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Omira R, Ramalho RS, Kim J, González PJ, Kadri U, Miranda JM, Carrilho F, Baptista MA. Global Tonga tsunami explained by a fast-moving atmospheric source. Nature 2022; 609:734-740. [PMID: 35697059 PMCID: PMC9492550 DOI: 10.1038/s41586-022-04926-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
Volcanoes can produce tsunamis by means of earthquakes, caldera and flank collapses, pyroclastic flows or underwater explosions1-4. These mechanisms rarely displace enough water to trigger transoceanic tsunamis. Violent volcanic explosions, however, can cause global tsunamis1,5 by triggering acoustic-gravity waves6-8 that excite the atmosphere-ocean interface. The colossal eruption of the Hunga Tonga-Hunga Ha'apai volcano and ensuing tsunami is the first global volcano-triggered tsunami recorded by modern, worldwide dense instrumentation, thus providing a unique opportunity to investigate the role of air-water-coupling processes in tsunami generation and propagation. Here we use sea-level, atmospheric and satellite data from across the globe, along with numerical and analytical models, to demonstrate that this tsunami was driven by a constantly moving source in which the acoustic-gravity waves radiating from the eruption excite the ocean and transfer energy into it by means of resonance. A direct correlation between the tsunami and the acoustic-gravity waves' arrival times confirms that these phenomena are closely linked. Our models also show that the unusually fast travel times and long duration of the tsunami, as well as its global reach, are consistent with an air-water-coupled source. This coupling mechanism has clear hazard implications, as it leads to higher waves along land masses that rise abruptly from long stretches of deep ocean waters.
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Affiliation(s)
- R Omira
- Instituto Português do Mar e da Atmosfera (IPMA), Lisbon, Portugal.
- Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.
| | - R S Ramalho
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA
- Instituto Dom Luiz (IDL) and Departamento de Geologia, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - J Kim
- Instituto Português do Mar e da Atmosfera (IPMA), Lisbon, Portugal
| | - P J González
- Volcanology Research Group, Department of Life and Earth Sciences, Instituto de Productos Naturales y Agrobiología, Consejo Superior de Investigaciones Científicas (IPNA-CSIC), La Laguna, Canary Islands, Spain
- COMET, Department of Earth, Ocean and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - U Kadri
- School of Mathematics, Cardiff University, Cardiff, UK
| | - J M Miranda
- Instituto Português do Mar e da Atmosfera (IPMA), Lisbon, Portugal
- Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - F Carrilho
- Instituto Português do Mar e da Atmosfera (IPMA), Lisbon, Portugal
| | - M A Baptista
- Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- Instituto Superior de Engenharia de Lisboa (ISEL), Instituto Politécnico de Lisboa (IPL), Lisbon, Portugal
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Omira R, Ramalho RS, Kim J, González PJ, Kadri U, Miranda JM, Carrilho F, Baptista MA. Global Tonga tsunami explained by a fast-moving atmospheric source. Nature 2022. [PMID: 35697059 PMCID: PMC9492550 DOI: 10.1038/s41586-022-04926-4,] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Volcanoes can produce tsunamis by means of earthquakes, caldera and flank collapses, pyroclastic flows or underwater explosions1-4. These mechanisms rarely displace enough water to trigger transoceanic tsunamis. Violent volcanic explosions, however, can cause global tsunamis1,5 by triggering acoustic-gravity waves6-8 that excite the atmosphere-ocean interface. The colossal eruption of the Hunga Tonga-Hunga Ha'apai volcano and ensuing tsunami is the first global volcano-triggered tsunami recorded by modern, worldwide dense instrumentation, thus providing a unique opportunity to investigate the role of air-water-coupling processes in tsunami generation and propagation. Here we use sea-level, atmospheric and satellite data from across the globe, along with numerical and analytical models, to demonstrate that this tsunami was driven by a constantly moving source in which the acoustic-gravity waves radiating from the eruption excite the ocean and transfer energy into it by means of resonance. A direct correlation between the tsunami and the acoustic-gravity waves' arrival times confirms that these phenomena are closely linked. Our models also show that the unusually fast travel times and long duration of the tsunami, as well as its global reach, are consistent with an air-water-coupled source. This coupling mechanism has clear hazard implications, as it leads to higher waves along land masses that rise abruptly from long stretches of deep ocean waters.
