[A rare case of hyperandrogenism: bilateral Leydig cell tumor of the ovary]. / Um caso raro de hiperandrogenismo tumor ovárico bilateral de células de Leydig.

BACKGROUND: The androgen-secreting tumors constitute fewer than 1% of ovarian tumors. Leydig cell tumor is one of the most common of this type of lesion and it is usually benign, small and unilateral. CASE REPORT: A 67 year old woman was referred to the Endocrine clinic due to hirsutism (score 22 Ferriman-Gallwey) and male type alopecia with 3 years of evolution and progressive worsening. Biochemically she had high levels of serum testosterone - 662 ng/dl (N < 62 ng/dl). Transvaginal ultrasonography and abdomen-pelvic CT scan didn't show any signs of adrenal or ovarian tumors. Bilateral oophorectomy was performed and histopathologic exam revealed bilateral Leydig cell tumors, measuring 1cm each. Four months after surgery, the patient had a marked improvement of the signs (score 3 Ferriman-Gallwey) and normalized testosterone levels (35.9 ng/dl). DISCUSSION: Androgen-secreting tumors are rare, but they should be excluded in cases of rapid onset of virilization and elevated androgen levels. Tumors are frequently undetectable by imaging techniques because of their small dimensions, exploratory surgery by a skilled team is frequently necessary and is often the best treatment for the majority of these cases. In this case report we present a rare case of bilateral Leydig cell tumor. Only five cases have been reported in the literature.The clinical history and the elevated levels of testosterone had suggested the presence of an androgen-producing tumor, despite the difficulty of the diagnosis on imaging techniques. Due to the fact that our patient was in a post-menopausal stage, we decided that the appropriate treatment would be bilateral oophorectomy. The histopathologic disclosed the diagnosis and allowed the patient's cure.

[Hyperthyroidism in a hospital environment: 5-year evaluation]. / Hipertiroidismo em meio hospitalar: avaliação em cinco anos.

INTRODUCTION: Thyroid diseases are an area of particular interest to this Department, constituting 30% of the 3561 patients observed over the last 5 years (when group consultations were set up and outpatient data computerised). OBJECTIVES: To determine the prevalence and aetiologies of Hyperthyroidism (HT) in outpatient clinic and characterise diagnostic and therapy practice. METHODOLOGY: All files of patients diagnosed with HT treated in the department over the last 5 years were reviewed. Of a total of 105 files, 96 were analysed. The data analysed included: demographic data, aetiology of disease, complementary diagnostic test reported, treatment options and follow-up. The data was analysed independently depending on whether 1st consultation occurred before or after 1999. The variables were analysed using descriptive statistical methods, namely frequency and contingency tables for categoric variables and mean, standard deviation, maximum and minimum values for continuous variables. RESULTS: Of the patients evaluated, 72% were female and 28% male, with an average age of 50. 49.0% had Graves' Disease (GD); 14.6% toxic multinodular goitre (TMNG); 11.5% autoimmune HT; 10.4% iatrogenic HT; 7.3% subacute thyroiditis and 7.3% toxic adenoma (TA). Medical treatment was 1st option for 92% of patients with GD (40.4% of cases combined with levothyroxine); 5% received 131Iodine treatment and 3% underwent surgery. In this group, 6 months after suspension of medical treatment, 30.4% had suffered a relapse. Of the patients who suffered a relapse, 42% underwent surgery and 28% received 131Iodine treatment. The remaining 30% made a second attempt with synthetic antithyroid drugs. For patients with TMNG, surgery was the 1st treatment option for the majority of patients (78.5%), followed by 131Iodine (14.2%). 70% of patients with toxic adenoma underwent surgery and 30% 131Iodine treatment. For other pathologies, namely autoimmune HT, iatrogenic HT and subacute thyroiditis, the option was medical treatment. CONCLUSIONS: Hyperthyroidism was diagnosed in 3.5% of patients observed as outpatients in this Department. GD was the most prevalent form of HT (49%). Medical treatment is the first treatment option (92%) for GD. 6 months after suspension of medical treatment, 30% of patients had suffered a relapse of GD. For these patients, surgery was the 1st option. For both TMNG and TA, surgery was the first treatment option. COMPLICATIONS: The adverse effects that occurred with ATDs (antithyroid drugs) were detected in 4,1% patients; one case of agranulocytosis with propylthiouracil, 2 cases of allergic reactions--rash (one due to the use of methimazole and the other to propylthiouracil), and one case of minor hepatocellular toxicity. In all patients there was improvement after stopping medical treatment.

[Obesity and quality of life]. / Obesidade e qualidade de vida.

