Management of prolactinomas in Brazil: an electronic survey.

Dopamine agonists are the treatment of choice for prolactinomas. However, there are still controversies concerning dose, treatment duration and criteria for drug withdrawal in different clinical situations. The aim of this study was to assess diagnostic and therapeutic approaches to prolactinomas among members of the Brazilian Society of Endocrinology and Metabolism (SBEM). SBEM members answered a questionnaire sent by e-mail that included 18 questions related to controversial issues about the management of prolactinomas. Among SBEM members, 721 (approximately 24% of total) answered the questionnaire. Concerning the diagnosis, 38% of the respondents stated that prolactin levels < 100 ng/ml would exclude the presence of a prolactinoma. Most of them favored the screening for macroprolactin in asymptomatic individuals instead of a routine screening (74% vs. 26%). Regarding the treatment, 70% of the respondents chose cabergoline as the drug of choice to treat macroprolactinomas whereas similar proportions advised cabergoline or bromocriptine as the best treatment for microprolactinomas (52% vs. 48%). Only 20% and 34% of respondents favored treatment withdrawal 2-3 years after prolactin normalization in patients with macroprolactinomas and microprolactinomas, respectively. In case of pregnancy, only 58 and 70% of respondents advocated discontinuation of treatment with dopamine agonists in patients with macroprolactinomas and microprolactinomas, respectively. Finally, only 36% would allow breast-feeding without restriction, 44% would restrict it to patients with microprolactinomas and 20% would not recommend it for women with prolactinomas There are several points of disagreement among SBEM members regarding the management of prolactinomas.

Ultrasonographic measurement of intra-abdominal fat thickness in HIV-infected patients treated or not with antiretroviral drugs and its correlation to lipid and glycemic profiles.

AIMS: To compare the intra-abdominal fat thickness measured by ultrasound between HIV-infected patients treated or not with antiretroviral drugs and to correlate these visceral adiposity measurements to other parameters of cardiovascular risks. METHODS: In a transversal observational study, 160 HIV-infected patients were recruited and divided in two groups, i.e., 123 antiretroviral (ARV)-treated and 37 ARV-naïve patients. These patients were submitted to anthropometric determinations, laboratorial analysis, ultrasonographic measurements of subcutaneous and intra- abdominal fat thickness and to tetrapolar bioelectrical impedance analysis in order to measure the body composition. RESULTS: In the patients treated with highly active antiretroviral therapy (HAART) the intra-abdominal fat pad was significantly thicker than that of the untreated group (69 +/- 21 mm, n = 123 vs. 60 +/- 18 mm, n = 37; p = 0.03 Student's t test). The intra-abdominal fat thickness correlated significantly with plasma triglyceride, total cholesterol, fasting glucose, glucose measurements 2 h after dextrose load, fasting insulin, HOMA-IR index, systolic and diastolic blood pressures, weight, BMI, WHR and caliper-measured total fat percentage. CONCLUSION: The results showed that antiretroviral therapy is associated with increased ultrasonographic measurements of visceral adiposity. Our data demonstrated a strong correlation between intra-abdominal fat thickness and independent risk factors of cardiovascular disease: atherogenic lipid profile and insulin resistance.

Gestational diabetes: a condition of early diastolic abnormalities in young women.

BACKGROUND: Gestational diabetes mellitus (GDM) is not merely a temporary condition, but a harbinger of type 2 diabetes mellitus, hypertension, and atherosclerotic disease. We examined the effect of GDM on cardiac diastolic function. METHODS: Diastolic function was evaluated by serial Doppler echocardiography with pulsed tissue Doppler imaging in 13 patients with GDM and 13 healthy pregnant women (control group) during the third trimester of pregnancy and after 8 weeks postpartum. Diagnostic criteria for GDM were those as recommended by the American Diabetes Association. Exclusion criteria were any disease or condition that could interfere with diastolic function. Measurements at both times in each group were compared by paired t tests and changes of patients with diabetes were compared with those in control patients by unpaired t tests. RESULTS: There were no differences in age, left ventricular mass, or systolic function between groups. The Doppler parameters that showed significant difference between groups were higher atrial contraction wave (A wave) (P = .008) and lower rapid filling wave (E)/A ratio (P = .006) in diabetic group, on both occasions. Tissue Doppler parameters showed a significant decrease in Em (P = .002) and early mitral annulus velocity (Em)/late mitral annulus velocity (Am) (P = .008) in diabetic group on both occasions, and the Am wave remained increased only in the diabetic group at postpartum. CONCLUSIONS: Patients with GDM showed a different diastolic function profile, suggesting a mild degree of diastolic abnormality. The persistence of some abnormalities postpartum corroborates our hypothesis of an early cardiovascular involvement in this group, enhancing the need of a close cardiovascular follow-up of these patients.

Acute metabolic effects of thiopental anesthesia on fed and fasted rats chronically treated with bromocriptine.

We investigated the acute effects of thiopental anesthesia (4 mg/100 g, i.v.) on plasma glucose, insulin, triacylglycerol, and prolactin levels in rats treated with bromocriptine (BR) (0.4 mg/100 g body wt, i.p., for two weeks). Thiopental anesthesia induced a rapid increase in plasma insulin that was more pronounced in the animals treated with BR (116%, P <0.05). Thiopental anesthesia also produced a 55% decreased in plasma prolactin levels (P <0.01) in control fed rats, and a 22% reduction in plasma triacylglycerol (P <0.05) in both controls and BR-treated rats. We conclude that BR may constitute and additional sympatholytic factor in animals submitted to thiopental anesthesia.