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Affiliation(s)
- R. Omira
- grid.420904.b0000 0004 0382 0653Instituto Português do Mar e da Atmosfera (IPMA), Lisbon, Portugal ,grid.9983.b0000 0001 2181 4263Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - R. S. Ramalho
- grid.5600.30000 0001 0807 5670School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK ,grid.21729.3f0000000419368729Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY USA ,grid.9983.b0000 0001 2181 4263Instituto Dom Luiz (IDL) and Departamento de Geologia, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - J. Kim
- grid.420904.b0000 0004 0382 0653Instituto Português do Mar e da Atmosfera (IPMA), Lisbon, Portugal
| | - P. J. González
- grid.466812.f0000 0004 1804 5442Volcanology Research Group, Department of Life and Earth Sciences, Instituto de Productos Naturales y Agrobiología, Consejo Superior de Investigaciones Científicas (IPNA-CSIC), La Laguna, Canary Islands Spain ,grid.10025.360000 0004 1936 8470COMET, Department of Earth, Ocean and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - U. Kadri
- grid.5600.30000 0001 0807 5670School of Mathematics, Cardiff University, Cardiff, UK
| | - J. M. Miranda
- grid.420904.b0000 0004 0382 0653Instituto Português do Mar e da Atmosfera (IPMA), Lisbon, Portugal ,grid.9983.b0000 0001 2181 4263Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - F. Carrilho
- grid.420904.b0000 0004 0382 0653Instituto Português do Mar e da Atmosfera (IPMA), Lisbon, Portugal
| | - M. A. Baptista
- grid.9983.b0000 0001 2181 4263Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal ,grid.418858.80000 0000 9084 0599Instituto Superior de Engenharia de Lisboa (ISEL), Instituto Politécnico de Lisboa (IPL), Lisbon, Portugal
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Ventura M, Melo M, Carrilho F. Outcome and long-term follow-up of adrenal lesions in multiple endocrine neoplasia type 1. Arch Endocrinol Metab 2019; 63:516-523. [PMID: 31482957 PMCID: PMC10522267 DOI: 10.20945/2359-3997000000170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 05/28/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the prevalence, clinical characteristics and outcome of adrenal lesions in long-term follow-up of Multiple endocrine neoplasia type 1 (MEN1) patients. SUBJECTS AND METHODS We retrospectively studied sixteen patients from six families of individuals with MEN1. Adrenal involvement was evaluated using clinical, biochemical and imaging data. RESULTS Adrenal lesions were identified in nine of sixteen (56.3%) patients: seven women and two men (mean age: 52.2 years). Adrenal involvement was detected at MEN1 diagnosis in more than half of the patients. Eighteen adrenal nodules were founded (median of two nodules per patient) with mean adrenal lesion diameter of 17.4 mm. Three patients had unilateral adrenal involvement. Hormonal hypersecretion (autonomous cortisol secretion) was found in two patients. None of the patients was submitted to adrenalectomy, presented an aldosterone-secreting lesion, a pheochromocytoma, an adrenal carcinoma or metastatic disease during the follow-up. A predominance of stable adrenal disease, in terms of size and hormonal secretion, was observed. Adrenal lesions were evenly distributed between the germline mutations. CONCLUSION Adrenal tumours are a common feature of MEN1 that can affect more than half of the patients. Most of the tumours are bilateral non-functional lesions, but hormonal secretion may occur and should be promptly identified to reduce the morbidity/mortality of the syndrome. Periodic surveillance of these patients should be performed.
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Affiliation(s)
- Mara Ventura
- Universidade da Beira InteriorFaculty of Health SciencesUniversity of Beira InteriorCovilhãPortugalFaculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Miguel Melo
- EndocrinologyDiabetes and Metabolism DepartmentUniversity and Hospital Center of CoimbraCoimbraPortugalEndocrinology, Diabetes and Metabolism Department, University and Hospital Center of Coimbra, Coimbra, Portugal
- Universidade de CoimbraFaculty of MedicineUniversity of CoimbraCoimbraPortugal Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Francisco Carrilho
- EndocrinologyDiabetes and Metabolism DepartmentUniversity and Hospital Center of CoimbraCoimbraPortugalEndocrinology, Diabetes and Metabolism Department, University and Hospital Center of Coimbra, Coimbra, Portugal
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Fadiga L, Saraiva J, Paiva I, Carrilho F. Thoracic spine metastasis presenting 18 years after complete resection of a phaeochromocytoma. BMJ Case Rep 2019; 12:12/8/e229621. [PMID: 31439569 DOI: 10.1136/bcr-2019-229621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Phaeochromocytomas are rare neuroendocrine tumours (NET) with malignant behaviour in about 10% of cases. The median time from the diagnosis of primary tumour and bone metastasis is 3.4 years. We report a case of a 66-year-old woman presenting with a hypertensive crisis and back pain. She has a history of a phaeochromocytoma completely resected 18 years before. MRI showed a neoplastic mass on the 10th thoracic vertebra (T10), with fracture and spinal cord compression. The CT-guided biopsy was consistent with metastasis of a NET. Therefore, she was treated with phenoxybenzamine and external beam radiotherapy. However, clinical (dorsal pain) and biochemical (ie, elevated chromogranin A) signs suggested persistent disease and the patient was treated with iodine-131 metaiodobenzylguanidine and T10 kyphoplasty. After 8 years, she remains clinically stable. This case demonstrates that phaeochromocytomas may reveal malignant behaviour several years after diagnosis, and therefore patients should be maintained under long term surveillance.
