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1.
Gynecol Endocrinol ; 29(7): 724-6, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23772787

RESUMO

Thyroid cancer in ovarian teratoma is reported to be rare and experiences are limited. A 26-year-old woman had undergone bilateral cystectomy and omentectomy for bilateral cystic adnexial masses. Pathological examination showed 1.5 cm follicular variant papillary thyroid carcinoma on the basis of unilateral mature cystic teratoma. Increased CA-125 and CA19-9 levels decreased to normal reference ranges after surgery, but postoperative magnetic resonance imaging indicated multiple abdominal cystic loci. After total thyroidectomy, high dose I-131 was administered to ablate thyroid tissue. Thereafter, levothyroxine was started to achieve subclinical hyperthyroidism. No iodine uptake was detected in post-therapeutic whole body scan (WBS) other than thyroid bed. This finding supported that tumor did not show dissemination to abdomen. No uptake on the first-year evaluation with low-dose I-131 WBS suggested the complete ablation of the thyroid gland. It is recommended that thyroid carcinoma arising from ectopic thyroid tissue in a teratoma should be managed as thyroid carcinoma in thyroid. However, direct dissemination to contiguous regions in abdomen and hematogenous dissemination to distant organs should be in mind. Radical surgery including total abdominal hysterectomy, bilateral salphingo-oopherectomy, pelvic and paraaortic lymph node excision and thyroidectomy is recommended. Fertility preserving surgery may be the surgical procedure as in the present case.


Assuntos
Carcinoma Papilar/diagnóstico , Carcinoma Papilar/terapia , Achados Incidentais , Neoplasias Ovarianas/terapia , Teratoma/terapia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Adulto , Carcinoma Papilar/complicações , Feminino , Preservação da Fertilidade/métodos , Seguimentos , Humanos , Neoplasias Ovarianas/complicações , Ovariectomia , Teratoma/complicações , Neoplasias da Glândula Tireoide/complicações , Tireoidectomia
2.
Arch Gynecol Obstet ; 287(5): 839-43, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23479052

RESUMO

INTRODUCTION: During pregnancy, a progressive increase in serum triglyceride (TG) and cholesterol levels is observed whereas TG levels mostly remain <300 mg/dl. In women with genetic forms of hypertriglyceridemia, pregnancy may cause extremely elevated TG levels leading to potentially life-threatening pancreatitis attacks and chylomicronemia syndrome. The only safe medical treatment option during pregnancy is ω-3 fatty acids, which have moderate TG lowering effects. Therapeutic apheresis could be used as primary treatment approach during pregnancy. MATERIALS AND METHODS: We reported the effect of double filtration apheresis in one pregnant women with severe hypertriglyceridemia, therapeutic plasmapheresis and double filtration methods in the other severe hypertriglyceridemic pregnant woman; a 32-year-old pregnant woman (patient 1) with a history of hypertriglyceridemia-induced acute pancreatitis during pregnancy and a 30-year-old pregnant woman with extremely high TG levels (12,000 mg/dl) leading to chylomicronemia syndrome (patient 2). Medical nutrition therapy and ω-3 fatty acids were also provided. Double filtration apheresis (patient 1) and plasmapheresis + double filtration apheresis (patient 2) were used. RESULT AND CONCLUSION: When we calculated the TG levels before and after therapeutic apheresis, maximum decrease achieved with double filtration apheresis was 46.3 % for patient 1 and 37.3 % for patient 2. However, with plasmapheresis TG level declined by 72 % in patient 2. Plasmapheresis seemed to be more efficient to decrease TG levels. Iron deficiency anemia was the main complication apart from technical difficulties by lipemic obstruction of tubing system. Healthy babies were born. Delivery led to decreases in TG levels. It is concluded that during pregnancy therapeutic apheresis is an effective method to decrease extremely high TG levels and risks of its potentially life-threatening complications.


Assuntos
Remoção de Componentes Sanguíneos/métodos , Hipertrigliceridemia/complicações , Hipertrigliceridemia/terapia , Plasmaferese , Complicações na Gravidez/terapia , Doença Aguda , Adulto , Cesárea , Ácidos Graxos Ômega-3/administração & dosagem , Feminino , Filtração/métodos , Idade Gestacional , Humanos , Masculino , Pancreatite/etiologia , Gravidez , Resultado da Gravidez
3.
Endocr Pract ; 18(6): 887-93, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22982786

