Pregnancy during the course of Cushing's syndrome: a case report and literature review.

SUMMARY: Cushing's syndrome is an endocrine disorder that causes anovulatory infertility secondary to hypercortisolism; therefore, pregnancy rarely occurs during its course. We present the case of a 24-year-old, 16-week pregnant female with a 10-month history of unintentional weight gain, dorsal gibbus, nonpruritic comedones, hirsutism and hair loss. Initial biochemical, hormonal and ultrasound investigations revealed hypokalemia, increased nocturnal cortisolemia and a right adrenal mass. The patient had persistent high blood pressure, hyperglycemia and hypercortisolemia. She was initially treated with antihypertensive medications and insulin therapy. Endogenous Cushing's syndrome was confirmed by an abdominal MRI that demonstrated a right adrenal adenoma. The patient underwent right laparoscopic adrenalectomy and anatomopathological examination revealed an adrenal adenoma with areas of oncocytic changes. Finally, antihypertensive medication was progressively reduced and glycemic control and hypokalemia reversal were achieved. Long-term therapy consisted of low-dose daily prednisone. During follow-up, despite favorable outcomes regarding the patient's Cushing's syndrome, stillbirth was confirmed at 28 weeks of pregnancy. We discuss the importance of early diagnosis and treatment of Cushing's syndrome to prevent severe maternal and fetal complications. LEARNING POINTS: Pregnancy can occur, though rarely, during the course of Cushing's syndrome. Pregnancy is a transient physiological state of hypercortisolism and it must be differentiated from Cushing's syndrome based on clinical manifestations and laboratory tests. The diagnosis of Cushing's syndrome during pregnancy may be challenging, particularly in the second and third trimesters because of the changes in the maternal hypothalamic-pituitary-adrenal axis. Pregnancy during the course of Cushing's syndrome is associated with severe maternal and fetal complications; therefore, its early diagnosis and treatment is critical.

Bases físicas da formação da imagem ultrassonográfica / Physical foundations of the formation of ultrasounographic image

A ultrassonografia é um método de diagnóstico por imagem que fornece informações em tempo real da arquitetura dos órgãos abdominais e pélvicos. As interfaces dos tecidos refletem o som, onde esta reflexão é processada por um computador produzindo uma fotografia ou uma imagem em movimento em um monitor. O presente artigo consiste de uma breve análise da formação da imagem ultrassonográfica, onde conceitos de terminologia, instrumentação e modos de exibição são detalhadamente discutidos. Ainda, compila as informações sobre os princípios físicos da ultrassonografia. A ampliação do conhecimento desta tecnologia possibilita a melhor compreensão das aplicações e limitações deste método diagnóstico, que tem se tornado rotina na medicina veterinária de pequenos animais.

The ultrasound scan is a diagnostic method by image that details information in real-time of the abdominal and pelvic organs structure. Tissues interfaces reflect the sounds and that mentioned reflection is processed by a computer which shoots either a picture or a real-time movement image into a screen. Thecurrent paper consists of a brief analysis of the ultrasound scan image formation in which terminologyconcepts, instrumentation and ways of displaying are circumstantially discussed. Yet, it summarizes information about the ultrasound scan material principles. The knowledge enlargement of this technology allows the best comprehension of the applications and limitations of this diagnostic method, which has become a routine in the veterinarian medicine for small animals.

Anomalias e prognóstico fetal associados à translucência nucal aumentada e cariótipo anormal / Fetal abnormalities and prognosis associated with increased nuchal translucency and abnormal karyotype

OBJETIVO: Descrever a frequência de anomalias cromossômicas em fetos com translucência nucal (TN) aumentada, e a frequência de malformações estruturais, a evolução e o resultado da gestação nos fetos com TN aumentada e cariótipo anormal. MÉTODOS: Estudo retrospectivo envolvendo 246 casos com medida da TN acima do percentil 95º para a idade gestacional, com cariótipo fetal conhecido ou avaliação clínica das crianças no período pós-natal. Os casos foram acompanhados no setor de Medicina Fetal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTADOS: O resultado do cariótipo fetal esteve alterado em 14,2 por cento dos casos. O acompanhamento dessas gestações revelou anormalidade estruturais em 80,8 por cento dos fetos, sendo as anormalidades cardíacas as mais comuns (61,5 por cento). Resultados gestacionais adversos, como abortamento, óbitos intraútero e neonatal ocorreram em 76,5 por cento dos fetos. CONCLUSÃO: Translucência nucal aumentada, entre 11 - 13 semanas e 6 dias, é importante marcador de anomalias cromossômicas fetais e malformações estruturais fetais, principalmente cardíacas. Diante deste achado, há aumento do risco de abortamento, óbito intrauterino e neonatal para estas gestações.