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Affiliation(s)
- Lúcia Fadiga
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Joana Saraiva
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal
| | - Isabel Paiva
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Francisco Carrilho
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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Ventura M, Serra-Caetano J, Cardoso R, Dinis I, Melo M, Carrilho F, Mirante A. The spectrum of pediatric adrenal insufficiency: insights from 34 years of experience. J Pediatr Endocrinol Metab 2019; 32:721-726. [PMID: 31194685 DOI: 10.1515/jpem-2019-0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/13/2019] [Indexed: 12/29/2022]
Abstract
Background Adrenal insufficiency (AI) is a life-threatening disease characterized by deficient production of glucocorticoids and/or mineralocorticoids. It is caused by primary or secondary/tertiary adrenal failure. Prompt diagnosis and management are essential and may even be life-saving. Methods We retrospectively collected clinical, laboratory and radiological data from AI patients observed over 34 years (1984-2017) in a pediatric endocrinology department of a tertiary care hospital. Results Seventy AI patients were identified: 59% with primary adrenal insufficiency (PAI) and 41% with central adrenal insufficiency (CAI). PAI patients were diagnosed at 1.5 ± 4.4 years and followed for 11.6 ± 6.2 years; 85% had classical congenital adrenal hyperplasia (CAH) and 7% had autoimmune PAI. At presentation, 73% had hyponatremia and more than half had mucocutaneous hyperpigmentation, asthenia, anorexia, weight loss, nausea and vomiting. All the patients were treated with hydrocortisone and 90% were also on fludrocortisone. Regarding CAI patients, they were diagnosed at 5.4 ± 5.0 years and they were followed for 9.6 ± 6.4 years; craniopharyngioma was present in 31% of the cases and 14% had pituitary hypoplasia. Besides corticotropin, thyrotropin (93%), growth hormone (63%) and antidiuretic hormone (52%) were the most common hormone insufficiencies. The most frequent manifestations were hypoglycemia (34.5%), nausea/vomiting (27.6%) and infectious diseases (27.6%); all the patients were treated with hydrocortisone. Conclusions Despite medical advances, the diagnosis and management of AI remains a challenge, particularly in the pediatric population. Raising awareness and knowledge in medical teams and population about the disease is of crucial importance to improve clinical outcomes and to reduce disease morbidity/mortality.
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Affiliation(s)
- Mara Ventura
- Department of Endocrinology, Diabetes and Metabolism, University and Hospital Center of Coimbra, Coimbra, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Joana Serra-Caetano
- Department of Paediatric Endocrinology, Diabetes and Growth, Pediatric Hospital of Coimbra, Coimbra, Portugal
| | - Rita Cardoso
- Department of Paediatric Endocrinology, Diabetes and Growth, Pediatric Hospital of Coimbra, Coimbra, Portugal
| | - Isabel Dinis
- Department of Paediatric Endocrinology, Diabetes and Growth, Pediatric Hospital of Coimbra, Coimbra, Portugal
| | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, University and Hospital Center of Coimbra, Coimbra, Portugal.,Faculty of Medicine of Coimbra University, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism, University and Hospital Center of Coimbra, Coimbra, Portugal
| | - Alice Mirante
- Department of Paediatric Endocrinology, Diabetes and Growth, Pediatric Hospital of Coimbra, Coimbra, Portugal
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Lages ADS, Vale B, Oliveira P, Cardoso R, Dinis I, Carrilho F, Mirante A. Congenital hyperreninemic hypoaldosteronism due to aldosterone synthase deficiency type I in a Portuguese patient - Case report and review of literature. Arch Endocrinol Metab 2019; 63:84-88. [PMID: 30864636 PMCID: PMC10118833 DOI: 10.20945/2359-3997000000107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 11/14/2018] [Indexed: 11/23/2022]
Abstract
Hyperreninemic hypoaldosteronism due to aldosterone synthase (AS) deficiency is a rare condition typically presenting as salt-wasting syndrome in the neonatal period. A one-month-old Portuguese boy born to non-consanguineous parents was examined for feeding difficulties and poor weight gain. A laboratory workup revealed severe hyponatremia, hyperkaliaemia and high plasma renin with unappropriated normal plasma aldosterone levels, raising the suspicion of AS deficiency. Genetic analysis showed double homozygous of two different mutations in the CYP11B2 gene: p.Glu198Asp in exon 3 and p.Val386Ala in exon 7. The patient maintains regular follow-up visits in endocrinology clinics and has demonstrated a favourable clinical and laboratory response to mineralocorticoid therapy. To our knowledge, this is the first Portuguese case of AS deficiency reported with confirmed genetic analysis.