RESUMO

OBJECTIVE: To investigate short-term effects of thyroidectomy-induced hypothyroidism on leptin, adiponectin, and resistin concentrations in association with anthropometric data. METHODS: Thirty premenopausal women with euthyroid nodular goiter-mean age, 44.0 ± 11.6 years; mean body mass index (BMI), 28.6 ± 5.9 kg/m2; 13 obese, 7 overweight, and 10 normal weight subjects-scheduled for total thyroidectomy were included in the study. Serum leptin, adiponectin, resistin, free triiodothyronine, free thyroxine, thyroid-stimulating hormone, glucose, insulin, and C-reactive protein concentrations, lipid profile, and anthropometric variables were determined in the euthyroid state (preoperatively) and the hypothyroid state (postoperatively, with a thyroid-stimulating hormone concentration >30 mIU/L). RESULTS: Body weight, BMI, waist and hip circumferences, body fat mass, and serum lipid concentrations increased significantly after thyroidectomy. No significant difference was found between preoperative and postoperative serum leptin, adiponectin, and resistin concentrations. Fat tissue mass-corrected leptin, adiponectin, and resistin concentrations did not differ significantly between euthyroid and hypothyroid periods. Thyroid hormone concentrations showed no significant correlations with adipokine levels. CONCLUSION: Serum adipokine concentrations seem not to change significantly during short-term thyroidectomy-induced hypothyroidism despite significant increases in body weight, BMI, fat mass, and lipid concentrations.


Assuntos
Adipocinas/sangue , Hipotireoidismo/sangue , Hipotireoidismo/etiologia , Tireoidectomia/efeitos adversos , Adulto , Índice de Massa Corporal , Peso Corporal , Feminino , Seguimentos , Bócio Nodular/cirurgia , Humanos , Leptina/sangue , Lipídeos/sangue , Pessoa de Meia-Idade , Resistina/sangue
4.
J Med Case Rep ; 6: 73, 2012 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-22369355

RESUMO

INTRODUCTION: Autopsy series have shown that metastasis to the thyroid gland has occurred in up to 24% of patients who have died of cancer. Neuroendocrine tumors may metastasize to thyroid gland. CASE PRESENTATIONS: Case 1 was a 17-year-old Turkish woman who was referred from our Endocrinology Department for a thyroidectomy for treatment of neuroendocrine tumor metastasis. She was treated with a bilateral total thyroidectomy. Histopathological examination results were consistent with a neuroendocrine tumor; neoplastic cells showed strong immunoreactivity to chromogranin A and synaptophysin, but the immunohistochemical profile was inconsistent with medullary thyroid carcinoma in that the tumor was negative for calcitonin, carcinoembryonic antigen, and thyroid transcription factor-1.Case 2 was a 54-year-old Turkish woman who presented with a 3-cm nodule on her right thyroid lobe. She had undergone surgery for a right lung mass four years previously. After a right pneumonectomy, thymectomy and lymph node dissection, a typical carcinoid tumor was diagnosed. Under ultrasonographic guidance, fine needle aspiration biopsy of her right thyroid pole nodule was performed and the biopsy was compatible with a neuroendocrine tumor metastasis. She was treated with a bilateral total thyroidectomy. Histopathological examination indicated three nodular lesions, 5 cm and 0.4 cm in diameter in her right lobe and 0.1 cm in diameter in her left lobe. The tumors were consistent with a neuroendocrine phenotype, showing strong immunoreactivity to chromogranin A and synaptophysin. CONCLUSION: Thyroid nodules detected during follow-up of neuroendocrine tumor patients should be thoroughly investigated. A fine needle aspiration biopsy of the thyroid confirms the diagnosis in most cases and leads to appropriate management of those patients and may prevent unnecessary treatment approaches.

5.
Pituitary ; 15(3): 386-92, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21833617

RESUMO

The aim was to evaluate the concentrations of lipid subfractions in relation to adipokines and metabolic parameters in adult growth hormone (GH)-deficient hypopituitary patients on conventional replacement therapy. The study included 21 GH deficient-hypopituitary patients (age: 36.0 ± 15.1 years, male/female: 7/14) on conventional replacement therapy other than GH and 20 comparable controls (age: 37.3 ± 14.0 years, male/female: 6/14). Lipid subfractions (Lipoprint system), serum adipokine (leptin, adiponectin, resistin) concentrations, body composition, a surrogate marker for insulin resistance (HOMA) and conventional lipid profile were evaluated. No statistically significant difference was found with respect to HOMA, adipokine concentrations and anthropometric parameters between patients and controls except for significantly increased waist-to-hip ratio in hypopituitary group. Total and LDL cholesterol concentrations were significantly higher in the patients. LDL particle size (268.88 ± 3.16 vs. 271.31 ± 3.11 Å, P = 0.151) and small-dense LDL subfraction did not differ significantly. According to logistic regression analysis, triglyceride concentrations ≥1.69 mmol/L was the sole parameter significantly and independently predicted small (<268 Å) LDL particle size (P = 0.019) in the whole group. Increased triglyceride concentrations affect LDL particle size in GH-deficient hypopituitary patients. Small dense LDL seems not directly contribute to atherogenic potential in hypopituitarism.