Obesity is considered one of the most relevant health problems of modern societies, as it constitutes a predominant risk factor in the development of various other diseases. The negative impact of obesity on the quality of life of individuals has been the subject of diverse research. The results of a test carried out at Gothenburg University in Sweden suggest that severe obesity is a debilitating factor both for health and psychosocial functioning. Research carried out in Madrid permitted identification of a profile of obese patients with impaired quality of life, which has enabled prophylactic intervention or early treatment of these cases to be considered. The results of a study carried out in the USA propose that pain would appear to be directly related with quality of life and could be considered a covariant of obesity, and should therefore be taken into account in obesity treatments. A study carried out in Oxford concluded that obese subjects or subjects with another chronic disease presented a deterioration in physical wellbeing, however only subjects with another chronic disease (without associated obesity) presented a deterioration in psychological wellbeing. The majority of studies suggest the negative influence of obesity and overweight on health and psychosocial functioning, however it is not possible to clearly define a linear relation between obesity and diminished quality of life.

[Hyperthyroidism and pregnancy]. / Hipertiroidismo e gravidez.

The authors describe most common hyperthyroidism aetiologies that occur during pregnancy and also the immunity changes that define Graves' disease and the immunity tolerance associated to pregnancy. They also refer the clinical picture, laboratorial diagnosis and the treatment to be carried out. Medical treatment is mostly based on anti-thyroid drugs. Their characteristics and use during pregnancy are discussed.

[Grave's disease and stress]. / Stress e Doença de Graves. Relações entre o número e o impacto dos acontecimentos geradores de Stress e o início da Doença de Graves.

INTRODUCTION: In recent years, there have been many reports about a possible association between Stressful Life Events (SLE) and the onset of Graves' Disease (GD). Nevertheless, most papers have been criticised and no such association has yet been proven. AIM OF THE STUDY: To assess the possible associations between SLE and the onset of GD. METHODS: Retrospective study of 62 subjects, divided into 2 groups of 31 each, GD (Gp1) and controls (Gp2). The patients in Gp1 had thyroid disease diagnosed within the last 12 months, with clinical and biochemical confirmation. In Gp2, psychopathological and endocrine disturbances had been ruled out. Each 2 group consisted of 9 males (29%) and 22 females (71%). The mean age was 38.48 + 10.9 in Gp1 and 41.1 + 11.8 in Gp2. SLE evaluation (number and impact) was reported for the 12 months preceding the onset of symptoms of thyroid disease. To assess SLE, we used the Life Experiences Survey-LES from Saranson, Johnson and Siegel (1978; 1985). Statistical analysis was done using Mann-Whitney and Kruskal-Wallis tests. RESULTS: Patients with GD had a significantly greater number of SLEs compared to Controls (p < .001). The number and impact of negative SLEs was significantly higher in Gp1 compared to Gp2 (p < .001). There were no significant differences between the groups in terms of the number and impact of both positive and neutral SLEs. DISCUSSION: The findings of this study support that SLEs may contribute to the precipitation of GD. We observed that patients with GD had significantly more negative events and experienced a greater negative impact from them prior to the onset of GD. The association of SLEs with GD is probably related to the association of stress with changes in the immune system, which can play an important role in the aetiology of thyrotoxicosis.

[Mature onset diabetes of the young (MODY)]. / Mature onset diabetes of the young (MODY).

Maturity-onset diabetes of the young (MODY) is a rare form of juvenile diabetes mellitus, defined by early onset, absence of ketosis, non-insulin-dependent diabetes and autosomal dominant inheritance. Advances in molecular genetic analysis have identified mutations accounting for different MODY subtypes, all of them associated with defects of insulin secretion. We present a case of a nine year-old boy, admitted to our outpatient clinic because of mild and intermittent osmotic symptoms (polyuria, polyphagia and polydipsia) and persistently high values of fasting blood glucose in the last year. He had a family history of diabetes in three consecutive generations compatible with autossomal dominant inheritance. His height was 138.5 cm (90th centile) and his weight was 33.5 Kg (90th centile). General examination was unremarkable, in a prepubertal boy. A standard oral glucose tolerance test was performed. The fasting blood glucose was 118 mg/dl with a two hour value of 160 mg/dl. ICA, IAA and GAD autoantibodies were undetectable. He started on diet therapy, keeping his fasting blood glucose measurements on the upper limits of normal and HbA1c in the normal range. He was diagnosed as having MODY 2 on a clinical basis, as it is not possible to perform molecular analysis of this pathology in Portugal. As MODY is recently thought to account for 2-5% of all cases of type 2 Diabetes Mellitus it is important to consider it as a possible diagnosis in children who present with incidental hyperglycaemia. Molecular genetic testing is very important as it enables us to make a firm diagnosis of MODY, to define a follow up plan and to reassure patients families, once the prognosis is significantly different among the different sub-types of MODY. We emphathize the need of creating national and international reference centres where such testing can be done.