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Affiliation(s)
- Adriana de Sousa Lages
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Beatriz Vale
- Pediatric Unit, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Patrícia Oliveira
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Rita Cardoso
- Pediatric Endocrinology Unit, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Isabel Dinis
- Pediatric Endocrinology Unit, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Francisco Carrilho
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Alice Mirante
- Pediatric Endocrinology Unit, Coimbra Hospital and University Center, Coimbra, Portugal
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Lages AS, Frade JG, Oliveira D, Paiva I, Oliveira P, Rebelo-Marques A, Carrilho F. Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing's Syndrome in a Portuguese Population. ACTA MEDICA PORT 2019; 32:381-387. [PMID: 31166899 DOI: 10.20344/amp.11265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Diagnosis of Cushing's syndrome remains a challenge in clinical endocrinology. Even though late-night salivary cortisol is used as screening tool, individualized cut-off levels for each population must be defined. MATERIAL AND METHODS Three groups of subjects were studied: normal subjects, suspected and proven Cushing's syndrome. Salivary cortisol was measured using an automated electrochemiluminescence assay. The functional sensitivity of the assay is 0.018 μg/dL. The diagnostic cut-off level was defined by Receiver Operating Characteristic curve and Youden's J index. RESULTS We studied 127 subjects: 57 healthy volunteers, 39 patients with suspected and 31 with proven Cushing's syndrome. 2.5th - 97.5th percentile of the late-night salivary cortisol concentrations in normal subjects was 0.054 to 0.1827 μg/dL. Receiver Operating Characteristic curve analysis showed an area under the curve of 0.9881 (p < 0.0001). A cut-off point of 0.1 μg/dL provided a sensitivity of 96.77% (95% CI 83.3 - 99.92%) and specificity of 91.23% (95% CI 80.7 - 97.09%). There was a significant correlation between latenight salivary cortisol and late-night serum cortisol (R = 0.6977; p < 0.0001) and urinary free cortisol (R = 0.5404; p = 0.0025) in proven Cushing's syndrome group. DISCUSSION The mean ± SD late-night salivary cortisol concentration in patients with proven Cushing's syndrome (0.6798 ± 0.52 μg/ dL) was significantly higher (p < 0.0001). In our population, the late-night salivary cortisol cut-off was 0.1 μg/dL with high sensitivity and specificity. CONCLUSION Late-night salivary cortisol has excellent diagnostic accuracy, making it a highly reliable, noninvasive, screening tool for outpatient assessment. Given its convenience and diagnostic accuracy, late-night salivary cortisol may be added to other traditional screening tests on hypercortisolism.
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Affiliation(s)
- Adriana Sousa Lages
- Endocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra. Portugal
| | - João Gonçalo Frade
- Clinical Pathology Department. Coimbra Hospital and University Center. Coimbra. School of Health Sciences. Polytechnic Institute of Leiria. Leiria. Portugal
| | - Diana Oliveira
- Endocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra. Portugal
| | - Isabel Paiva
- Endocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra. Portugal
| | - Patrícia Oliveira
- Endocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra. Portugal
| | - Alexandre Rebelo-Marques
- Family Health Unit from Condeixa. Agrupamento de Centros de Saúde do Baixo Mondego, Administração Regional de Saúde do Centro. Condeixa-A-Nova. Faculty of Medicine. University of Coimbra. Coimbra. Portugal
| | - Francisco Carrilho
- Endocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra. Portugal
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Ventura M, Gomes L, Rosmaninho-Salgado J, Barros L, Paiva I, Melo M, Oliveira D, Carrilho F. Bifocal germinoma in a patient with 16p11.2 microdeletion syndrome. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM180149. [PMID: 30738016 PMCID: PMC6373620 DOI: 10.1530/edm-18-0149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 12/12/2022] Open
Abstract
Intracranial germinomas are rare tumors affecting mostly patients at young age. Therefore, molecular data on its etiopathogenesis are scarce. We present a clinical case of a male patient of 25 years with an intracranial germinoma and a 16p11.2 microdeletion. His initial complaints were related to obesity, loss of facial hair and polydipsia. He also had a history of social-interaction difficulties during childhood. His blood tests were consistent with hypogonadotropic hypogonadism and secondary adrenal insufficiency, and he had been previously diagnosed with hypothyroidism. He also presented with polyuria and polydipsia and the water deprivation test confirmed the diagnosis of diabetes insipidus. His sellar magnetic resonance imaging (MRI) showed two lesions: one located in the pineal gland and other in the suprasellar region, both with characteristics suggestive of germinoma. Chromosomal microarray analysis was performed due to the association of obesity with social disability, and the result identified a 604 kb 16p11.2 microdeletion. The surgical biopsy confirmed the histological diagnosis of a germinoma. Pharmacological treatment with testosterone, hydrocortisone and desmopressin was started, and the patient underwent