Assuntos
Adipocinas/sangue , LDL-Colesterol/sangue , Hormônio do Crescimento/deficiência , Hipopituitarismo/sangue , Lipoproteínas LDL/sangue , Adulto , Idoso , Feminino , Homeostase , Humanos , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangue , Relação Cintura-Quadril
6.
Thyroid ; 21(12): 1301-8, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22136265

RESUMO

BACKGROUND: In papillary thyroid carcinoma (PTC), recurrences during long-term follow-up (R-LTFU) occur even in those who appear to have an excellent prognosis after initial thyroid surgery and usually, radioactive iodine (i.e., "primary treatment"). Initial studies that predict R-LTFU are not well defined. Values for serum thyroglobulin (Tg) measurements when serum thyrotropin (TSH) is >30 µU/mL, as a result of either recombinant TSH or L-thyroxine withdrawal, referred to here as stimulated Tg (STg), have been previously evaluated. The aim of the current study was to determine the parameters associated with R-LTFU in patients with PTC categorized as having low-risk disease 9 to 12 months after their primary treatment. METHODS: This was a retrospective study of 469 patients with PTC with a mean follow-up 5.8±3.9 years. Study patients had to have no uptake in the first postablative diagnostic (131)iodine whole body scan (WBS) performed 9-12 months after primary treatment, a normal cervical ultrasonography (C-US), and STg of <2 ng/mL if their test for antithyroglobulin antibody (anti-Tg) was negative. The first two criteria were required for patients with a positive anti-Tg test, and their nominal serum Tg concentrations were not analyzed. RESULTS: Twelve patients developed recurrences (2.6%) in cervical region. Greater tumor size, higher STg, and positive anti-Tg tests at initial evaluation were associated with greater R-LTFU. The recurrence rates were 1.5% (7/450) and 26% (5/19), respectively, in patients with negative and positive anti-Tg tests at initial evaluation. Recurrence-free survival was lower in the patients with initial lymph node metastases, positive anti-Tg tests, and STg of ≥0.3 ng/mL at the first postablative WBS (p=0.022, 0.001, 0.035, respectively, by log-rank test). Regression analysis in patients who were anti-Tg negative revealed that STg ≥0.3 ng/mL at this first WBS was the only parameter related to recurrence (p=0.031, odds ratio: 10.30, confidence interval: 1.23-83.3). CONCLUSION: Patients with PTC traditionally categorized as low risk during their first 9 to 12 months after primary treatment have a greater risk of R-LTFU if their postablative STg is ≥0.3 ng/mL, or they have positive anti-Tg, even at this early stage. Periodic C-US is important in these patients and should probably be more frequent in patients with PTC who have positive anti-Tg tests or STg ≥0.3 ng/mL in the first year after diagnosis.


Assuntos
Autoanticorpos/sangue , Biomarcadores Tumorais/sangue , Recidiva Local de Neoplasia , Tireoglobulina/imunologia , Neoplasias da Glândula Tireoide/imunologia , Adolescente , Adulto , Idoso , Carcinoma , Carcinoma Papilar , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tireoglobulina/sangue , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/secundário , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Fatores de Tempo , Resultado do Tratamento , Turquia , Adulto Jovem
7.
Am J Surg ; 201(5): 685-91, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21545922

RESUMO

BACKGROUND: The etiology of postoperative hypocalcemia after total thyroidectomy appears to be multifactorial, that is, postoperative transient hypoparathyroidism, low 25-hydroxy vitamin D (25-OHD) concentrations, aging, and hyperthyroidism with increased bone turnover. Our aim was to evaluate the factors responsible for postoperative hypocalcemia in euthyroid vitamin D-deficient/insufficient Graves patients who underwent total thyroidectomy at our institution. METHODS: Thirty-five consecutive patients with Graves disease treated by total thyroidectomy were included in the present study. All patients were vitamin D deficient/insufficient (ie, 25-OHD concentrations of <20/<30 ng/mL, respectively). Patients were divided into 2 groups according to postoperative serum albumin corrected calcium concentrations: group 1 (n = 13) patients had postoperative serum calcium concentrations of 8 mg/dL or less; group 2 (n = 22) patients had serum calcium concentrations greater than 8 mg/dL. Bone turnover markers (deoxypiridinoline, bone-specific alkaline phosphatase) and 25-OHD were determined the day before surgery. RESULTS: In group 1 patients, disease duration was significantly longer, 25-OHD and postoperative parathyroid hormone concentrations were significantly lower, and bone turnover markers were significantly higher. Logistic regression analysis revealed that a postoperative parathyroid hormone concentration less than 10 pg/mL was the most powerful parameter to predict postoperative hypocalcemia (odds ratio, 23; 95% confidence interval, 3.3-156). CONCLUSIONS: In Graves patients with vitamin D deficiency/insufficiency, postoperative (transient) hypoparathyroidism is the most significant parameter to determine the development of postoperative hypocalcemia.


