Electroneuromyography and neuromuscular findings in 16 primary hypothyroidism patients.

There has been few reports on electroneuromyography (ENMG) changes in hypothyroidism. The objectives of the present study were to investigate the frequency of ENMG abnormalities in hypothyroidism and correlate them with neurological signs and symptoms and muscle enzyme levels; and to compare latency, amplitude and nerve conduction velocity from selected nerves with controls. Sixteen patients suffering from primary hypothyroidism were submitted to ENMG before treatment. ENMG abnormalities were found in 87.5% of the patients; 46.6% had myopathy and 43.7% had carpal tunnel syndrome. There was no case of polyneuropathy. A clear-cut clinical, laboratorial and ENMG correlation was observed in patients with myopathy and carpal tunnel syndrome. The patients showed a significant tendency of nerve conduction slowness as compared with controls. The findings are in accordance with the well-known nerve and muscle damage in hypothyroidism.

Recovery of adrenal function after treatment of paracoccidioidomycosis.

In endemic areas, the systemic mycosis paracoccidioidomycosis (PCM) is the most frequent etiology of Addison's disease. Paracoccidioides brasiliensis, the causative agent of PCM, exhibits a high tropism for the adrenal glands, which results in a low hormone reserve and in more severe cases, in symptoms of primary adrenal insufficiency. In these cases, the hormone deficit is usually treated with replacement corticoid therapy for the rest of the patient's life. Recently, we identified three patients with disseminated PCM who had adrenal insufficiency; one of them had Addison's disease. All showed complete recovery of adrenal function after a 1-2-year period of specific therapy with ketoconazole or sulfonamides. Plasma cortisol levels were determined by radioimmunoassay of baseline blood samples, as well as those taken after the rapid stimulation test with synthetic adrenocorticotrophic hormone, and before and after the antifungal therapy.

Computed tomography and ultrasonography of the adrenal glands in paracoccidioidomycosis. Comparison with cortisol and aldosterone responses to ACTH stimulation.

Fifteen patients with proven disseminated paracoccidioidomycosis (PCM) had computed tomography (CT) and ultrasonography (US) performed to evaluate the form, shape, density and size of their adrenal glands. Plasma and urinary cortisol were determined and adrenal reserve assessed by measuring the cortisol and aldosterone responses to synthetic ACTH. The adrenal CT showed unilateral lesions in two cases and bilateral in another four. The US study showed more frequent alterations, unilateral in seven and bilateral in three subjects. Combining both methods increased the sensitivity to 85% of the cases. All patients had normal plasma cortisol concentrations and normal or increased urinary cortisol excretion. Plasma aldosterone concentration was also normal except in one patient with hypokalemia. Seven patients showed diminished cortisol responses, five had subnormal aldosterone responses and in five plasma aldosterone concentration increased more than normally after stimulation by ACTH. There was an incidence of limited adrenal reserve in 53% of the patients on ACTH stimulation. No correlation was evident between the disorders in adrenal steroid responses to ACTH and changes in morphology revealed by CT and/or US.

Manifestacoes neuromusculares nas endocrinopatias. / Neuromuscular manifestations in endocrine diseases

Os autores descrevem, de maneira objetiva, os recentes avancos obtidos no terreno das manifestacoes neuromusculares presentes nas afeccoes endocrinas, quer em seus aspectos etiopatogenicos e fisiopatologicos, quer em relacao ao quadro clinico e as medidas terapeuticas preconizadas. Ressaltam finalmente, que o perfeito reconhecimento do conjunto de sinais e sintomas neurologicos e musculares permitira o correto diagnostico de endocrinopatia e possibilitara a formulacao do esquema terapeutico necessario a recuperacao adequada do paciente

Diabetes insipidus central. Estudo de 13 casos. / Central diabetes insipidus. Study of 13 cases

O presente trabalho considera o diabetes insipidus central em seus aspectos etiopatogenicos e fisiopatologicos, enfatiza o quadro sintomatologico classico e os testes diagnosticos empregados na afeccao e finalmente destaca os mais recentes avancos no terreno terapeutico a luz de 13 pacientes portadores da condicao, acompanhados pelos autores

[Myxedema tuberosum atypicum (Jadassohn-Doesserkker, 1916) in the clinical picture of the myxodermias and in the normal course of Graves-Basedow's disease]. / O myxedema tuberosum atypicum (Jadassohn-Doesserkker, 1916) no quadro das mixodermias e no ciclo formal da moléstia de Graves-Basedow.

An extraordinary case: large cutaneous tumors, intense "endocrine" exophthalmos, macroglossia, acropachie, prétibial mucinosis, diffuse myxodermia, symptoms of systemic involvement.

Doenca de Basedow-Graves: grave comprometimento sistemico cutaneo e ocular. / Basedow-Graves' disease: severe systemic cutaneous and ocular involvement

Os autores apresentam dois casos de oftalmopatia infiltrativa de Graves-Basedow em sua forma mais grave e exuberante associada a dermopatia (mucinosis cutis: tanto na forma localizada - mixedema pre-tibial, como na forma tuberosa intensa) e a acropaquia tireotoxica. Discutem a etiopatogenia de cada uma dessas condicoes e consideram as varias medidas terapeuticas locais e sistemicas preconizadas nesses casos

Antigeno de histocompatibilidade H-Y (seu papel na diferenciacao gonadica). / Histocompatibility antigen H-Y (its role in gonadal differentiation)

Os autores fazem breve referencia aos estudos iniciais sobre a provavel vinculacao entre o antigeno de histocompatibilidade H-Y e o determinismo para a diferenciacao gonadica, a partir dos quais foi elaborado o conceito de que no cromosoma Y deve situar-se o complexo genico responsavel pela producao do antigeno e consequente diferenciacao testicular. Passam em revista numerosas publicacoes que parecem fortalecer essa hipotese. Mostram, no entanto, a seguir, como a progressao das pesquisas sobre o problema conduziram a verificacao de eventos de explicacao mais dificil, como, por exemplo, possiveis variacoes na expressividade do antigeno H-Y em presenca de um cromossoma Y aparentemente normal e, de outro lado, expressividade do antigeno (com diferenciacao de estrutura testicular) na ausencia de cromossoma Y. Sao abordadas, ao final, varias hipoteses sobre a etiopatogenia dessas condicoes