radiotherapy (40 Gy divided in 25 fractions). Three months after radiotherapy, a significant decrease in suprasellar and pineal lesions without improvement in pituitary hormonal deficiencies was observed. The patient is currently under follow-up. To the best of our knowledge, we describe the first germinoma in a patient with a 16p11.2 deletion syndrome, raising the question about the impact of this genetic alteration on tumorigenesis and highlighting the need of molecular analysis of germ cell tumors as only little is known about their genetic background. Learning points: Central nervous system germ cell tumors (CNSGTs) are rare intracranial tumors that affect mainly young male patients. They are typically located in the pineal and suprasellar regions and patients frequently present with symptoms of hypopituitarism. The molecular pathology of CNSGTs is unknown, but it has been associated with gain of function of the KIT gene, isochromosome 12p amplification and a low DNA methylation. Germinoma is a radiosensitive tumor whose diagnosis depends on imaging, tumor marker detection, surgical biopsy and cerebrospinal fluid cytology. 16p11.2 microdeletion syndrome is phenotypically characterized by developmental delay, intellectual disability and autism spectrum disorders. Seminoma, cholesteatoma, desmoid tumor, leiomyoma and Wilms tumor have been described in a few patients with 16p11.2 deletion. Bifocal germinoma was identified in this patient with a 16p11.2 microdeletion syndrome, which represents a putative new association not previously reported in the literature.
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Affiliation(s)
- Mara Ventura
- Department of Endocrinology, Diabetes and Metabolism
| | - Leonor Gomes
- Department of Endocrinology, Diabetes and Metabolism
| | - Joana Rosmaninho-Salgado
- Department of Medical Genetics, Pediatric Unit, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - Luísa Barros
- Department of Endocrinology, Diabetes and Metabolism
| | - Isabel Paiva
- Department of Endocrinology, Diabetes and Metabolism
| | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism
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Azevedo S, Saraiva J, Caramelo F, Fadiga L, Barros L, Baptista C, Melo M, Gomes L, Carrilho F. [The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes]. ACTA MEDICA PORT 2019; 32:17-24. [PMID: 30753799 DOI: 10.20344/amp.10778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/31/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The use of continuous subcutaneous insulin infusion therapy in type 1 diabetes mellitus has increased due to its benefits on glycemic control and on the lifestyle flexibility. The aim of this study was to assess the impact of continuous subcutaneous insulin infusion therapy on glycemic control, body mass index, total daily dose of insulin and complications associated with this therapy, during 20 years of experience in Centro Hospitalar e Universitário de Coimbra. MATERIAL AND METHODS This retrospective study included patients with type 1 diabetes mellitus who started continuous subcutaneous insulin infusion therapy up until 2005, followed at Centro Hospitalar e Universitário de Coimbra. Glycated hemoglobin A1c, body mass index, total daily dose of insulin and acute complications associated with continuous subcutaneous insulin infusion therapy were evaluated immediately prior to initiation of continuous subcutaneous insulin infusion therapy with follow-up at six months, one year, five, 10, 15 and 20 years. The frequency of acute complications associated with this type of therapy was also evaluated. RESULTS This study included 20 patients (seven males, 13 females) with mean disease duration up to the start of continuous subcutaneous insulin infusion therapy of 16.1 ± 7.9 years, mean age of onset of continuous subcutaneous insulin infusion therapy of 31.1 ± 8.4 years and follow-up during 13.2 ± 2.3 years. The reasons for initiating pump therapy were: inadequate metabolic control in 15 patients, history of asymptomatic or severe hypoglycemia in four patients, and pregnancy/pregnancy planning in one patient. The previous median of glycated hemoglobin A1c was 9.3% (6.5 - 16.0) and, at six months, decreased to the minimum value of 7.2% (5.3 - 9.8); p < 0.0125. The reduction of glycated hemoglobin A1c remained statistically significant in the first 10 years of follow-up. There was a statistically significant difference in the body mass index variation at 10 years with continuous subcutaneous insulin infusion therapy compared to previous body mass index; 24.7 kg/m2 (18.9 - 31.8) vs 25,5 kg/m2 (18.9 - 38.9), p <0.0125. Daily insulin requirements were reduced from 56.5 U (32.0 - 94.0) to 43.8 U (33.0 - 64.0) (p < 0.0125) at six months and no statistical differences were found in the remaining follow-up. There were two severe episodes of hypoglycemia (incidence 0.0095/patient/year), five episodes of diabetic ketoacidosis (0.0238/patient/year) and no infections at the site of catheter insertion. DISCUSSION This study shows that continuous subcutaneous insulin infusion therapy improved glycemic control, especially during the first 10 years of follow-up and allowed a significant decrease in total daily dose of insulin in the first six months. The rate of acute complications was low. CONCLUSION Treatment with continuous subcutaneous insulin infusion therapy seems effective in achieving metabolic control in selected patients with type 1 diabetes mellitus.