Assuntos
Cálcio/sangue , Doença de Graves/cirurgia , Hipocalcemia/diagnóstico , Hormônio Paratireóideo/sangue , Deficiência de Vitamina D/cirurgia , Vitamina D/análogos & derivados , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Feminino , Seguimentos , Doença de Graves/sangue , Doença de Graves/complicações , Humanos , Hipocalcemia/sangue , Hipocalcemia/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Tireoidectomia/efeitos adversos , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Adulto Jovem
8.
Eur J Endocrinol ; 163(5): 825-31, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20732956

RESUMO

OBJECTIVE: Fibroblast growth factor 23 (FGF23), a phosphatonin, inhibits renal phosphate reabsorption and suppresses 1-α hydroxylase activity. Calcitriol stimulates FGF23 synthesis in bone. We aimed to determine the effect of vitamin D replacement therapy on serum FGF23 concentrations in vitamin D-deficient women and to compare the FGF23 concentrations of vitamin D-deficient patients with healthy subjects and patients with genetically determined hypophosphatemic rachitis. DESIGN AND METHODS: The study group was composed of vitamin D-deficient females (n=18, mean age 29.1 ± 9.9 years), vitamin D-sufficient healthy females (control group; n=19, mean age 28.5 ± 5.2 years), and patients with genetically determined hypophosphatemic rachitis (n=13, mean age 26.5 ± 15.1 years). The groups were compared for serum FGF23, 1,25-dihydroxyvitamin D3 (1,25(OH)2D), calcium, phosphate, bone turnover markers, intact parathyroid hormone (PTH), and urinary excretion of calcium and phosphate. The vitamin D-deficient group was re-evaluated after a standard treatment regimen. RESULTS: Serum FGF23 concentrations were significantly lower in vitamin D-deficient patients than in vitamin D-sufficient women and hypophosphatemic rachitis group. Serum FGF23 and phosphate concentrations further decreased significantly during replacement of vitamin D (P<0.05). A significant negative correlation was evident between FGF23 and PTH before vitamin D replacement in the patients (r=-0.469, P<0.05). CONCLUSION: Decreased FGF23 concentrations, which further decline during vitamin D replacement therapy, may have favorable action on bone mineralization by counterregulatory effect on phosphate homeostasis. Lower 1,25(OH)2D concentrations at baseline and hypophosphatemia during treatment may have dominating effects on FGF23 concentrations in vitamin D deficiency, leading to decreased FGF23 concentrations at baseline and during replacement therapy.


Assuntos
Fatores de Crescimento de Fibroblastos/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/uso terapêutico , Adulto , Biomarcadores/sangue , Feminino , Fator de Crescimento de Fibroblastos 23 , Humanos , Fatores de Tempo , Vitamina D/sangue , Adulto Jovem
9.
Endocr Pathol ; 20(4): 256-61, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19705299

RESUMO

Transient pregnancy-induced Cushing's syndrome (CS) is extremely rare, with only several cases reported in the literature. Ectopic LH/hCG-receptors (LHCGR) in the adrenal gland have been suggested to be involved in the pathogenesis of this condition. We report the clinical, molecular, and genetic features of a patient with pregnancy-induced CS. A 29-year-old female patient developed CS during multiple pregnancies, leading to repeated miscarriage. Signs and symptoms of hypercortisolism resolved soon after delivery or abortion, only to recur in subsequent pregnancies. In the non-pregnant state, hCG stimulation testing resulted in elevated cortisol levels. Serum cortisol was not suppressible with dexamethasone. The adrenals exhibited bilateral adrenal cortical nodular hyperplasia. Quantitative RT-PCR revealed a 2-fold increase in LHCGR and progesterone receptor mRNA expression and decreased estrogen receptor-beta expression in the patient's adrenal tissue relative to normal adrenals. Higher intensity of immunostaining for LHCGR was observed, particularly within the nodular lesions, compared to controls. Quantitative PCR revealed a LHCGR-to-beta-actin ratio of 1.5 in genomic DNA from adrenal and peripheral leukocytes, suggesting the presence of a germline duplication of the LHCGR gene. LHCGR overexpression resulting from germline gene duplication may be a potential pathogenic mechanism underlying this case of pregnancy-induced CS.


Assuntos
Córtex Suprarrenal/patologia , Glândulas Suprarrenais/metabolismo , Síndrome de Cushing/etiologia , Expressão Gênica , Complicações na Gravidez , Receptores do LH/genética , Aborto Habitual/etiologia , Glândulas Suprarrenais/química , Glândulas Suprarrenais/patologia , Adrenalectomia , Adulto , Gonadotropina Coriônica , Síndrome de Cushing/cirurgia , Dexametasona , Receptor beta de Estrogênio/genética , Feminino , Humanos , Hidrocortisona/sangue , Hiperplasia , Leucócitos/química , Gravidez , RNA Mensageiro/análise , Receptores da Corticotropina/genética , Receptores de Progesterona/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa
10.
World J Surg ; 33(10): 2099-105, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19649755

RESUMO

BACKGROUND: It is not clear whether nonfunctional adrenal incidentaloma (NFA) increases the risk of atherosclerosis and metabolic syndrome or whether this type of adrenal tumor has been found more frequently in patients with cardiometabolic risk factors. We aimed to determine the effects of NFA on cardiometabolic risk factors and endothelial function and to compare the patients with a 1:1 cardiometabolic risk factor matched control group. METHODS: Thirty-five patients with NFA were studied, and 35 body mass index-, age-, and sex-matched subjects were regarded as group 2 controls. Thirty-five cardiometabolic risk factors-matched subjects were then regarded as group 3 controls. RESULTS: Patients with NFA had significantly lower flow-mediated dilation (FMD)-a parameter for endothelial function-measurements compared with groups 2 and 3 (7.1 +/- 2.9% vs. 12.9 +/- 3.8% and 13.5 +/- 4.5%; P < 0.02). Frequency of metabolic syndrome was also significantly higher in NFA patients than in control groups 2 and 3 (31.4, 5.7, and 20.0%, respectively; P < 0.05). Age (Odds Ratio [OR] = 2.9), total cholesterol (OR = 2.3), and presence of adrenal incidentaloma (OR = 10) were significant independent predictors of lower FMD (P < 0.05 for all). CONCLUSIONS: Patients with NFA have increased prevalence of metabolic syndrome and impaired endothelial function compared with 1:1 cardiometabolic risk factor-matched controls.


