RESUMEN
INTRODUCTION: Non-androgenic growth factors are involved in the growth regulation of prostate cancer (PCa). OBJECTIVE: This is the first Brazilian study to correlate, in a population of patients operated for PCa, PSA, total testosterone, insulin-like growth factor-I (IGF-I) and insulin-like growth factor-binding protein-3 (IGFBP-3) with Gleason score and to compare with a control group with benign prostate hyperplasia (BPH). MATERIALS AND METHODS: This retrospective single-center study included 49 men with previously diagnosed PCa and 45 with previously diagnosed BPH. PSA, testosterone, IGF-I, IGFBP-3 were determined in both groups. RESULTS: PSA and IGFBP-3 levels were significantly higher in the PCa group as compared to the BPH group (p < 0.001 and p=0.004, respectively). There was a significant difference when we compared the PSA before surgery (p < 0.001) and at the inclusion in the study (p < 0.001) and IGFBP3 (0.016) among patients with Gleason < 7, ≥7 and BPH. In the PCa group, PSA, testosterone, IGF-I and IGFBP-3 levels were comparable between Gleason < 7 and ≥7. CONCLUSIONS: Our data suggest that in localized PCa, the quantification of PSA and, not of IGF-1, may provide independent significant information in the aggressiveness. IGFBP-3 could be a biochemical marker of disease control in PCa patients.
Asunto(s)
Adenocarcinoma/patología , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Antígeno Prostático Específico/sangre , Hiperplasia Prostática/patología , Neoplasias de la Próstata/patología , Testosterona/sangre , Adenocarcinoma/sangre , Anciano , Biomarcadores de Tumor , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Hiperplasia Prostática/sangre , Neoplasias de la Próstata/sangre , Valores de Referencia , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no ParamétricasRESUMEN
Introduction Non-androgenic growth factors are involved in the growth regulation of prostate cancer (PCa). Objective This is the first Brazilian study to correlate, in a population of patients operated for PCa, PSA, total testosterone, insulin-like growth factor-I (IGF-I) and insulin-like growth factor-binding protein-3 (IGFBP-3) with Gleason score and to compare with a control group with benign prostate hyperplasia (BPH). Materials and Methods This retrospective single-center study included 49 men with previously diagnosed PCa and 45 with previously diagnosed BPH. PSA, testosterone, IGF-I, IGFBP-3 were determined in both groups. Results PSA and IGFBP-3 levels were significantly higher in the PCa group as compared to the BPH group (p<0.001 and p=0.004, respectively). There was a significant difference when we compared the PSA before surgery (p<0.001) and at the inclusion in the study (p<0.001) and IGFBP3 (0.016) among patients with Gleason <7, ≥7 and BPH. In the PCa group, PSA, testosterone, IGF-I and IGFBP-3 levels were comparable between Gleason <7 and ≥7. Conclusions Our data suggest that in localized PCa, the quantification of PSA and, not of IGF-1, may provide independent significant information in the aggressiveness. IGFBP-3 could be a biochemical marker of disease control in PCa patients. .