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Affiliation(s)
- Sérgio Azevedo
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Joana Saraiva
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Francisco Caramelo
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Laboratório de Bioestatística e Informática Médica. Instituto Biomédico de Investigação da Luz e da Imagem. Coimbra. Portugal
| | - Lúcia Fadiga
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Luísa Barros
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Carla Baptista
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Miguel Melo
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Leonor Gomes
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Francisco Carrilho
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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10
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Oliveira D, Ventura M, Melo M, Paiva S, Carrilho F. Addison's disease in antiphospholipid syndrome: a rare complication. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180118. [PMID: 30481151 PMCID: PMC6280132 DOI: 10.1530/edm-18-0118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022] Open
Abstract
Addison’s disease (AD) is the most common endocrine manifestation of antiphospholipid syndrome (APS), but it remains a very rare complication of the syndrome. It is caused by adrenal venous thrombosis and consequent hemorrhagic infarction or by spontaneous (without thrombosis) adrenal hemorrhage, usually occurring after surgery or anticoagulant therapy. We present a clinical case of a 36-year-old female patient with a previous diagnosis of APS. She presented with multiple thrombotic events, including spontaneous abortions. During evaluation by the third episode of abortion, a CT imaging revealed an adrenal hematoma, but the patient was discharged without further investigation. A few weeks later, she presented in the emergency department with manifestations suggestive of adrenal insufficiency. Based on that assumption, she started therapy with glucocorticoids, with significant clinical improvement. After stabilization, additional investigation confirmed AD and excluded other etiologies; she also started mineralocorticoid replacement. This case illustrates a rare complication of APS that, if misdiagnosed, may be life threatening. A high index of suspicion is necessary for its diagnosis, and prompt treatment is crucial to reduce the morbidity and mortality potentially associated.
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Affiliation(s)
- Diana Oliveira
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Mara Ventura
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Miguel Melo
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Sandra Paiva
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Francisco Carrilho
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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11
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Coelho A, Paula A, Mota M, Laranjo M, Abrantes M, Carrilho F, Ferreira M, Silva M, Botelho F, Carrilho E. Dental caries and bacterial load in saliva and dental biofilm of type 1 diabetics on continuous subcutaneous insulin infusion. J Appl Oral Sci 2018; 26:e20170500. [PMID: 29898180 PMCID: PMC6007967 DOI: 10.1590/1678-7757-2017-0500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/16/2018] [Indexed: 01/06/2023] Open
Abstract
Objectives Since most of the studies evaluates diabetics on multiple daily injections therapy and continuous subcutaneous insulin infusion may help gain better metabolic control and prevent complications, the objective of this study was to evaluate the prevalence of dental caries, the unstimulated salivary flow rate and the total bacteria load, Streptococcus spp. levels and Lactobacillus spp. levels in saliva and supragingival dental biofilm of type 1 diabetics on insulin pump. Material and Methods Sixty patients with type 1 diabetes on insulin pump and 60 nondiabetic individuals were included. The dental caries evaluation was performed using ICDAS and the oral hygiene was assessed according to Greene and Vermillion Simplified Oral Hygiene Index. Unstimulated saliva and supragingival dental biofilm were collected. Total bacteria, Streptococcus spp. and Lactobacillus spp. was quantified by qPCR. Results Patients with type 1 diabetes had a higher prevalence of dental caries and filled and missing teeth when compared with the control group. These patients were associated with more risk factors for the development of dental caries, namely a lower unstimulated salivary flow rate and a higher bacterial load in saliva and dental biofilm. Conclusion Some risk factors related to dental caries were associated with type 1 diabetics. An early diagnosis combined with the evaluation of the risk profile of the diabetic patient is imperative, allowing the dental caries to be analyzed through a perspective of prevention and the patient to be integrated into an individualized oral health program.