Assuntos
Neoplasias das Glândulas Suprarrenais/epidemiologia , Aterosclerose/epidemiologia , Síndrome Metabólica/epidemiologia , Neoplasias das Glândulas Suprarrenais/complicações , Adulto , Aterosclerose/etiologia , Endotélio Vascular , Feminino , Humanos , Incidência , Achados Incidentais , Masculino , Síndrome Metabólica/etiologia , Pessoa de Meia-Idade , Fatores de Risco
11.
Endocr Pathol ; 20(2): 127-32, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19301154

RESUMO

Ectopic secretion of growth hormone-releasing-hormone (GHRH) is a rare cause of acromegaly-representing less than 1% of patients. A 25-year-old woman was admitted to the hospital with acromegaly and a 6 x 6 cm infrahepatic mass. Sellar magnetic resonance imaging indicated diffuse pituitary enlargement consistent with hyperplasia. The infrahepatic mass was resected, and the histopathological diagnosis was a well-differentiated invasive neuroendocrine carcinoma of the duodenum with metastases to local lymph nodes. The tumor cells contained cytoplasmic immunoreactivity for GHRH. Because increased IGF-1 concentrations persisted after the operation, the patient was treated with octreotide long-acting repeatable (LAR) injections of 20 mg/month. Growth hormone and IGF-1 levels normalized. After 6 years of surveillance, a left paraaortic mass was detected by uptake of indium 111 octreotide. Surgical exploration revealed metastatic neuroendocrine carcinoma in a 2.5-cm lymph node. Postoperatively, the IGF-1 concentration was mildly elevated. Octreotide LAR therapy is being continued at 10 mg/month. This case suggests that octreotide treatment may have a beneficial effect on disease course and can be maintained for as long as 7 years in a patient with acromegaly due to a GHRH-secreting neuroendocrine carcinoma.


Assuntos
Acromegalia/etiologia , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/metabolismo , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/metabolismo , Hormônio Liberador de Hormônio do Crescimento/metabolismo , Hormônios Ectópicos/metabolismo , Adulto , Antineoplásicos Hormonais/uso terapêutico , Carcinoma Neuroendócrino/complicações , Neoplasias Duodenais/complicações , Feminino , Seguimentos , Teste de Tolerância a Glucose , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Imageamento por Ressonância Magnética , Octreotida/uso terapêutico , Recidiva
12.
Clin Endocrinol (Oxf) ; 71(1): 33-9, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18803679

RESUMO

CONTEXT: Data regarding serum adipocytokine and ghrelin concentrations in different stages of anorexia nervosa (AN) is conflicting. OBJECTIVE: Our aim is to determine serum concentrations of adiponectin (ApN), leptin and ghrelin in different stages of AN and to evaluate their relationships with study parameters. DESIGN SETTING AND PARTICIPANTS: Study group was composed of four subgroups: Group 1: patients with a recent diagnosis of AN (n = 19); group 2: weight recovered (10% increase in body weight compared with baseline) subgroup of group 1 during follow-up (n = 10); group 3: recovered patients with a previous history of AN but normal menstrual cycles and body weight currently (n = 10); group 4: control group (n = 10). Venous blood was obtained for measurements of biochemical/hormonal parameters, ApN, leptin and ghrelin. Body composition was determined by bioimpedance analysis. MAIN OUTCOME MEASURES: Changes in adipocytokine and ghrelin concentrations and relationships with anthropometric/biochemical parameters. RESULTS: Leptin: fat mass (kg) ratio was significantly higher in group 1 patients compared with group 4 (4.3 +/- 4.6 vs. 1.1 +/- 0.5 microg/l kg, P < 0.01). No significant difference was observed among ghrelin concentrations. Leptin showed significant positive correlation with body fat mass in all groups. ApN showed significant positive association with body mass index in Group 1. CONCLUSIONS: Leptin concentrations indexed to fat mass may indicate a nonphysiological higher set point of leptin per unit fat mass in treatment-naive AN patients. Correlation pattern between ApN and fat mass is modified also. Altered adipocytokine profile in AN may contribute to anorectic behaviour.


