SE - Serviço de Endocrinologia
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- GRAVIDEZ E TIRÓIDEPublication . Pereiras, C.; Horta, C.Acta Med Port. 2003 Sep-Oct;16(5):329-31. [Pregnancy and the thyroid] [Article in Portuguese] Pereiras C, Horta C. Serviço de Endocrinologia, Diabetes e Metabolismo, Hospital Geral Sto António, Porto. Abstract The author points out the changes occurred in the axis hypothalamus/hypofysis/thyroid during normal pregnancy. They mention fetus thyroid development different stages, as well as the thyroid hormone secretion through the fetus. They also give special attention to those pregnancies and its special features occurring in places where the amount of iodine isn't enough and how treatment must be carried out. PMID: 14750275 [PubMed - indexed for MEDLINE]
- HIPERTIROIDISMO E GRAVIDEZPublication . Castro, J.; Borges, F.Os autores descrevem as etiologias mais frequentes do hipertiroidismo que ocorre na gravidez e referem as alterações imunológicas que caracterizam a doença de Graves e a tolerância imunológica associada à gravidez. Referem o quadro clínico, o diagnóstico laboratorial e o tratamento a efectuar. Como o tratamento médico é o mais frequente, referem os antitiroideus de síntese, suas características e a opção mais conveniente para o tratamento durante a gravidez. The authors describe most common hyperthyroidism aetiologies that occur during pregnancy and also the immunity changes that define Graves disease and the immunity tolerance associated to pregnancy. They also refer the clinical pictur, laboratorial diagnosis and the treatment to be carried out. Medical treatment is mostly based on anti-thyroid drugs. Their characteristics and use during pregnancy are discussed.
- A prospective, multicentre study to investigate the efficacy,Publication . MERCADO, M.; BORGES, F.; BOUTERFA, H.; CHANG, T.C.; CHERVIN, A.; FARRALL, A.J.; PATOCS, A.; PETERSENN, S.; PODOBA, J.; SAFARI, M.; WARDLAW, J.; SMS995B2401 STUDY GROUP.Clin Endocrinol (Oxf). 2007 Jun;66(6):859-68. Epub 2007 Apr 25. A prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of patients with acromegaly. Mercado M, Borges F, Bouterfa H, Chang TC, Chervin A, Farrall AJ, Patocs A, Petersenn S, Podoba J, Safari M, Wardlaw J; SMS995B2401 Study Group. SourceHospital de Especialidades, Centro Medico Nacional Siglo XXI, IMSS, Mexico City, Mexico. moises.mercado@imss.gob.mx Abstract OBJECTIVE: To evaluate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of acromegaly. DESIGN AND PATIENTS: Ninety-eight previously untreated acromegalics were recruited into this prospective multicentre study. A total of 68 patients successfully completed 48 weeks of the study period, received 12 doses of octreotide LAR 10-30 mg every 4 weeks, and constituted the population used for this analysis. MEASUREMENTS AND RESULTS: A clinically relevant reduction (i.e. to < or = 5 microg/l) in mean GH (mGH) was recorded in 72% of patients after 24 weeks of treatment, and 42% reached a 'safe' GH value (< or = 2.5 microg/l). At week 48, 16 more patients were considered partial GH responders (GH > 2.5 microg/l and < or = 5 microg/l) and 44% had reached a GH level < or = 2.5 microg/l. IGF-1 levels normalized in 38% and 34% of patients after 24 and 48 weeks of treatment, respectively. At study completion, 10 patients (14.7%) who had not normalized their IGF-1 levels had achieved at least a 50% decrement in this marker. In eight microadenoma patients, tumour volume decreased from a mean baseline level of 298 +/- 145 mm3 to 139 +/- 94 mm3 after 24 weeks and to 99 +/- 70 mm3 after 48 weeks of therapy. In 60 patients with macroadenoma, the corresponding values were 3885 +/- 5077 mm3 at baseline and 2723 +/- 3435 and 2406 +/- 3207 mm3 after 24 and 48 weeks, respectively. At weeks 24 and 48, a significant (> 20%) tumour volume reduction was reported in 63% and 75% of patients, respectively. A reduction in the severity of symptoms of acromegaly was observed early in treatment and was maintained throughout the study period. CONCLUSION: Octreotide LAR represents a viable alternative to surgery for primary treatment of acromegaly leading to a progressive regression of tumour volume, a sustained control of biochemical abnormalities and an adequate relief of symptoms of the disease.
