocarbon receptor interacting protein (AIP) was normal. As nearly 80% of patients with FIPA do not have a mutation in the AIP gene, future studies in these families are required to identify other affected genes involved in their physiopathology.


Subject(s)
Humans , Female , Adult , Pituitary Neoplasms/genetics , Adenoma/genetics , Growth Hormone-Secreting Pituitary Adenoma , Pituitary Neoplasms/diagnosis , Neoplastic Syndromes, Hereditary/diagnosis , Neoplastic Syndromes, Hereditary/genetics , Magnetic Resonance Spectroscopy , Adenoma/diagnosis , Multiple Endocrine Neoplasia Type 1/genetics , Mutation
18.
J. coloproctol. (Rio J., Impr.) ; 40(2): 149-155, Apr.-Jun. 2020. tab
Article in English | LILACS | ID: biblio-1134968

ABSTRACT

ABSTRACT Background: An inverse association between circulating vitamin D and adenoma risk hasbeen reported, but less is known about proximal inflammatory-hyperplastic polyps.Purpose: To investigate circulating 25(OH)D3and risk factors of proximal inflammatory-hyperplastic and adenoma colorectal polyps.Methods: From January 2017 to June 2019, consecutive asymptomatic average-risk partic-ipants undergoing initial screening colonoscopy. Questionnaires provided information oncolorectal polyp risk factors, and plasma samples were assayed for 25-Hydroxyvitamin-D ­25(OH)D3. The colorectal polyps were assessed, and medical history and demographic datawere obtained from each patient.Results: Of the 220 asymptomatic subjects, the prevalence of proximal inflammatory-hyperplastic polyps and adenoma polyps were 16.8%; 18.1% and 22.2%, respectively.Multivariate analysis revealed that low vitamin D (25(OH)D3< 18 ng/mL, OR = 3.94; 95%CI: 1.81­9.51) and current/former smoking (OR = 6.85; 95% CI: 2.98­15.70), high bodymass index (BMI > 24, OR = 5.32, 95% CI: 2.62­4.71) were independent predictors forproximal inflammatory-hyperplastic colorectal polyps (non-adenoma). Low vitamin D(25(OH)D3< 18 ng/mL, OR = 7.75; 95% CI: 3.19­18.80) and current/former smoking (OR = 3.75;95% CI: 1.30­10.81), age over 60 years old (OR = 2.38, 95% CI: 1.02­5.57), were independentpredictors for adenoma colorectal polyps.Conclusion: Low vitamin D and smoking are common risk factors for both adenomatous andproximal inflammatory hyperplastic polyps. Old age and BMI are additional risk factors forthe development of adenomatous and non-adenomatous colorectal polyps.


RESUMO Background: An inverse association between circulating vitamin D and adenoma risk hasbeen reported, but less is known about proximal inflammatory-hyperplastic polyps.Purpose: To investigate circulating 25(OH)D3and risk factors of proximal inflammatory-hyperplastic and adenoma colorectal polyps.Methods: From January 2017 to June 2019, consecutive asymptomatic average-risk partic-ipants undergoing initial screening colonoscopy. Questionnaires provided information oncolorectal polyp risk factors, and plasma samples were assayed for 25-Hydroxyvitamin-D ­25(OH)D3. The colorectal polyps were assessed, and medical history and demographic datawere obtained from each patient.Results: Of the 220 asymptomatic subjects, the prevalence of proximal inflammatory-hyperplastic polyps and adenoma polyps were 16.8%; 18.1% and 22.2%, respectively.Multivariate analysis revealed that low vitamin D (25(OH)D3< 18 ng/mL, OR = 3.94; 95%CI: 1.81­9.51) and current/former smoking (OR = 6.85; 95% CI: 2.98­15.70), high bodymass index (BMI > 24, OR = 5.32, 95% CI: 2.62­4.71) were independent predictors forproximal inflammatory-hyperplastic colorectal polyps (non-adenoma). Low vitamin D(25(OH)D3< 18 ng/mL, OR = 7.75; 95% CI: 3.19­18.80) and current/former smoking (OR = 3.75;95% CI: 1.30­10.81), age over 60 years old (OR = 2.38, 95% CI: 1.02­5.57), were independentpredictors for adenoma colorectal polyps.Conclusion: Low vitamin D and smoking are common risk factors for both adenomatous andproximal inflammatory hyperplastic polyps. Old age and BMI are additional risk factors forthe development of adenomatous and non-adenomatous colorectal polyps.