Asunto(s)
Animales , Femenino , Humanos , Masculino , Ratones , Embarazo , Contaminantes Atmosféricos/toxicidad , Diferenciación Celular/efectos de los fármacos , Trastorno Depresivo/fisiopatología , Nanopartículas/toxicidad , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Animales Recién Nacidos , Western Blotting , Células Cultivadas , Ciudades , Trastorno Depresivo/etiología , Hipocampo/metabolismo , Proteínas Quinasas JNK Activadas por Mitógenos/metabolismo , Aprendizaje por Laberinto/efectos de los fármacos , Neuritas/efectos de los fármacos , Neuritas/fisiología , Neuronas/citología , Neuronas/efectos de los fármacos , Proyectos Piloto , Material Particulado/toxicidad , Efectos Tardíos de la Exposición Prenatal/etiologíaRESUMEN
INTRODUCTION: Published data suggest that patients with acromegaly have an increased prevalence of prostate disorders. OBJECTIVE: To evaluate prostatic disorders in acromegalic patients comparing these results after one year of treatment of acromegaly and with a group of healthy men. MATERIALS AND METHODS: This study was composed of two parts: sectional study comparing patients with healthy controls (baseline) and prospective, longitudinal study (at baseline and after one year of treatment). Forty acromegalic patients were enrolled and evaluated at baseline and after one year with the application of international prostatic symptoms score (IPSS), digital rectal examination, measurements of growth hormone (GH), insulin-like growth factor-I (IGF-I), insulin-like growth factor-binding protein-3 (IGFBP-3), sex hormone-binding globulin (SHBG), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, total and free prostate-specific antigen (PSA) levels and prostate ultrasonography (US). Thirty healthy men were selected as control group. RESULTS: We stratified patients and controls according to age, considering 40 years-old as cut off. Healthy controls under 40 had IPSS values lower than acromegalic patients. When considering only older patients and controls prostate hyperplasia and structural abnormalities were more frequent in acromegalics. After one year of treatment there was significant decrease in GH, IGF-I and prostate volume in acromegalics over 40 years-old. CONCLUSIONS: Acromegalics under 40 have more urinary symptoms according to IPSS and above 40 years-old higher frequency of structural changes and increased prostate volume than healthy men. Significant reduction of GH and IGF-I levels during treatment of acromegaly leads to decrease in the prostate volume.
Asunto(s)
Acromegalia/fisiopatología , Acromegalia/terapia , Enfermedades de la Próstata/fisiopatología , Acromegalia/metabolismo , Adulto , Factores de Edad , Anciano , Brasil , Estudios de Casos y Controles , Tacto Rectal , Gonadotropinas Hipofisarias/sangre , Hormona del Crecimiento/sangre , Humanos , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Enfermedades de la Próstata/metabolismo , Globulina de Unión a Hormona Sexual/análisis , Testosterona/sangre , Resultado del TratamientoRESUMEN
Introduction Published data suggest that patients with acromegaly have an increased prevalence of prostate disorders. Objective To evaluate prostatic disorders in acromegalic patients comparing these results after one year of treatment of acromegaly and with a group of healthy men. Materials and Methods This study was composed of two parts: sectional study comparing patients with healthy controls (baseline) and prospective, longitudinal study (at baseline and after one year of treatment). Forty acromegalic patients were enrolled and evaluated at baseline and after one year with the application of international prostatic symptoms score (IPSS), digital rectal examination, measurements of growth hormone (GH), insulin-like growth factor-I (IGF-I), insulin-like growth factor-binding protein-3 (IGFBP-3), sex hormone-binding globulin (SHBG), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, total and free prostate-specific antigen (PSA) levels and prostate ultrasonography (US). Thirty healthy men were selected as control group. Results We stratified patients and controls according to age, considering 40 years-old as cut off. Healthy controls under 40 had IPSS values lower than acromegalic patients. When considering only older patients and controls prostate hyperplasia and structural abnormalities were more frequent in acromegalics. After one year of treatment there was significant decrease in GH, IGF-I and prostate volume in acromegalics over 40 years-old. Conclusions Acromegalics under 40 have more urinary symptoms according to IPSS and above 40 years-old higher frequency of structural changes and increased prostate volume than healthy men. Significant reduction of GH and IGF-I levels during treatment of acromegaly leads to decrease in the prostate volume. .
Asunto(s)
Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Acromegalia/fisiopatología , Acromegalia/terapia , Enfermedades de la Próstata/fisiopatología , Factores de Edad , Acromegalia/metabolismo , Brasil , Estudios de Casos y Controles , Tacto Rectal , Gonadotropinas Hipofisarias/sangre , Hormona del Crecimiento/sangre , /sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Antígeno Prostático Específico/sangre , Enfermedades de la Próstata/metabolismo , Globulina de Unión a Hormona Sexual/análisis , Resultado del Tratamiento , Testosterona/sangreRESUMEN
Acromegalic patients have an increased prevalence of prostatic disorders compared to age-matched healthy subjects. Increased size of the whole prostate or the transitional zone, together with an elevated incidence of other structural changes, such as nodules, cysts, and calcifications, have been reported. Prostate enlargement in young acromegalic patients with low testosterone levels due to central hypogonadism supports the hypothesis that chronic GH and IGF-I excess cause prostate hyperplasia. The relationship between prostatic carcinoma and acromegaly is, until now, only circumstantial. Long-term follow-up of these patients is necessary since epidemiologic studies showed association between serum IGF-I levels in the upper normal limit and prostate cancer in the general population. This review approaches prostate diseases in patients with acromegaly.