Assuntos
Tecido Adiposo/metabolismo , Anorexia Nervosa/metabolismo , Leptina/sangue , Adiponectina/sangue , Adulto , Anorexia Nervosa/sangue , Índice de Massa Corporal , Peso Corporal , Feminino , Grelina/sangue , Humanos , Masculino , Adulto Jovem
13.
Int J Surg ; 7(1): 58-61, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19027373

RESUMO

BACKGROUND: Incidental resection of parathyroid tissue is not uncommon during thyroidectomy and may occur even in the hands of experienced thyroid surgeons. We aimed to investigate the clinical relevance of incidental parathyroidectomy and to determine which risk factors are important for it. PATIENTS: Four hundred and forty consecutive patients with non-toxic multinodular goitre treated by total and near-total thyroidectomy were included prospectively in the present study. Patients in group 1 (n=48) had inadvertent resection of parathyroid gland, whereas patients in group 2 (n=392) did not have parathyroid glands removed. RESULTS: There was a positive correlation between the incidental parathyroidectomy and total thyroidectomy (r(s)=0.519, p=0.0001), and thyroid pathology (r(s)=0.338, p=0.0001) and intrathyroid parathyroid locations. Incidental parathyroidectomy did not have an impact on postoperative hypocalcemia. The risk for incidental parathyroidectomy was increased 13-fold for patients who underwent total thyroidectomy (OR: 13.7; 95% CI:4.08-46.05), 4-fold for patients with substernal goitre (OR: 4.1; 95% CI: 1.1-14.3). CONCLUSIONS: Total thyroidectomy, thyroid pathology, and intrathyroid parathyroid locations are risk factors for incidental parathyroidectomy. All established risk factors for incidental parathyroidectomy are also risk factors for postoperative hypocalcemia. Incidental parathyroidectomy during thyroid surgery may be a potential complication.


Assuntos
Bócio Nodular/cirurgia , Doença de Graves/cirurgia , Erros Médicos/estatística & dados numéricos , Paratireoidectomia , Tireoidectomia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Bócio Nodular/patologia , Doença de Graves/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Eur J Endocrinol ; 158(5): 615-22, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18426819

RESUMO

OBJECTIVE: Endothelial nitric oxide synthase (eNOS) intron 4a/b polymorphism is associated with plasma NO concentrations and coronary artery disease/hypertension in various populations. GH deficiency in adulthood predisposes to reduced NO concentrations and premature atherosclerosis. Our aim was to determine whether intron 4a/b polymorphism of eNOS gene influences endothelial function and early atherosclerotic changes in GH-deficient hypopituitary patients. DESIGN: Thirty-three hypopituitary GH-deficient patients on conventional replacement therapy other than GH and 43 age-, sex-, and body mass index (BMI)-matched controls were studied in this cross-sectional case-control study. METHODS: Early atherosclerotic changes were determined by flow-mediated dilation (FMD) of brachial artery and carotid artery intima-media thickness (IMT). eNOS4a/b polymorphism was detected by PCR. RESULTS: Hypopituitary patients had significantly higher total/low-density lipoprotein cholesterol and fat mass and lower IGF-I concentrations compared with controls. IMT was significantly higher in patients (0.777+/-0.23 vs 0.639+/-0.17 mm, P<0.01). No significant difference was observed with respect to FMD measurements. eNOS4a/b genotype frequencies were similar between patients and controls. Patients carrying 'a' allele (a/a and a/b) had significantly higher IMT compared with controls carrying 'a' allele and bb genotype (P<0.05). However, logistic regression analysis revealed that presence of hypopituitarism, age> or =45 years, and BMI> or =27.9 kg/m(2) were significant independent predictors of IMT> or =0.65 mm. CONCLUSION: No compelling data are evident to suggest that eNOS4a/b polymorphism modifies the atherosclerotic process in GH-deficient situations. A large case-control study is needed to confirm our findings.


Assuntos
Aterosclerose/genética , Hipopituitarismo/genética , Óxido Nítrico Sintase Tipo III/genética , Polimorfismo Genético , Adulto , Aterosclerose/complicações , Estudos de Casos e Controles , LDL-Colesterol/sangue , Estudos Transversais , Feminino , Genótipo , Hormônio do Crescimento/deficiência , Humanos , Hipopituitarismo/complicações , Fator de Crescimento Insulin-Like I/metabolismo , Íntrons/genética , Masculino , Pessoa de Meia-Idade
16.
Arch Surg ; 142(12): 1182-7, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18086985

