[Intra-gastric ballon in the treatment of morbid obesity]. / Balão intra-gástrico no tratamento da obesidade mórbida.

BACKGROUND: Intragastric balloon is a temporary treatment for weight loss with proven safety and efficacy when associated with lifestyle intervention. It is indicated in the super--obese who are candidates for bariatric surgery to lose weight and to reduce their high surgical risk. Our aim was to retrospectively evaluate the results of the patients in whom this device was inserted during a three-year period from the beginning of this practice in the Hospital de Santa Maria. METHODS: Data from the medical records in what concerns bioanthropometric characteristics in the beginning and following balloon removal were reviewed and submitted to descriptive analysis. RESULTS: Fifty-seven patients underwent intragastric balloon placement, of whom 46 female and 11 male, with median age 44,2 ± 11,77 years. Median body mass index (BMI) 51,6 ± 9,45 kg/m(2). Five patients were lost to follow-up. The balloon was inserted for a median time of 206 ± 62,62 days, during which there was a median weight loss of 17,2 ± 9,46 kg, a reduction of 6,7 ± 3,73 kg/m(2) in BMI and a mean excessive weight loss of 26,7 ± 16,99%. There were 5 patients in whom serious complications occurred, one of which died. One half of the patients went on to bariatric surgery. The median time between balloon removal and surgery was 241,6 ± 243,66 days in which there was a median weight variation of + 3,5 ± 11,69 kg. The remaining patients: 15 dropped out further treatment, 5 patients are under medical therapy and have no invasive procedure scheduled, 4 patients are to be submitted to another balloon insertion and 2 patients were submitted to the insertion of a second balloon during the time this article refers to. CONCLUSIONS: Our findings are similar to some previously described. Intragastric balloon is a temporary and efficacious option in the treatment of morbid obesity. However, it is very important to strictly select the patients and to have a good coordination with the Surgical department so that results can be optimized.

[Malnutrition in morbid obesity]. / Desnutrição na obesidade mórbida.

Nutritional deficiences are common in patients who have undergone bariatric surgery for morbid obesity. There are limited data on nutritional status before surgery. We now begin to realize the importance and the high frequency of that situation in the morbidly obese who have never undergone any invasive procedure. It is very important to acknowlegde this fact, so that specific therapy is begun before surgery. It is our conviction that in doing so we minimize the risk of having serious deficiencies after surgery. We report a case of a morbidly obese woman with nutritional deficiencies before bariatric surgery.

[Autoimmune thyroid disease: a case report]. / Doença auto-imune da tiroideia.

Autoimmune thyroid disease is the most common cause of subclinical thyroid dysfunction (hypo and hyperthyroidism) in the western countries. Autoimmune thyroid diseases with clinical relevance (Graves' disease and autoimmune hypothyroidism) are common and can present with a large clinical and laboratorial spectrum. Hypo and hyperthyroidism can exist in the same patient, on different times. Progression from Graves hyperthyroidism to chronic autoimmune thyroiditis and hypothyroidism is now well-recognized and the inverse might also occur, although being rare. We describe a case report of Graves' disease in a patient with a chronic autoimmune hypothyroidism of long course (diagnosed 21 years ago).

[Pituitary macroadenoma associated with pulmonary and cutaneous sarcoidosis--a clinical case]. / Macroadenoma da hipófise Associado a Sarcoidose Pulmonar e Cutânea.