OBJECTIVES: This study aimed to evaluate the incidence of chromosomal abnormalities in fetuses with increased nuchal translucency (NT) measurement. Incidence of structural abnormalities and pregnancy outcome was also described in fetuses with increased NT and abnormal karyotype. METHODS: This was a retrospective study involving 246 fetuses with increased NT and known karyotype followed at the Fetal Medicine Unit, Hospital das Clínicas, São Paulo University Medical School. RESULTS: Fetal karyotype was abnormal in 14.2 percent of the cases. Ultrasound anomaly scan and specialized echocardiographic studies in these cases showed fetal structural abnormalities in 80.8 percent and cardiac defects were found in 61.5 percent of the fetuses. Pregnancy outcome was abnormal in 76.5 percent of these women. CONCLUSION: Increased NT measurement at 11 to 13 weeks and 6 days is an important marker for fetal chromosomal and structural abnormalities, mainly fetal cardiac defects. This finding also indicates increased risk of spontaneous fetal and neonatal death.

Complicaciones postoperatorias en colecistectomía abierta, hospital Teodoro Maldonado Carbo, enero a junio de 2003 / Postoperative complications in open cholecystectomy, hospital Teodoro Maldonado Carbo January to June/2003

Los procedimientos y técnicas quirúrgicas de las vías biliares se realizan para producir la mejoría y/o curación de los diferentes síndromes que las involucran. Sin embargo, siguen existiendo situaciones en las que el propio tratamiento quirúrgico es responsable directo de cuadros de morbilidad y mortalidad. Tipo de estudio: Descriptivo, retrospectivo, transversal, Objetivos: Conocer las complicaciones de la colecistectomía abierta; distribuir la incidencia y secuelas de las complicaciones posquirúrgicas en cada grupo etáreo. Metodología: Se realizó el estudio durante 6 meses con 223 pacientes a los que se les realizó colecistectomía abierta. Resultados: de éstos, sólo 16 pacientes se mostraron con complicaciones (7). Según el género, los pacientes masculinos fueron 10 (62) y las pacientes femeninas 6 (38). Las edades con mayor complicación fueron de 40 a 49 años (5 pacientes). Con respecto a las complicaciones, la hemorragia fue la mayor causa, con 5 pacientes. En conclusión, si bien existe una alta incidencia de pacientes, el número de casos complicados no es grande. Afortunadamente la morbilidad supera a la mortalidad y estas complicaciones pudieron ser diagnosticadas y tratadas. Conclusión: Aunque los métodos realizados en el acto quirúrgico y el cuidado postoperatorio que se lleva a cabo siguen siendo efectivos para la gran mayoría de pacientes, hay que considerar siempre la existencia de complicaciones.

Surgical procedures and techniques in bile ducts are carried out to obtain improvement and/or healing of syndromes involving bile ducts. Nevertheless, there are still situations in which the surgical treatment itself is the direct responsible of morbidity and mortality profiles. Type of study: Descriptive, retrospective, transverse. Objectives: To know the complications of open cholecystectomy, arrange the impact and after-effects of postoperative complications in each age group. Methodology: the study was made for 6 months with 223 patients to whom an open cholecystectomy was carried out. Results: only 16 patients had complications (7). Male patients: 10 (62). Female: 6 (38). Ages with greatest complications: 40 to 49 (5 patients). Among complications, Haemorrhage was the greatest cause: 5 patients. In conclusion, although there is a high incidence of patients, the amount of complicated cases is not big. Fortunately morbidity exceeds mortality and these complications were diagnosed and treated. Conclusion: Although methods used in surgery and postoperative care are still effective for most of patients, we must always regard the possibility of complications.