RESUMO

HYPOTHESIS: Age, postoperative serum parathormone (PTH) level, and preoperative serum 25-hydroxyvitamin D(3) (25-OHD) level predict postoperative hypocalcemia after total thyroidectomy. DESIGN: Prospective clinical trial. SETTING: Tertiary referral center. PATIENTS: One hundred thirty patients with nontoxic multinodular goiter. Patients were divided into 2 groups according to the postoperative serum calcium level. Group 1 (n = 32) consisted of patients with a postoperative serum calcium level of 8 mg/dL or less, and group 2 (n = 98) consisted of patients with a postoperative serum calcium level higher than 8 mg/dL. INTERVENTIONS: The preoperative serum 25-OHD level and preoperative and postoperative serum calcium and PTH levels were determined. MAIN OUTCOME MEASURES: The number of patients developing hypocalcemia and prediction of postoperative hypocalcemia by the serum 25-OHD and PTH levels. RESULTS: Hypocalcemia developed in 32 patients (24.6%) (group 1). The preoperative serum 25-OHD level and postoperative serum calcium and PTH levels in group 1 were significantly lower than in group 2 (P = .001). With logistic regression analysis, factors that were predictive of postoperative hypocalcemia included a preoperative serum 25-OHD level less than 15 ng/mL (P < .001; odds ratio, 558.5), a postoperative serum PTH level less than 10 pg/mL (P = .01; odds ratio, 16.4), and being older than 50 years (P = .01; odds ratio, 4.6). CONCLUSIONS: Age, a low preoperative serum 25-OHD level, and a low postoperative serum PTH level are significantly associated with postoperative hypocalcemia. The low preoperative serum 25-OHD level was more significant than the low postoperative serum PTH level in the prediction of postoperative hypocalcemia.


Assuntos
Colecalciferol/sangue , Bócio Nodular/cirurgia , Hipocalcemia/etiologia , Hormônio Paratireóideo/sangue , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Bócio Nodular/sangue , Humanos , Hipocalcemia/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
17.
Int J Eat Disord ; 40(8): 762-5, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17607716

RESUMO

OBJECTIVE: To describe and discuss potential relationships between anorexia nervosa (AN) and Raynaud's phenomenon, the course and concurrent treatment of these two disorders as they appeared simultaneously, and a potential treatment modification entailed in such concurrent therapies. BACKGROUND: Although Raynaud's phenomenon has been described during the course of AN, the associations and interactions between these two conditions are not clear. METHOD: We report the medical workup, treatment, and outcomes in a 19-year old female patient who developed Raynaud's phenomenon following the onset of AN. RESULTS: After treatment with nutritional rehabilitation, counseling, and individual and group therapy, the patient's weight, eating disorder-related behaviors, and attitudes improved significantly. Raynaud's related symptoms improved, following treatment with a calcium channel blocker and antiaggregant therapy. In conjunction with nutritional efforts to treat the patient's long-standing amenorrhea and osteopenia, the treatment team elected to also administer estrogen hormone in addition to oral calcium and vitamin D supplementation. Since oral contraceptives are to be avoided in patients with Raynaud's phenomenon who show clinical findings suggesting connective tissue disorder, the treatment team elected to treat this patient with transdermal hormone replacement therapy. CONCLUSION: The co-occurrence of AN and Raynaud's phenomenon merits close and persistent follow-up by a multidisciplinary team and may lead to alterations of usual therapeutic approaches.


Assuntos
Anorexia Nervosa/complicações , Doença de Raynaud/etiologia , Administração Cutânea , Adulto , Amenorreia/etiologia , Amenorreia/terapia , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/terapia , Aspirina/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Doenças Ósseas Metabólicas/etiologia , Doenças Ósseas Metabólicas/terapia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Terapia Combinada , Aconselhamento , Terapia de Reposição de Estrogênios , Terapia Familiar , Feminino , Seguimentos , Humanos , Nifedipino/uso terapêutico , Terapia Nutricional , Inibidores da Agregação Plaquetária/uso terapêutico , Psicoterapia , Psicoterapia de Grupo , Doença de Raynaud/diagnóstico , Doença de Raynaud/terapia
18.
Clin Endocrinol (Oxf) ; 66(4): 524-9, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17371470

RESUMO

OBJECTIVE: Relationship between adult growth hormone deficiency (AGHD) and increased cardiovascular disease risk is very well known in hypopituitary patients treated with conventional hormone replacement therapy other than growth hormone (GH) administration. Endothelial dysfunction, an early and reversible event in pathogenesis of atherosclerosis, is associated with increased vascular smooth muscle tone, arterial stiffening and intima-media thickness (IMT). Coronary flow reserve (CFR) measurement by transthoracic Doppler echocardiography (TTDE) reflects coronary microvascular and endothelial functions, as a cheaper and an easy screening test. We have used TTDE to evaluate endothelial function and coronary microvascular function in AGHD. DESIGN: Cross-sectional observational study. PATIENTS: A total of 10 GH-deficient adults on conventional replacement therapy other than GH (4 males, 6 females; mean age 37 +/- 11 years) and 15 healthy subjects (7 males, 8 females; mean age 41 +/- 11 years) were studied. Patients and controls were all nonsmokers, normotensive and nondiabetic. MEASUREMENTS: IGF-1, free T4, lipid profile, insulin, glucose, insulin resistance (IR), anthropometrical and physical parameters were recorded. CFR recordings and IMT measurements were performed using the Vivid 7 echocardiography device. RESULTS: IMT were significantly higher in patients than controls (0.70 + 0.19 mm and 0.53 + 0.13 mm, respectively; P = 0.02). CFR was significantly lower in patients than in controls (1.96 +/- 0.35 and 2.62 +/- 0.45, respectively; P < 0.001). CFR was positively correlated with IGF-1 levels (r = 0.54, P = 0.005). CONCLUSION: CFR is significantly lower in adults with GH deficiency than in controls. Direct correlation between CFR and IGF-1 concentrations suggests GH replacement could improve microvascular function and thereby could decrease cardiovascular morbidity and mortality in AGHD.