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Affiliation(s)
- Ana Coelho
- Universidade de Coimbra, Faculdade de Medicina iCBR, Coimbra, Portugal
| | - Anabela Paula
- Universidade de Coimbra, Faculdade de Medicina iCBR, Coimbra, Portugal
| | - Marta Mota
- Universidade de Coimbra, Faculdade de Medicina, Departamento de Microbiologia, Coimbra, Portugal
| | - Mafalda Laranjo
- Universidade de Coimbra, Faculdade de Medicina iCBR, Coimbra, Portugal
| | | | - Francisco Carrilho
- Centro Hospitalar e Universitário de Coimbra, Departamento de Endocrinologia, Diabetes e Metabolismo, Coimbra, Portugal
| | - Manuel Ferreira
- Universidade de Coimbra, Faculdade de Medicina iCBR, Coimbra, Portugal
| | - Mário Silva
- Universidade do Porto, Faculdade de Medicina Dentária, Porto, Portugal
| | - Filomena Botelho
- Universidade de Coimbra, Faculdade de Medicina iCBR, Coimbra, Portugal
| | - Eunice Carrilho
- Universidade de Coimbra, Faculdade de Medicina iCBR, Coimbra, Portugal
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12
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Rebelo-Marques A, De Sousa Lages A, Andrade R, Ribeiro CF, Mota-Pinto A, Carrilho F, Espregueira-Mendes J. Aging Hallmarks: The Benefits of Physical Exercise. Front Endocrinol (Lausanne) 2018; 9:258. [PMID: 29887832 PMCID: PMC5980968 DOI: 10.3389/fendo.2018.00258] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/03/2018] [Indexed: 12/15/2022] Open
Abstract
World population has been continuously increasing and progressively aging. Aging is characterized by a complex and intraindividual process associated with nine major cellular and molecular hallmarks, namely, genomic instability, telomere attrition, epigenetic alterations, a loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. This review exposes the positive antiaging impact of physical exercise at the cellular level, highlighting its specific role in attenuating the aging effects of each hallmark. Exercise should be seen as a polypill, which improves the health-related quality of life and functional capabilities while mitigating physiological changes and comorbidities associated with aging. To achieve a framework of effective physical exercise interventions on aging, further research on its benefits and the most effective strategies is encouraged.
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Affiliation(s)
- Alexandre Rebelo-Marques
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
| | - Adriana De Sousa Lages
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
| | | | | | - Francisco Carrilho
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- 3B’s Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B’s–PT Government Associate Laboratory, Guimarães, Braga, Portugal
- Orthopaedics Department of Minho University, Minho, Portugal
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13
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Oliveira D, Lages A, Paiva I, Ventura M, Cunha N, Fadiga L, Catarino D, Paiva S, Carrilho F. Performance-enhancing drugs and adverse endocrine effects. ACTA ACUST UNITED AC 2018. [DOI: 10.1530/endoabs.56.p322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Oliveira D, Lages A, Paiva S, Carrilho F. Treatment of Addison's disease during pregnancy. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM170179. [PMID: 29675257 PMCID: PMC5900459 DOI: 10.1530/edm-17-0179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/23/2018] [Indexed: 11/24/2022] Open
Abstract
Addison’s disease, or primary adrenocortical insufficiency, is a long-term, potentially severe, rare endocrine disorder. In pregnancy, it is even rarer. We report the case of a 30-year-old pregnant patient with Addison’s disease, referred to Obstetrics-Endocrinology specialty consult at 14 weeks gestation. She had been to the emergency department of her local hospital various times during the first trimester presenting with a clinical scenario suggestive of glucocorticoid under-replacement (nausea, persistent vomiting and hypotension), but this was interpreted as normal pregnancy symptoms. Hydrocortisone dose was adjusted, and the patient maintained regular follow-up. No complications were reported for the remainder of gestation and delivery. Pregnant patients with Addison’s disease should be monitored during gestation and in the peripartum period by multidisciplinary teams. Adjustments in glucocorticoid and mineralocorticoid replacement therapy are often necessary, and monitoring should be based mainly on clinical findings, which becomes increasingly difficult during pregnancy. Patient education and specialized monitoring are key to avoiding complications from under- or over-replacement therapy in this period.
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Affiliation(s)
- Diana Oliveira
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Adriana Lages
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Sandra Paiva
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Francisco Carrilho
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal
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15
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Martins D, Rodrigues D, Melo M, Carrilho F. Laparoscopic adrenalectomy as an effective approach to massive bilateral pheochromocytomas. BMJ Case Rep 2017; 2017:bcr-2017-221009. [PMID: 28883010 DOI: 10.1136/bcr-2017-221009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pheochromocytomas are catecholamine-secreting neoplasms, arising from adrenomedullary chromaffin cells. In type 2 multiple endocrine neoplasia (MEN2) syndrome, pheochromocytomas are usually benign but with predisposition to be bilateral (50%-80% of cases).The authors present the case of a young patient diagnosed with uncommonly large bilateral cystic pheochromocytomas and simultaneous detection of medullary thyroid carcinoma. Molecular testing confirmed germline RET codon C634 mutation, consistent with MEN2A syndrome. The patient underwent bilateral laparoscopic adrenalectomy plus total thyroidectomy with central lymph node dissection without associated complications. The histopathological study of the surgical specimens revealed bilateral benign pheochromocytomas (Ki67 of 2%) and a medullary carcinoma of the thyroid T1bN0M0; R0, respectively. One year after surgery, the patient was considered free of disease.This case demonstrates that bilateral laparoscopic adrenalectomy can be a safe and feasible approach for phechromocytomas in MEN2 syndrome, even in lesions with large diameter. However, due to elevated possibility of recurrence, patients should maintain lifelong follow-up.
