ABSTRACT
Objective. This prospective open trial aimed to evaluate the efficacy and safety of isotretinoin (13-cis-retinoic acid) in patients with Cushing's disease (CD). Methods. Sixteen patients with CD and persistent or recurrent hypercortisolism after transsphenoidal surgery were given isotretinoin orally for 6-12 months. The drug was started on 20 mg daily and the dosage was increased up to 80 mg daily if needed and tolerated. Clinical, biochemical, and hormonal parameters were evaluated at baseline and monthly for 6-12 months. Results. Of the 16 subjects, 4% (25%) persisted with normal urinary free cortisol (UFC) levels at the end of the study. UFC reductions of up to 52.1% were found in the rest. Only patients with UFC levels below 2.5-fold of the upper limit of normal achieved sustained UFC normalization. Improvements of clinical and biochemical parameters were also noted mostly in responsive patients. Typical isotretinoin side-effects were experienced by 7 patients (43.7%), though they were mild and mostly transient. We also observed that the combination of isotretinoin with cabergoline, in relatively low doses, may occasionally be more effective than either drug alone. Conclusions. Isotretinoin may be an effective and safe therapy for some CD patients, particularly those with mild hypercortisolism.
ABSTRACT
OBJECTIVE: To determine vitamin D (25OHD) status and its relationship with bone mineral density (BMD) in 93 postmenopausal women. SUBJECTS AND METHODS: Patients were distributed in two groups: Group 1 - 51 to 65 years (n = 45) and Group 2 - 66 to 84 years (n = 48); 25OHD and PTH serum were analyzed and a DXA scan of the lumbar spine (LS) and femoral neck (FN) were taken. RESULTS: Mean +/- SD of serum 25OHD levels were 80.6 +/- 43.3 nmol/L (Group 1) and 63.7 +/- 27.6 nmol/L (Group 2); 24% had 25OHD levels < 25 nmol/L and 43.7% < 50 nmol/L. The prevalence of vitamin D deficiency at the 62.5 nmol/L cutoff increased significantly with age. Patients with hypovitaminosis D had a lower BMD at the FN (0.738 +/- 0.102 vs. 0.793 +/- 0.115 g/cm, p = 0.03) and had been postmenopausal for longer (21.0 +/- 8.4 vs. 16.2 +/- 8.4 years, p = 0.01). CONCLUSION: We found a high prevalence of hypovitaminosis D in postmenopausal women. Age, years elapsed since menopause and low BMD in the FN were associated with deficiency.
Subject(s)
Bone Density/physiology , Parathyroid Hormone/blood , Postmenopause/physiology , Vitamin D Deficiency/epidemiology , Age Distribution , Aged , Aged, 80 and over , Brazil/epidemiology , Cross-Sectional Studies , Female , Humans , Middle Aged , Osteoporosis, Postmenopausal/diagnosis , Prevalence , Tropical Climate , Vitamin D Deficiency/physiopathologyABSTRACT
OBJECTIVE: To determine vitamin D (25OHD) status and its relationship with bone mineral density (BMD) in 93 postmenopausal women. SUBJECTS AND METHODS: Patients were distributed in two groups: Group 1 - 51 to 65 years (n = 45) and Group 2 - 66 to 84 years (n = 48); 25OHD and PTH serum were analyzed and a DXA scan of the lumbar spine (LS) and femoral neck (FN) were taken. RESULTS: Mean ± SD of serum 25OHD levels were 80.6 ± 43.3 nmol/L (Group 1) and 63.7 ± 27.6 nmol/L (Group 2); 24 percent had 25OHD levels < 25 nmol/L and 43.7 percent < 50 nmol/L. The prevalence of vitamin D deficiency at the 62.5 nmol/L cutoff increased significantly with age. Patients with hypovitaminosis D had a lower BMD at the FN (0.738 ± 0.102 vs. 0.793 ± 0.115 g/cm, p = 0.03) and had been postmenopausal for longer (21.0 ± 8.4 vs. 16.2 ± 8.4 years, p = 0.01). CONCLUSION: We found a high prevalence of hypovitaminosis D in postmenopausal women. Age, years elapsed since menopause and low BMD in the FN were associated with deficiency.
OBJETIVO: Determinar o perfil da vitamina D (25OHD) e sua relação com a densidade mineral óssea (DMO) em 93 mulheres na pós-menopausa. SUJEITOS E MÉTODOS: As pacientes foram distribuídas em dois grupos: grupo 1 - 51 a 65 anos (45 pacientes) e 2 - 66 a 84 anos (48 pacientes); foram analisados 25OHD e PTH séricos e realizou-se exame de DXA em coluna lombar (LS) e colo do fêmur (FN). RESULTADOS: As médias ± desvio-padrão (DP) dos níveis de 25OHD foram 80,6 ± 43,3 nmol/L (grupo 1) e 63,7 ± 27,6 nmol/L (grupo 2); 24 por cento tinham 25OHD < 25 nmol/L e 43,7 por cento, < 50 nmol/L. A prevalência de deficiência de 25OHD, considerando 62,5 nmol/L como ponto de corte, aumentou significativamente com a idade. Pacientes com hipovitaminose D tinham uma menor DMO no FN (0,738 ± 0,102 vs. 0,793 ± 0,115 g/cm², p = 0,03) e maior tempo de pós-menopausa (21,0 ± 8,4 vs. 16,2 ± 8,4 anos, p = 0,01). CONCLUSÃO: Encontrou-se alta prevalência de hipovitaminose D em mulheres na pós-menopausa. Idade, anos desde a menopausa e baixa DMO no FN estavam associados à deficiência.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Middle Aged , Bone Density/physiology , Parathyroid Hormone/blood , Postmenopause/physiology , Vitamin D Deficiency/epidemiology , Age Distribution , Brazil/epidemiology , Cross-Sectional Studies , Osteoporosis, Postmenopausal/diagnosis , Prevalence , Tropical Climate , Vitamin D Deficiency/physiopathologyABSTRACT
Foram investigadas 41 pacients com incontinência urinária de esforço (IUE), através da ultra-sonografia transvulvar, para ser determinada a mobilidade vertical da junção uretrovesical (JUV). relacionou-se essa mobilidade com idade, paridade, tipo de parto, uretrocele e retocele. Medidas em repouso e esforço, da posição da JUV foram obtidas através deste método, considerando uma linha reta longitudinal, do bordo inferior da sínfise pública (SP) até o encontro de uma reta transversal, iniciada na JUV. As pacientes foram examinadas em posição de litotomia dorsal com 50ml de urina na bexiga. Foi demonstrado: que o exame ultra-sonografico proposto é fácil, objetivo e de baixo custo monetário; que a hipermobilidade vertical da JUV pcorre em 75,6 por cento das pacientes com IUE; e que é mais frequente hipermobilidade vertical da JUV em mulheres com mais de 3 partos, quando comparadas com as que tem no máximo 3 partos