Pacientes com acromegalia têm uma prevalência aumentada de desordens prostáticas em comparação a controles saudáveis da mesma idade. Aumento do tamanho de toda a próstata ou da zona de transição, juntamente com uma incidência elevada de outras alterações estruturais, como nódulos, cistos e calcificações, foi descrito. O aumento da próstata em acromegálicos jovens e com níveis baixos de testosterona devido ao hipogonadismo central sugere que o excesso crônico do GH e do IGF-I cause hiperplasia prostática. A relação entre câncer de próstata e acromegalia é, até o momento, apenas circunstancial. Entretanto, um seguimento prolongado desses pacientes é necessário uma vez que estudos epidemiológicos reportaram uma associação entre níveis séricos de IGF-I no limite superior da normalidade e câncer de próstata na população geral. Esta revisão aborda as patologias prostáticas em pacientes com acromegalia.
Asunto(s)
Humanos , Masculino , Acromegalia/complicaciones , Neoplasias de la Próstata/etiología , Hormona de Crecimiento Humana/fisiología , /fisiología , Factor I del Crecimiento Similar a la Insulina/análisis , Factor I del Crecimiento Similar a la Insulina/fisiología , Próstata/metabolismo , Próstata/patología , Hiperplasia Prostática/etiología , Neoplasias de la Próstata/sangreRESUMEN
Prostate cancer is the second most frequent malignancy diagnosed in adult men. Androgens are considered the primary growth factors for prostate normal and cancer cells. However, other non-androgenic growth factors are involved in the growth regulation of prostate cancer cells. The association between IGF-I and prostate cancer risk is well established. However, there is no evidence that the measurement of IGF-I enhances the specificity of prostate cancer detection beyond that achievable by serum prostate-specific antigen (PSA) levels. Until now, there is no consensus on the possible association between IGFBP-3 and prostate cancer risk. Although not well established, it seems that high insulin levels are particularly associated with risk of aggressive prostatic tumours. This review describes the physiopathological basis, epidemiological evidence, and animal models that support the association of the IGFs family and insulin with prostate cancer. It also describes the potential therapies targeting these growth factors that, in the future, can be used to treat patients with prostate cancer.
O câncer de próstata é a segunda neoplasia mais frequentemente diagnosticada em homens adultos. Os androgênios são considerados fatores de crescimento primários para células prostáticas normais e malignas. Entretanto, outros fatores de crescimento não androgênicos estão envolvidos na regulação do crescimento das células prostáticas malignas. Associação entre IGF-I e risco de câncer de próstata é bem estabelecida. No entanto, não há evidência de que a dosagem do IGF-I melhore a especificidade na detecção do câncer de próstata, além daquela alcançada pelos níveis de antígeno prostático específico (PSA). Até hoje, não há consenso sobre a possível associação entre IGFBP-3 e risco de câncer de próstata. Apesar de não estar estabelecido, altos níveis de insulina parecem particularmente associados ao risco de tumores prostáticos agressivos. Esta revisão descreveu base fisiopatológica, evidências epidemiológicas e modelos animais que apoiam a associação da família das IGFs e insulina com câncer de próstata. Também foram descritas terapias potenciais que têm como alvo esses fatores de crescimento, os quais, no futuro, poderão ser usados para tratar pacientes com câncer de próstata.
Asunto(s)
Adulto , Animales , Humanos , Masculino , /fisiología , Factor I del Crecimiento Similar a la Insulina/fisiología , Neoplasias de la Próstata/etiología , Modelos Animales , Neoplasias de la Próstata/epidemiologíaRESUMEN
Acromegalic patients have an increased prevalence of prostatic disorders compared to age-matched healthy subjects. Increased size of the whole prostate or the transitional zone, together with an elevated incidence of other structural changes, such as nodules, cysts, and calcifications, have been reported. Prostate enlargement in young acromegalic patients with low testosterone levels due to central hypogonadism supports the hypothesis that chronic GH and IGF-I excess cause prostate hyperplasia. The relationship between prostatic carcinoma and acromegaly is, until now, only circumstantial. Long-term follow-up of these patients is necessary since epidemiologic studies showed association between serum IGF-I levels in the upper normal limit and prostate cancer in the general population. This review approaches prostate diseases in patients with acromegaly.
