RESUMO
A 38-years-old woman presented to our hospital 2 years ago with 5-year history of reduced vision, chronic cephaleea and secondary amenorrhea. Her baseline prolactin level was 46504 ?IU/mL (reference range=127-637mUI/ml) with secondary hypogonadism, and pituitary magnetic resonance imaging revealed a giant prolactinoma (4 × 2.2 × 2.6 cm3) with suprasellar extension, optic chiasma and right cavernous sinus compression. She was initially treated with cabergoline in order to reduce the prolactin level and tumoral mass, but after 6 months of medical treatment she proceed to transsphenoidal tumor debulking surgery. Prolactin level dropped in the normal range only after the addition of cabergoline treatment after surgery (1 mg/day 3 times/per week). However, the extensive tumour was not completely resectable so she remained amenorrheic requiring hormone replacement therapy as well as thyroxine replacement due to the development of TSH deficiency (free T4 6.03 pmol/L)
RESUMO
Aim: To assess the impact of dietetic intervention on the nutritional status and calcium–phosphorus metabolism in maintenance hemodialysis (MHD) patients. Material and methods: Six-month longitudinal intervention study of 162 MHD patients selected from one dialysis unit in Romania. They were divided into 4 groups according to serum albumin (SA) level and the comorbid condition of chronic liver disease (CLD). Clinical and biochemical parameters were measured at baseline and 6 months after PNC (personalized nutritional counseling). Nutritional status was assessed by mSGA (modified Subjective Global Assessment) and dietary calorie and protein intake by diet history with the help of 72 h recall method. Nutritional counselling and personalized diets were recommended by the dietician bimonthly for a period of 6 months only to groups I and III (groups with hypoalbuminemia). Results: Comparison of data collected prior PNC (T0) and 6 months after (T6) showed: phosphorus (P) level decreased significantly in all 4 groups: group I- T0 vs. T6 p=0.005, group II: T0 vs. T6 p= 0.002; group III: T0 vs. T6 p=0.001, and group IV T0 vs. T6 p=0.042; serum Ca followed a similar trend; serum parathyroid hormone (PTH) remained stationary; SA level was significantly improved in both nutrition counseling groups (group I: T0 vs. T6 p= 0.001, group III: T0 vs. T6 p=0.001, respectively). Conclusions: Our study suggests that dietetic intervention focused on phosphate and albumin control in MHD patients with hyperphosphatemia and hypoalbuminemia contributes to an improvement in important nutritional parameters and to a positive calcium-phosphorus balance.