- Abordagem da hipertrigliceridemia severa na gravidez: a propósito de um caso clínicoPublication . Giestas, A.; Palma, I.; Teixeira, S.; Carvalho, R.; Pichel, F.; Ramos, M. H.RESUMO Durante a gravidez o metabolismo lipídico é afectado pelas hormonas placentárias de modo a assegurar um adequado aporte nutricional para o feto, constatando-se um aumento fisiológico dos níveis de triglicerídeos (TG), em particular no terceiro trimestre. Se o aumento do valor dos triglicerídeos for superior ao esperado na gravidez a paciente deve ser cuidadosamente monitorizada. A principal complicação da hipertrigliceridemia severa é a pancreatite aguda que está associada a uma mortalidade materno-fetal elevada (20%). Os autores apresentam o caso de uma mulher de 31 anos, com gestação de 34 semanas e hipertrigliceridemia severa (TG=1127 mg/dl). Foi internada e submetida a dieta pobre em gorduras, suplementos de ácidos gordos ómega 3 e a apertada vigilância clínica e analítica. O parto decorreu às 37 semanas de gestação sem complicações. O recém-nascido, do sexo feminino, pesava 3220 g e o score Apgar era de 9 ao primeiro minuto. Após o parto os níveis de TG maternos mostraram uma redução marcada. Este caso ilustra a importância do diagnóstico precoce e da instituição de medidas estratégicas relativamente simples na prevenção de pancreatite aguda em grávidas com hipertrigliceridemia severa.
- Hiperaldosteronismo primário: novas perspectivasPublication . Carvalho, A.; Carvalho, R.RESUMO O hiperaldosteronismo primário (HAP) é a forma secundária de hipertensão arterial mais frequente. A prevalência real é desconhecida, mas em estudos recentes cerca de 10% dos hipertensos apresentam esta forma potencialmente curável de hipertensão arterial. Este artigo visa rever de uma forma breve os aspectos históricos, bioquímicos, patológicos e clínicos do HAP, assim como os dilemas que se colocam no seu rastreio e diagnóstico diferencial. Para tal foram avaliados os artigos indexados na MEDLINE e PubMed publicados entre Janeiro de 1970 a Julho de 2008 com os seguintes termos Primary Aldosteronism, Aldosteronism, Conn’s Syndrome, Screening, Diagnosis, Treatment, Plasma Aldosterone-to-Renin Ratio, Direct Renin Concentration ou Renin Activity. Apesar das inúmeras publicações sobre este assunto só muito recentemente foi tentado um consenso internacional sobre o seu rastreio, diagnóstico e diferenciação. No entanto, algumas das questões clínicas mais polémicas não foram completamente esclarecidas, nomeadamente aquelas que se levantam quando pretendemos definir qual o valor de corte para os testes de rastreio, a prova de confirmação mais indicada para cada doente e a forma mais simples e menos invasiva de distinguir os vários subtipos de HAP. De uma maneira geral um rastreio positivo obtido através da relação aldosterona-renina deve ser confirmado com uma prova de sobrecarga salina. Na continuação deve ser obtida uma imagem das supra-renais através duma tomografia axial computorizada (TAC) seguida, ou não, do cateterismo das veias supra-renais, conforme exista demonstração de unilateralidade e vontade expressa do doente em ser submetido a uma cirurgia. O tratamento de eleição para qualquer forma unilateral de HAP é a adrenalectomia laparoscópica, a qual permite cura clínica em mais de metade dos doentes. Todos os restantes devem ser tratados com doses eficazes e toleráveis de antagonistas da aldosterona (espironolactona ou eplenerona) de modo a obterem um melhor controlo tensional e redução do número de eventos cardiovasculares.
- SISTEMA RENINA-ANGIOTENSINA-ALDOSTERONA E sua Modulação FarmacológicaPublication . Giestas, A.; Palma, I.; Ramos, M:O sistema-renina-angiotensina-aldosterona (SRAA) é um sistema neuroendócrino complexo responsável pela modulação do equilíbrio hidroelectrolítico e regulação da pressão arterial. Através das suas múltiplas interacções contribui para a protecção do tecido endotelial, cardíaco, cerebral e renal. Adicionalmente, regula ainda a resposta do endotélio à inflamação e lesão. A sua activação crónica/desregulação induz hipertensão e perpetuação de uma cascata pró-inflamatória, pró-trombótica e aterogénica, que está na base da lesão de vários órgãos-alvo (coração, cérebro, rim, endotélio). Consequentemente, o SRAA constitui um alvo terapêutico importante nestas situações. O artigo aborda a fisiologia, patofisiologia e mecanismos de modulação farmacológica do SRAA. The renin-angiotensin-aldosterone system (RAAS) is a neuroendocrine complex system that regulates the modulation of salt and water homeostasis, and regulation of blood pressure. Through its multiple interactions it protects the endothelium, heart, brain and kidney. In addition, the RAAS regulates the vascular response to injury and inflammation. Chronic activation/dysregulation of the RAAS leads to hypertension and perpetuates a cascade of proinflammatory, prothrombotic and atherogenic effects associated with endorgan damage (heart, brain, kidney, endothelium). Consequently, the RAAS is an important therapeutic target in these situations. This article presents an overview of physiology, pathophysiology and pharmacologic modulation of the RAAS.