Asunto(s)
Acromegalia/complicaciones , Neoplasias de la Próstata/etiología , Hormona de Crecimiento Humana/fisiología , Humanos , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/fisiología , Factor I del Crecimiento Similar a la Insulina/análisis , Factor I del Crecimiento Similar a la Insulina/fisiología , Masculino , Próstata/metabolismo , Próstata/patología , Hiperplasia Prostática/etiología , Neoplasias de la Próstata/sangreRESUMEN
Prostate cancer is the second most frequent malignancy diagnosed in adult men. Androgens are considered the primary growth factors for prostate normal and cancer cells. However, other non-androgenic growth factors are involved in the growth regulation of prostate cancer cells. The association between IGF-I and prostate cancer risk is well established. However, there is no evidence that the measurement of IGF-I enhances the specificity of prostate cancer detection beyond that achievable by serum prostate-specific antigen (PSA) levels. Until now, there is no consensus on the possible association between IGFBP-3 and prostate cancer risk. Although not well established, it seems that high insulin levels are particularly associated with risk of aggressive prostatic tumours. This review describes the physiopathological basis, epidemiological evidence, and animal models that support the association of the IGFs family and insulin with prostate cancer. It also describes the potential therapies targeting these growth factors that, in the future, can be used to treat patients with prostate cancer.
Asunto(s)
Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/fisiología , Factor I del Crecimiento Similar a la Insulina/fisiología , Neoplasias de la Próstata/etiología , Adulto , Animales , Humanos , Masculino , Modelos Animales , Neoplasias de la Próstata/epidemiologíaRESUMEN
BACKGROUND: Acromegalic patients are considered "discordant" if their insulin-like growth factor type I (IGF-I) levels are increased for their age with "safe" growth hormone (GH) levels or if their IGF-I levels are normal for their age with "unsafe" GH levels. The prevalence of discordance in acromegalics has been described to vary from 9.4% to 39%, and it may be observed at diagnosis or during the follow up. OBJECTIVE: To evaluate the prevalence of discordant levels of IGF-I and GH in our acromegalic population. METHODS: Hormonal evaluation was made with an oral glucose tolerance test (OGTT) with the IGF-I being assessed in the basal sample at diagnosis and after 3 months of the adenomectomy. During treatment with octreotide LAR, a GH curve (for the calculation of mean GH) and IGF-I assessment were made every 3 months. RESULTS: Among the 51 patients evaluated at diagnosis, the prevalence of discordance was 13.7% (7/51). Among the 58 patients evaluated after the surgical procedure, eight (13.8%) had discordant GH and IGF-I levels. Among the 42 patients evaluated during treatment with octreotide LAR, the prevalence of discordant GH and IGF-I levels was 33.3% (14/42). Using 1 microg/L as a cut off level for "safe" GH, the prevalence of discordance was 3.9%, 8.6% and 28.6% at diagnosis, after surgery and during treatment with octreotide LAR, respectively. No difference of sex, age or treatment modality was observed among discordant and concordant patients with any GH cut off level. CONCLUSION: We observed a prevalence of discordance similar to that previously described in the literature. We believe that studies evaluating morbidity and mortality in discordant patients are also necessary and will enlighten the true impact of this condition in the follow up of acromegaly.
