Endocrinologia, Diabetes e Metabolismo
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- Diabetes Mellitus após transplante renalPublication . Ruas, L; Bastos, M; Alves, R; Rodrigues, D; Barros, L; Mota, A; Carvalheiro, M; Ruas, A; Furtado, AL
- Transplantação renal em doentes com diabetes mellitus tipo I e tipo IIPublication . Baptista, C; Bastos, M; Gomes, L; Macário, F; Ruas, L; Rodrigues, D; Alves, R; Gomes, H; Ferreira, C; Roseiro, A; Paiva, S; Barros, L; Carvalheiro, M; Mota, A; Furtado, AL; Ruas, AA total of 618 patients with end-stage renal disease received kidney transplants between 1980 and September 1996. Twenty eight of them were diabetics. Better results were achieved for type 1 diabetic patients than for type 2 (mortality: 5.9% vs 27.3%; functioning graft: 88.2% vs 72.7%). The morbility was also higher in those patients (infections: 81.8% vs 29.4%; vascular complications: 45.5% vs 17.6%). Actuarial patient and graft survival were lower for type 2 than for non diabetic patients. For type 1 diabetics the results are similar to those for non diabetics. Better results can probably be achieved by restricting the selection criteria. The decision to transplant or maintain on dialysis should be made on a case by case basis.
- Tiroidites agudasPublication . Paiva, S; Bastos, M; Gomes, L; Durão, A; Moreira, A; Barros, L; Rodrigues, D; Ruas, L; Ribeiro, C; Rodrigues, F; Paiva, I; Fagulha, A; Carrilho, F; Geraldes, E; Carvalheiro, M; Ruas, AWe review the pathophysiology, clinical features and therapy of acute thyroiditis. Four cases are reported stressing the role of fine needle aspiration for the diagnosis of this clinical entity.
- Nefropatia diabética: protocolo de estudo pré-transplantação renalPublication . Baptista, C; Bastos, M; Paiva, S; Martins, T; Leitão, P; Lemos, MC; Alves, R; Bastos, C; Mota, A; Carvalheiro, M; Furtado, AL; Ruas, ABetween May 1990 and October 1998, 67 diabetic patients with end-stage renal disease, on dialysis, were submitted to a standardized protocol in order to assess the coexistence and degree of other diabetic and nondiabetic complications that could affect transplantation. Some of the results were analysed. Type 2 diabetic patients had more abnormal results on the lower limbs doppler ultrasound and on the lower limbs arteriography than type 1 (p < 0.05). Type 2 diabetic patients had more cardiovascular complications so the decision to transplant should be taken on a case by case basis.
- Ácido acetilsalicílico e diabetes mellitusPublication . Paiva, SThe physiopathologic mechanisms underlying cardiovascular disease in diabetic patients are briefly reviewed. The use of inhibitors of platelet aggregation is discussed as being potentially valuable in the pharmacological prevention of this condition. Acetylsalisylic acid turns out to be the reference within the repertoire of currently available drugs since it has been extensively tested in clinical trials. We conclude by discussing the recommendations of the American Diabetes Association (ADA) concerning the primary and secondary prevention of cardiovascular disease in diabetes mellitus.
- Radioterapia em tumores hipofisáriosPublication . Baptista, C; Paiva, I; Gomes, L; Gomes, F; Carvalheiro, M; Ruas, AThe aim of this study is to evaluate the use of conventional external radiotherapy in patients with pituitary adenomas. Between October 1970 and May 1998, 27 patients with pituitary adenoma were followed at the Department of Endocrinology and Diabetes of the Hospitais da Universidade de Coimbra. They received radiation therapy at Instituto Português de Oncologia. Seven of those tumors were classified as nonfunctioning adenomas, 17 as growth-hormone-secreting adenomas, 2 as prolactinomas and 1 as adrenocorticotropic adenoma. Twenty-six patients received radiation as adjuvant therapy after incomplete resection and one patient as primary treatment. The majority of these cases were treated using the parallel opposed-field technique with a total dose between 45 and 52 Gy. The patients were submitted, before and after radiotherapy, to a protocol in order to assess the efficacy of this treatment. Some of the results were analyzed. Reduction of tumor mass was achieved in 66.6% of nonfunctioning tumors and in 25% of the secreting ones. Reduction or stabilization of hormonal levels was achieved in 55% of the cases and normalization in 30%. The average duration of follow-up was 126.3 months. Complications observed: hypopituitarism, stroke (3 patients), cerebral edema (1 patient), memory loss (2 patients) and hearing loss (2 patients). None of the patients developed brain tumors
- Efeitos da amiodarona na tiroide: aspectos actuaisPublication . Campos, MVAmiodarone is a benzofuranic-derivate iodine-rich drug widely used for the treatment of tachyarrhythmias. In 14-18% of amiodarone-treated patients, there is overt thyroid disfunction, either amiodarone-induced hyperthyroidism (AIT) or amiodarone-induced hypothyroidism (AIH). Both AIT and AIH, may develop in apparently normal thyroid glands or in glands with preexisting, clinically silent abnormalities. In this article the author review the problems concerning the diagnosis and treatment of these two different situations.
- Disfunção tiroideia no recém-nascidoPublication . Campos, MV; Campos, BThe authors refer to congenic hypothyroidism, hypotyroxinemia in premature new-borns, thyroid dysfunction, congenic thyrotoxicosis, breastfeeding, composed anti-thyroid drugs and children nutrition based on iodine. Concerning to the fetus and new-born thyroid dysfunction, it's very important to make an early diagnosis in order to avoid later complications. Several studies revealed that the different types of composed anti-thyroid drugs can induce pregnant woman choice.
- Hipofisite Auto-imune ou LinfocíticaPublication . Paiva, I; Gomes, L; Ribeiro, C; Carvalheiro, M; Ruas, AThis entity, due to the pituitary lymphoplasmacytic infiltrate, was described for the first time in 1962. The clinical suspicion relies on a rapidly progressing hypopituitarism, particularly with adrenal involvement, affecting women in the peripartum period or patients with previously recognized autoimmune disease. Diabetes insipidus is also often reported. A sellar mass is found in 80% of cases. The diagnosis is confirmed by histology, due to the absence of a specific serological test. The endocrine deficiencies are frequently definitive. Corticotherapy is usually effective in reducing neurological symptoms due to pituitary enlargement, and frequently allows to avoid surgery. The disease-related deaths were due to acute adrenal insufficiency or ineffectively treated hypopituitarism. We are reporting a clinical case of probable lymphocytic hypophysitis in the early post partum of a woman with depression and Graves disease. She has hyperprolactinemia and ACTH deficiency, without pituitary changes in the magnetic resonance imaging. She was treated and her depression and hyperthyroidism were relieved. Hyperprolactinemia recovered spontaneously but she still needs glucocorticoid substitution.
- Outras disfunções tiroideias do pós-partoPublication . Carrilho, FThe author refers Graves' disease as the second most common cause of post-partum thyroid dysfunction. It is more common a long term persistence of hyperthyroidism but a transitory hyperthyroidism can be also possible. The disease hypothalamus/hypophysis can also be responsible for the post-partum thyroid dysfunction, even though it is extremely rare. The auto-immunity of hypophysis plus Sheehan syndrome are two main reasons for hypothyroidism, associated with other hypophysis hormones production deficit.