- SÍNDROME METABÓLICA NA GRAVIDEZ COMO FACTOR PREDITIVO DE OUTCOMES OBSTÉTRICOS E NEONATAIS ADVERSOSPublication . Teixeira, C.; Dores, J.O reconhecimento da Síndrome Metabólica (SM) durante a gravidez poderá ajudar a identificar um conjunto de mulheres que não só terão um risco aumentado para desenvolver complicações cardiovasculares e metabólicas mais tardiamente na vida, mas também, potencialmente, estarão em risco de desenvolver uma patologia relacionada com a gravidez. A implementação do rastreio da SM, na segunda metade da gravidez, poderá permitir identificar grávidas de alto risco e definir estratégias de intervenção adequadas. Este trabalho teve como objectivos (i) Determinar a prevalência de SM em gestações normais e complicadas; (ii) Avaliar o impacto do diagnóstico de SM na ocorrência de outcomes obstétricos e neonatais adversos.
- Insulinoterapia na diabetes mellitus tipo 2Publication . Dores, JorgeType 2 diabetes is a growing prevalent disease, usually symptomless, with devastating chronic complications for the individual, family and society. Its progressive nature leads to the dose escalating and the association of different drugs which will rapidly become insufficient to achieve the glycemic goals established individually. Insulin is the most effective drug to control diabetes but there is frequently a silent contract to resist to its implementation between the healthcare team and people with type 2 diabetes. This publication aims to share information about this therapeutic option, eliminating old myths and giving an understandable teaching about all the process of insulin therapy centered on the person with type 2 diabetes. Sharing knowledge with different groups of healthcare professionals regarding the glycemic goals and how to reach them with distinct kinds of available insulins, will allow the release by multiprofessional teams of a homogeneous and non contradictory information to the people with type 2 diabetes. Moreover, a good engagement between physicians and nurse educators in the same team is the cornerstone to the initiation and intensification of insulin therapy. The decision of starting insulin therapy is not the end of the process. The progressive nature of the disease compels to empower the patient to adjust its dose of insulin according to the self monitoring blood glucose data and to realize that the decision of a single therapeutic scheme is not definitive, being adapted upon the clinical condition of the person along the diabetes evolution
- O Papel dos Testes de Estimulação Farmacológica no Diagnóstico da Deficiência de Hormona do Crescimento em Crianças e AdolescentesPublication . Gonçalves, J.; Correia, F.; Cardoso, H.; Borges, T.; Oliveira, M.INTRODUCTION: The incidence of short stature associated with growth hormone deficiency has been estimated to be about 1:4000 to 1:10000. It is the main indication for treatment with recombinant growth hormone. OBJECTIVES: The aims of the study were to evaluate the results of growth hormone stimulation tests and identify the growth hormone deficiency predictors. MATERIAL AND METHODS: A cross-sectional, analytical and observational study was conducted. We studied all the children and adolescents submitted to growth hormone pharmacological stimulation tests between January 2008 and May 2012. Growth hormone deficiency diagnosis was confirmed by two negatives growth hormone stimulation tests (growth hormone peak < 7 ng/ml). The statistical analysis was performed using student t-test, chi-square, Pearson correlation and logistic regression. Statistical significance determined at the 5% level (p ≤ 0.05). RESULTS: Pharmacological stimulation tests were performed in 89 patients, with a median age of 10 [3-17] years. Clonidine (n = 85) and insulin tolerance test (n = 4) were the first growth hormone stimulation tests performed. Growth hormone deficiency was confirmed in 22 cases. In cases with two growth hormone stimulation tests, the growth hormone peak showed a moderate correlation (r = 0.593, p = 0.01). In logistic regression model height (z-score) and the growth hormone peak in first stimulation test were predictors of growth hormone deficiency diagnosis (each one unit increase in z-score decrease the growth hormone deficiency probability). DISCUSSION: Measurement of IGF-1 cannot be used in diagnosing growth hormone deficiency. CONCLUSION: Auxological criteria associated with a positive test seems to be a reliable diagnostic tool for growth hormone deficiency.
- Predictors of quality of life in Portuguese obese patients: a structural equation modeling applicationPublication . Vilhena, E.; Pais-Ribeiro, J.; Silva, I.; Cardoso, H.; Mendonça, D.Living with obesity is an experience that may affect multiple aspects of an individual's life. Obesity is considered a relevant public health problem in modern societies. To determine the comparative efficacy of different treatments and to assess their impact on patients' everyday life, it is important to identify factors that are relevant to the quality of life of obese patients. The present study aims to evaluate, in Portuguese obese patients, the simultaneous impact of several psychosocial factors on quality of life. This study also explores the mediating role of stigma in the relationship between positive/negative affect and quality of life. A sample of 215 obese patients selected from the main hospitals in Portugal completed self-report questionnaires to assess sociodemographic, clinical, psychosocial, and quality of life variables. Data were analysed using structural equation modeling. The model fitted the data reasonably well, CFI = 0.9, RMSEA = 0.06. More enthusiastic and more active patients had a better quality of life. Those who reflect lower perception of stigma had a better physical and mental health. Partial mediation effects of stigma between positive affect and mental health and between negative affect and physical health were found. The stigma is pervasive and causes consequences for psychological and physical health.