Asunto(s)
Acromegalia/terapia , Hormona de Crecimiento Humana/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Octreótido/uso terapéutico , Acromegalia/diagnóstico , Acromegalia/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Hormona de Crecimiento Humana/metabolismo , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Persona de Mediana Edad , Octreótido/administración & dosificación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM OF THE STUDY: To evaluate the glucose metabolism in acromegalic patients before and after treatment with octreotide LAR. PATIENTS AND METHODS: This was a prospective and longitudinal study involving 30 patients from the acromegaly research outpatient clinic of the Endocrinology unit of the HUCFF/UFRJ. They underwent clinical and laboratorial evaluations, with measurements of growth hormone (GH), insulin-like growth factor type I (IGF-I), insulin, proinsulin, C peptide, glycosylated hemoglobin (HbA1c), IGF binding protein type 1 (IGFBP-1) and glucose, during oral glucose tolerance test (OGTT), before and after six months of treatment with octreotide LAR. The Wilcoxon signed-rank test was used and values of 5% were considered statistically significant. RESULTS: We found 16 (54%) patients with normal glucose tolerance, 7 (23%) with impaired glucose tolerance and 7 (23%) diabetics. Twelve patients completed the six-month treatment, out of which three showed worsening of glucose tolerance and two (diabetics) had worse blood glucose control. Whereas there was an increase in waist circumference (p=0.03), there was a decrease in GH (p=0.04), with %IGF-I above the upper limit of reference values (% ULRV) [p=0.001], insulin (p=0.019), C peptide levels (p=0.002) and homeostatic model assessment (HOMA-IR) [p=0.039]. CONCLUSIONS: In this series, treatment with octreotide LAR led to a worsening of glucose tolerance in three non-diabetic patients and worsened glycemic control in two diabetics, in spite of reducing insulin resistance.
Asunto(s)
Acromegalia/metabolismo , Antineoplásicos Hormonales/uso terapéutico , Intolerancia a la Glucosa/diagnóstico , Glucosa/metabolismo , Hormona de Crecimiento Humana/sangre , Octreótido/uso terapéutico , Acromegalia/tratamiento farmacológico , Adolescente , Antineoplásicos Hormonales/efectos adversos , Biomarcadores/sangre , Femenino , Intolerancia a la Glucosa/inducido químicamente , Prueba de Tolerancia a la Glucosa , Hormona de Crecimiento Humana/metabolismo , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Octreótido/efectos adversos , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: To determine the prevalence of sleep apnea (SA) and SA syndrome (SAS) in patients with acromegaly and correlate SA with clinical, laboratory, and cephalometric parameters. DESIGN AND METHODS: Prospective and cross-sectional study of 24 patients with active acromegaly evaluated by clinical and laboratory (GH, IGF-I) parameters, polysomnography and magnetic resonance imaging (MRI) of the pharynx. RESULTS: Out of 24 patients, 21 had SA (87.5%), of which 20 (95.3%) had the predominant obstructive type. Median age of these 21 patients was 54 years (range 23-75) and median estimated disease duration was 60 months (range 24-300). The frequency in SA patients of impaired glucose tolerance, diabetes mellitus (DM), and hypertension was 19, 33.3, and 71.4% respectively. Goiter was found in 10 patients (47.6%) and obesity in 18 (90%). Median GH level was 14 mug/l (1.4-198) and median %IGF-I (percentage above the upper limit of normal range of IGF-I) was 181% (-31.6 to 571.2). The prevalence of SAS was 52.4%. Apnea-hypopnea index (AHI) correlated significantly with age, waist circumference, body mass index, and hypopharynx area. The AHI was significantly higher in patients with hypertension and DM. CONCLUSIONS: The prevalence of SA and SAS in acromegaly was similar to the one previously described in other series. Age was a significant risk factor, and hypertension and DM were significantly associated complications of SA. Obesity was also significantly related to SA, as a risk factor, a complication or both. Overall, cephalometric parameters by MRI did not correlate with SA.
