RESUMEN
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.
Asunto(s)
Glándulas Suprarrenales/patología , Hormona Adrenocorticotrópica , Aldosterona/sangre , Hidrocortisona/metabolismo , Paracoccidioidomicosis/diagnóstico , Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/fisiopatología , Adulto , Humanos , Masculino , Persona de Mediana Edad , Paracoccidioidomicosis/diagnóstico por imagen , Paracoccidioidomicosis/fisiopatología , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
A silicose aguda e uma forma de pneumoconiose que aparece em curto prazo de exposicao a poeiras com alto teor de silica e com evolucao muitas vezes fatal.A silicose aguda e encontrada especificamente em alguns grupos profissionais, principalmente o dos ajatadores de areia. Os autores descrevem quatro casos desta doenca em ajatadores de areia. A idade dos pacientes variou de 26 a 46 anos, com a media de 32 anos. O tempo medio de exposicao a poeira foi de dois anos e oito meses, dois pacientes evoluiram para o obito. Os achados radiologicos mais comuns foram os de infiltrado intersticial reticulo-nodular difuso, com areas de ocupacao alveolar confluente e fibrose. Os autores ressaltam a importancia do conhecimento da entidade no sentido de evitar erros diagnosticos que podem levar a condutas por vezes ate nocivas ao paciente