Assuntos
Circulação Coronária , Endotélio Vascular/metabolismo , Hormônio do Crescimento/deficiência , Hipopituitarismo/metabolismo , Adulto , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Vasos Coronários , Estudos Transversais , Ecocardiografia Doppler , Endotélio Vascular/diagnóstico por imagem , Feminino , Humanos , Hipopituitarismo/diagnóstico por imagem , Hipopituitarismo/tratamento farmacológico , Fator de Crescimento Insulin-Like I/análise , Masculino , Microcirculação , Pessoa de Meia-Idade , Processamento de Sinais Assistido por Computador , Túnica Média/diagnóstico por imagem , Túnica Média/metabolismo
19.
Endocrine ; 32(3): 264-70, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18224461

RESUMO

BACKGROUND/AIMS: Overt and subclinical hypothyroidism are reported to be associated with increased cardiovascular disease risk. We have used coronary flow reserve (CFR) measurement by trans-thoracic Doppler echocardiography (TTDE) to determine coronary microvascular function in Hashimoto's thyroiditis patients with overt and subclinical hypothyroidism and to evaluate effects of L-thyroxine replacement on coronary endothelial function. METHODS: In total, 10 overt hypothyroid patients, 10 subclinical hypothyroid patients, and 10 controls were enrolled. FT4, TSH, anti-thyroid antibodies, lipid profile, insulin, glucose, HOMA-IR, physical parameters, and CFR measured by TTDE were recorded before and after 6 months of L: -thyroxine replacement in all groups. RESULTS: CFR values of all hypothyroid patients at baseline were significantly lower than those in controls. After L: -thyroxine, CFR increased significantly in overt and subclinical hypothyroidism with respect to the baseline measurements (P < 0.05). When baseline and second measurements were evaluated collectively for patients and controls, CFR was positively correlated with FT4 levels (r = 0.31, P = 0.01) and negatively correlated with TSH and HOMA-IR (r = -0.38, P = 0.002 and r = -0.42, P < 0.001, respectively). CONCLUSION: Subclinical as well as overt hypothyroid patients have impaired coronary microvascular function which improved after L: -thyroxine therapy. Treatment of Hashimoto's thyroiditis patients with subclinical hypothyroidism should be considered to improve cardiovascular disease risk.


Assuntos
Vasos Coronários/fisiologia , Doença de Hashimoto/tratamento farmacológico , Hipotireoidismo/tratamento farmacológico , Tiroxina/uso terapêutico , Adulto , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Ecocardiografia , Feminino , Seguimentos , Doença de Hashimoto/complicações , Humanos , Hipotireoidismo/complicações , Masculino , Microcirculação/efeitos dos fármacos , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Sanguíneo Regional/efeitos dos fármacos , Fluxo Sanguíneo Regional/fisiologia , Fatores de Risco , Tiroxina/farmacologia
20.
Eur J Intern Med ; 17(8): 545-50, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17142172

RESUMO

BACKGROUND: The aim of our study was to evaluate the oxidant/antioxidant status of thyroid tissue in Graves' disease (GD) patients and to compare the results of GD thyroid tissue with plasma of patients and healthy controls. METHODS: We studied 25 consecutive patients with GD hyperthyroidism who underwent surgical treatment. The patients were divided into groups according to the duration of antithyroid drug treatment, the type of antithyroid drugs used, the presence of ophthalmopathy, and recurrence after a complete course of antithyroid drugs. Thiobarbituric acid-reacting substances (TBARS), glutathione peroxidase (GPx) activity, superoxide dismutase (SOD) activity, and total thiol (t-SH) content of tissue and plasma samples were determined. RESULTS: TBARS concentrations were found to be significantly increased in GD patients' plasma compared with controls' plasma (0.1+/-0.02 nmol/mg protein vs. 0.062+/-0.01 nmol/mg protein). Significantly decreased t-SH concentrations were measured in GD patients' plasma compared with controls (8.26+/-1.9 nmol/mg protein vs. 13.03+/-3.3 nmol/mg protein). Tissue TBARS, t-SH, GPx, and SOD measurements in GD patients indicated significantly increased concentrations compared with the plasma levels of patients. Patients with shorter treatment duration before the operation had significantly increased plasma and tissue TBARS and decreased plasma and tissue t-SH concentrations. Patients on propylthiouracil treatment had significantly lower plasma and tissue concentrations of TBARS than patients on methimazole. Patients with recurrence had significantly higher plasma and tissue TBARS and lower plasma and tissue t-SH concentrations than patients treated for the first time. CONCLUSIONS: In euthyroid GD patients on antithyroid drugs, increased oxidative stress and a compensatory increase in the antioxidant defense system are more prominent in thyroid tissue than in plasma. Patients who relapsed had markers indicating increased oxidative stress. Thus, ongoing autoimmunity may contribute to increased oxidative stress in GD patients, even in the euthyroid state.

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