Asunto(s)
Acromegalia/epidemiología , Cabeza/anatomía & histología , Imagen por Resonancia Magnética , Enfermedades Metabólicas/epidemiología , Síndromes de la Apnea del Sueño/epidemiología , Acromegalia/complicaciones , Adulto , Anciano , Cefalometría , Femenino , Humanos , Masculino , Enfermedades Metabólicas/complicaciones , Persona de Mediana Edad , Faringe/anatomía & histología , Prevalencia , Síndromes de la Apnea del Sueño/complicacionesRESUMEN
OBJETIVO: Avaliar o metabolismo da glicose em pacientes acromegálicos antes e após o tratamento com octreotide LAR. PACIENTES E MÉTODOS: Este foi um estudo longitudinal e prospectivo com 30 pacientes do ambulatório de pesquisa em acromegalia do Serviço de Endocrinologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF/UFRJ). Eles foram submetidos à avaliação clínica e laboratorial com dosagens de hormônio do crescimento (GH), fator de crescimento semelhante à insulina tipo I (IGF-I), insulina, pró-insulina, peptídeo C, hemoglobina glicosilada (HbA1c), proteína de ligação do IGF tipo 1 (IGFBP-1) e a um teste oral de tolerância à glicose (TOTG), antes e após seis meses de tratamento com octreotide LAR. Foi aplicado o teste dos postos sinalizados de Wilcoxon e o critério de determinação de significância adotado foi o nível de 5 por cento. RESULTADOS: Encontraram-se 16 pacientes (54 por cento) com tolerância normal à glicose, sete (23 por cento) com intolerância à glicose e sete (23 por cento) com diabetes melito (DM). Doze pacientes completaram os seis meses de tratamento, sendo que houve piora da tolerância à glicose em três e piora do controle glicêmico dos dois pacientes diabéticos. Houve aumento da circunferência abdominal (p = 0,03) e queda do GH (p = 0,04), por cento IGF-I acima do limite superior do valor de referência ( por centoLSVR) (p = 0,001), insulina (p = 0,019), peptídeo C (p = 0,002) e do modelo de avaliação homeostática (HOMA-IR) (p = 0,039). CONCLUSÕES: Nesta série, o tratamento com octreotide LAR acarretou piora da tolerância à glicose em três pacientes não-diabéticos e piora do controle glicêmico em dois diabéticos, apesar da diminuição da resistência insulínica (RI).
AIM OF THE STUDY: To evaluate the glucose metabolism in acromegalic patients before and after treatment with octreotide LAR. PATIENTS AND METHODS: This was a prospective and longitudinal study involving 30 patients from the acromegaly research outpatient clinic of the Endocrinology unit of the HUCFF/UFRJ. They underwent clinical and laboratorial evaluations, with measurements of growth hormone (GH), insulin-like growth factor type I (IGF-I), insulin, proinsulin, C peptide, glycosylated hemoglobin (HbA1c), IGF binding protein type 1 (IGFBP-1) and glucose, during oral glucose tolerance test (OGTT), before and after six months of treatment with octreotide LAR. The Wilcoxon signed-rank test was used and values of 5 percent were considered statistically significant. RESULTS: We found 16 (54 percent) patients with normal glucose tolerance, 7 (23 percent) with impaired glucose tolerance and 7 (23 percent) diabetics. Twelve patients completed the six-month treatment, out of which three showed worsening of glucose tolerance and two (diabetics) had worse blood glucose control. Whereas there was an increase in waist circumference (p=0.03), there was a decrease in GH (p=0.04), with percentIGF-I above the upper limit of reference values ( percent ULRV) [p=0.001], insulin (p=0.019), C peptide levels (p=0.002) and homeostatic model assessment (HOMA-IR) [p=0.039]. CONCLUSIONS: In this series, treatment with octreotide LAR led to a worsening of glucose tolerance in three non-diabetic patients and worsened glycemic control in two diabetics, in spite of reducing insulin resistance.
Asunto(s)
Adolescente , Femenino , Humanos , Masculino , Adulto Joven , Acromegalia/metabolismo , Antineoplásicos Hormonales/uso terapéutico , Intolerancia a la Glucosa/diagnóstico , Glucosa/metabolismo , Hormona de Crecimiento Humana/sangre , Octreótido/uso terapéutico , Acromegalia/tratamiento farmacológico , Antineoplásicos Hormonales/efectos adversos , Biomarcadores/sangre , Prueba de Tolerancia a la Glucosa , Intolerancia a la Glucosa/inducido químicamente , Hormona de Crecimiento Humana , Factor I del Crecimiento Similar a la Insulina/metabolismo , Octreótido/efectos adversos , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
A acromegalia é uma doença sistêmica com diversas etiologias. A grande maioria dos casos se manifesta de forma esporádica, e uma minoria tem transmissão familiar. Além disso, a acromegalia pode ser acompanhada de várias complicações como alterações endócrinas, cardiovasculares, respiratórias, metabólicas, osteoarticulares e neoplásicas que devem ser consideradas quando a estratégia de tratamento for estabelecida. O acompanhamento dos pacientes requer reavaliações periódicas do status das complicações. Neste artigo serão abordados os aspectos etiológicos e o manejo da acromegalia.