Sarcoidosis is a granulomatous disease of unknown etiology that can affect all organs and systems, including the central nervous system in approximately 5% of patients. Although the hypothalamo-hypophyseal system may be one of the areas affected by neurosarcoidosis, pseudotumoral lesions are very rare. This paper reports the case of a 42-year-old male Caucasian patient followed by the Pneumology and Dermatology services for pulmonary and cutaneous sarcoidosis. Corticotherapy was initiated five months from diagnosis and the patient showed clear clinical and imagiological signs of improvement. In the following two months, the patient experienced visual disturbances and a slight decrease in libido, but denied having other symptoms associated with hypothalamo-hypophyseal hypofunction. Laboratorial evaluation (basal determinations and stimulation tests) revealed panhypopituitarism. The EC-NMR showed a bulky intrasellar lesion extending into the suprasellar and right parasellar regions, with evidence of optic chiasm compression, erosion of the floor of the sella and cavernous sinus invasion. Campimetry showed a bitemporal hemianopsia. For the purposes of chiasmatic decompression and histological study of the lesion the patient underwent a right frontal craniotomy, with a subtotal resection of the hypophyseal lesion. The histological diagnosis revealed a pituitary adenoma with no immunohistochemical expression. The patient began radiotherapy six months after surgery. Although today's diagnostic tools allow for a high degree of accuracy, hypophyseal lesions still present problems to the endocrinologist as their identification is essential for determining the appropriate treatment. At times the final diagnosis is only achieved after a histological identification of the lesion (biopsy/surgery). It should be noted that the described cases of association between sarcoidosis and hypophyseal adenoma are very rare, making the differential diagnosis with neurosarcoidosis difficult--a condition which has a preferential medical approach and a different prognosis.

[Assessment of an obesity clinic in a center hospital]. / Avaliação de uma consulta de obesidade num serviço de endocrinologia hospitalar.

INTRODUCTION: Slight weight losses (5%) are consensually accepted as important in the treatment of obesity today. Some authors also consider that maintaining weight is an indicator of success in the treatment of this condition. OBJECTIVE: Characterisation and assessment of changes in weight in obese patients monitored at an obesity clinic in a hospital endocrinology department. METHODOLOGY: Retrospective analysis of the clinical files of the Endocrinology Clinic. The patients included were overweight adults (BMI = 25 kg/m2) who had been monitored since 1999 and were not suffering from thyroid dysfunction or hypercortisolism. Data were gathered on bio-demographic and anthropometric characteristics, reason for consultation, type of treatment, results achieved and dropouts. The statistical analysis included calculating central tendency measures and dispersion for the continuous variables and building frequency tables to describe the categorical variables. We used the t-test to compare average values between samples. Frequencies were compared by means of the chi-squared test or Fisher's exact test. The significance level was 5%. RESULTS: We studied 457 patients (60.6% female) with an average age of 53 years (DP +/- 15) and an average BMI of 32.4 +/- 5.1 Kg/m2. 51.9% of the patients came to the clinic because of overweight (n = 237) (Obesity Group-OBG), while the rest did so because of diabetes mellitus (35.4%) or some other disease (12.7%) (Other Cause Group-OCG). A dietary plan was prescribed for 86.1% (OBG) and 81.8% (OCG), drugs for 16.9% (OBG) and 6.4% (OCG) and physical activity for 77.6% (OBG) and 77.7% (OCG). The average weight loss was 2.1% in the OBG. The individuals who dropped out of the clinic had lost less weight (1.3% vs. 2.9%), although the difference was not significant. More than half (57.7%) of the individuals studied lost weight, 14.4% remained the same and 27.8% gained weight. CONCLUSIONS: 1) Only 50% of overweight patients come to our department to lose weight. 2) More than 75% of overweight patients have a prescribed, structured diet plan, regardless of the reason for their first visit. 3) About 75% of patients achieve acceptable objectives (maintaining or losing weight), and 25% of these have lost more than 5% of their initial weight.

[A rare case of malabsorption of thyroid hormones]. / Má absorção das hormonas tiroideias.

We describe the case of a 22-year old male undergoing a total thyroidectomy for euthyroid multi-nodular goitre (TSH: 1.6 microUI/ml). He was discharged treated with LT4 100 mg id. After discharge, he went into full clinical and laboratorial hypothyroidism (TSH = 396 microUI/mL). We were able to rule out failure to take the medication and concomitant use of drugs. In the evaluation of intestinal absorption, only the D-Xylose test proved to be abnormal. After unsuccessful administration of oral T4 and T3, under close nursing supervision, intramuscular (IM) and subcutaneous (SC) forms of administration of T4 were experimented. While both forms achieved normal levels of thyroid hormones, we opted for IM injection as the patient complained of local pain during SC administration. This seems to be the second case described in which it was necessary to resort to parenteral administration of T4 to achieve clinical and laboratorial euthyroidism.