Subject(s)
Humans , Male , Female , Calcitriol , Adenoma/prevention & control , Colonic Polyps/prevention & control , Tobacco Use Disorder , Vitamin D , Colorectal Neoplasms/pathology , Risk Factors , Colonoscopy , Adenomatous Polyps/prevention & control
19.
Rev. argent. neurocir ; 34(1): 15-35, mar. 2020. ilus, grafs
Article in Spanish | LILACS, BINACIS | ID: biblio-1151244

ABSTRACT

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


Subject(s)
Adenoma , Pituitary Gland , Pituitary Neoplasms , Skull , Neuroendocrinology
20.
Arq. neuropsiquiatr ; 78(1): 28-33, Jan. 2020. tab
Article in English | LILACS | ID: biblio-1088982

ABSTRACT

Abstract Prolactin (PRL) secreting adenomas are associated with high incidence of headache. The role of hyperprolactinemia in the headache context is not clear, nor is the effect of its treatment on headache. Methods: The present longitudinal study evaluated hyperprolactinemic patients (69), in terms of presence and characteristics of headache before and after hyperprolactinemia treatment. Results: Headache was reported by 45 (65.2%) patients, independent of the etiology of hyperprolactinemia. The migraine phenotype was the most prevalent (66.6%). Medications used in the treatment of headache not changed during the study. The first line of treatment of hyperprolactinemia was dopaminergic agonists. In the last reevaluation, PRL level under treatment was within the reference range in 54.7% of the cases, and it was observed complete or partial resolution of the headache in 75% of the cases. The median PRL at this time in patients with complete headache resolution was 17 ng/mL, in those who reported partial recovery was 21 ng/mL, and in those in whom the headache did not change was 66 ng/mL, with a significant difference between the group with complete headache resolution vs. the group with unchanged headache (p=0.022). In the cases with complete headache resolution, the median fall on PRL levels was 89% and in those cases with partial headache resolution 86%, both significantly different (p<0.001) from the fall in the cases with an unchanged headache. Conclusion: Data allow us to conclude that, in this series, in the majority of cases the reduction in the level of PRL was followe3d by cessation or relief of the pain.


Resumo Os adenomas secretores de prolactina (PRL) estão associados à alta incidência de cefaleia. O papel da hiperprolactinemia no contexto da dor de cabeça não está claro, nem o efeito da redução dos níveis da PRL na cefaleia. Métodos: O presente estudo longitudinal avaliou pacientes hiperprolactinêmicos (69), quanto à presença e às características da cefaleia antes e após o tratamento da hiperprolactinemia. Resultados: Cefaleia foi relatada por 45 (65,2%) pacientes, independente da etiologia da hiperprolactinemia. O fenótipo de enxaqueca foi mais prevalente (66,6%). Os medicamentos usados ​​no tratamento da cefaleia não foram alterados durante o estudo. A primeira linha de tratamento da hiperprolactinemia foram os agonistas dopaminérgicos. Na última reavaliação, o nível de PRL sob tratamento estava dentro da faixa de referência em 54,7% dos casos, observando-se resolução completa ou parcial da cefaleia em 75% dos casos. A mediana de PRL neste momento em pacientes com resolução completa da cefaleia foi de 17 ng/mL, nos que relataram recuperação parcial foi de 21 ng/mL, e naqueles em que a cefaleia não se alterou foi de 66 ng/mL, com uma diferença significativa entre o grupo com resolução completa da cefaleia versus o grupo com cefaleia inalterada (p=0,022). Nos casos com resolução completa da cefaleia, a queda mediana nos níveis de PRL foi de 89% e nos casos com resolução parcial de cefaleia de 86%, ambos significativamente diferentes (p<0,001) da queda nos casos com cefaleia inalterada. Conclusão: Os dados permitem concluir que, nesta série, na maioria dos casos, a redução do nível de PRL foi seguida pela cessação ou alívio da dor.


Subject(s)
Humans , Male , Adult , Middle Aged , Prolactin/blood , Hyperprolactinemia/therapy , Headache/prevention & control , Headache/blood , Pituitary Neoplasms/complications , Pituitary Neoplasms/therapy , Reference Values , Hyperprolactinemia/complications , Adenoma/complications , Adenoma/therapy , Analysis of Variance , Longitudinal Studies , Treatment Outcome , Statistics, Nonparametric , Dopamine Agonists/therapeutic use , Headache/etiology
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