Asunto(s)
Humanos , Acromegalia , Acromegalia/etiología , Acromegalia/terapiaRESUMEN
Initially used to measure algic symptoms, visual analogue scales (VAS) can also be useful for the evaluation of satiety. The antiobesity agent sibutramine, unlike anorectic agents, decreases food intake mainly by stimulating satiety. To evaluate the effect of sibutramine on satiety, we used a VAS in obese adolescents participating in a double-blind, randomized trial comparing 10 mg of sibutramine to placebo. Each patient received 13 scales to be checked at hourly intervals, in a single day, from 9 am to 9 pm. A 500 kcal deficit diet was divided into 3 meals, with previously fixed times: 9:30 h, 12:30 h, 18:30 h. Using the scores obtained from each scale, a line graph was designed to represent the average satiety score throughout the day. Comparing the area under the curve for the 2 groups, we found 4.609 +/- 1.309 for the group treated with sibutramine and 4.141 +/- 1.432 for the placebo group, not reaching statistical significance (p= NS). Therefore, sibutramine does not seem do have an effect on satiety of obese adolescents, at least when satiety is evaluated by a VAS.
Asunto(s)
Depresores del Apetito/uso terapéutico , Ciclobutanos/uso terapéutico , Obesidad/tratamiento farmacológico , Respuesta de Saciedad/efectos de los fármacos , Adolescente , Depresores del Apetito/farmacología , Ciclobutanos/farmacología , Método Doble Ciego , Femenino , Humanos , Masculino , Respuesta de Saciedad/fisiología , Factores de Tiempo , Pérdida de Peso/efectos de los fármacos , Pesos y MedidasRESUMEN
Inicialmente empregadas para mensuracão de sintomas álgicos, as escalas visuais analógicas (EVAs) podem ser também um instrumento útil para avaliacão da saciedade. O agente antiobesidade sibutramina, ao contrário dos anorexígenos, parece exercer seu efeito de reducão de ingestão alimentar principalmente por estímulo da saciedade. Com o objetivo de avaliar o efeito da sibutramina sobre a saciedade, utilizamos uma EVA em adolescentes obesos que participaram de um estudo duplo-cego randomizado, comparando sibutramina 10mg com placebo. Cada paciente recebeu 13 escalas para serem preenchidas em intervalos de uma hora, num único dia, das 9 às 21h. Uma dieta com déficit de 500kcal diárias foi dividida em 3 refeicões, com horários previamente estipulados: 9:30h, 12:30h, 18:30h. A partir da pontuacão obtida em cada uma das escalas, construiu-se um gráfico de linha representativo da pontuacão média de saciedade ao longo do dia. Comparando-se a área sob a curva dos 2 grupos, encontramos 4.609 n 1.309 para o grupo tratado com sibutramina e 4.141 n 1.432 para o grupo placebo (p= NS). Desta forma, a sibutramina não parece apresentar efeito sobre a saciedade de adolescentes obesos, pelo menos quando avaliado através de uma EVA.
Asunto(s)
Adolescente , Humanos , Masculino , Femenino , Depresores del Apetito/uso terapéutico , Ciclobutanos/uso terapéutico , Obesidad/tratamiento farmacológico , Dimensión del Dolor/métodos , Respuesta de Saciedad/efectos de los fármacos , Depresores del Apetito/farmacología , Ciclobutanos/farmacología , Método Doble Ciego , Respuesta de Saciedad/fisiología , Factores de Tiempo , Pérdida de Peso/efectos de los fármacosRESUMEN
Acromegaly is a systemic disease with various etiologies. It can occur as a sporadic or, more rarely, as a familial disease. Numerous complications such as endocrine, cardiovascular, respiratory, metabolic, osteoarticular and neoplastic disturbances occur and must be taken into account when establishing a therapeutic strategy. For this reason, the decision as to a treatment modality of acromegaly must be followed by a thorough evaluation of the patient and once the diagnosis of complications is settled, adequate treatment should be instituted. Follow up of the patients requires periodical re-assessment of complications status.