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Affiliation(s)
- Diana Martins
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Dírcea Rodrigues
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal
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Cardoso L, Rodrigues D, Gomes L, Carrilho F. Short- and long-term mortality after bariatric surgery: A systematic review and meta-analysis. Diabetes Obes Metab 2017; 19:1223-1232. [PMID: 28244626 DOI: 10.1111/dom.12922] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 12/16/2022]
Abstract
AIMS The objective of this study was to investigate short- (≤ 30 days) and long-term (≥ 2 years) all-cause mortality after bariatric surgery among adult patients with obesity. MATERIALS AND METHODS For short-term mortality, eligible studies comprised randomized controlled trials (RCTs) reporting perioperative mortality. For long-term mortality, eligible studies comprised RCTs and observational studies comparing mortality between obese patients after bariatric surgery and non-operated controls. Random-effects models using a Bayesian or frequentist approach were used to pool effect estimates of short- and long-term mortality, respectively. RESULTS Short-term all-cause mortality based on 38 RCTs involving 4030 patients was 0.18% (95% CI, 0.04%-0.38%) and was higher for open surgeries (0.31%; 95% CI, 0.03%-0.97%) and similar in mixed surgeries (0.17%; 95% CI, 0.03%-0.43%) and restrictive surgeries (0.17%; 95% CI, 0.03%-0.45%). For long-term mortality, 12 observational studies involving 27 258 operated patients and 97 154 non-operated obese controls were included. Of these, 8 studies were eligible for the meta-analysis, which showed a reduction of 41% in all-cause mortality (hazard ratio, 0.59; 95% CI, 0.52-0.67; P < .001). Additionally, operated patients were 0.42 times as likely (95% CI, 0.25-0.72, P < .001) and 0.47 times as likely (95% CI, 0.36-0.63, P < .001) as non-operated obese controls to die from cardiovascular diseases and cancer, respectively. CONCLUSIONS Bariatric surgery is associated with low short-term mortality and may be associated with long-term reductions in all-cause, cardiovascular and cancer-related mortality.
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Affiliation(s)
- Luís Cardoso
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Dírcea Rodrigues
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Leonor Gomes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Melo M, Gaspar da Rocha A, Batista R, Vinagre J, Martins MJ, Costa G, Ribeiro C, Carrilho F, Leite V, Lobo C, Cameselle-Teijeiro JM, Cavadas B, Pereira L, Sobrinho-Simões M, Soares P. TERT, BRAF, and NRAS in Primary Thyroid Cancer and Metastatic Disease. J Clin Endocrinol Metab 2017; 102:1898-1907. [PMID: 28323937 DOI: 10.1210/jc.2016-2785] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Little is known about the frequency of key mutations in thyroid cancer metastases and its relationship with the primary tumor genotype. OBJECTIVES To evaluate the frequency of TERT promoter (TERTp), BRAF, and NRAS mutations in metastatic thyroid carcinomas, analyzing primary thyroid tumors, lymph node metastases (LNMs), and distant metastases. DESIGN AND PATIENTS Mutation analysis was performed in 437 tissue samples from 204 patients, mainly with papillary thyroid carcinomas (PTCs; n = 180), including 196 LNMs and 56 distant metastases. All the distant metastases included corresponded to radioiodine-refractory metastatic tissue. RESULTS We found the following mutation frequency in primary PTCs, LNMs, and distant metastases, respectively: TERTp: 12.9%, 10.5%, and 52.4%; BRAF: 44.6%, 41.7%, and 23.8%; and NRAS: 1.2%, 1.3%, and 14.3%. There was a significant concordance between the primary tumor genotype and the corresponding LNM for all the genes, in particular BRAF-mutated PTC. The overall concordance between primary tumors and respective distant metastases was low. In the group of patients with PTCs, we found a high frequency of TERTp mutations and a low frequency of BRAF mutations in distant metastases, in comparison with the paired primary tumors. When present in distant metastases, BRAF mutations frequently coexisted with TERTp mutations. CONCLUSIONS When the genotype of primary tumors is compared with the genotype of LNMs, the concordance is high for all the genes studied. On the other hand, distant metastases show an enrichment in TERTp mutations and a decrease in BRAF mutations. TERTp mutations may play a role in distant metastases.
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Affiliation(s)
- Miguel Melo
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Department of Endocrinology, Diabetes, and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
- Unit of Endocrinology, Faculty of Medicine, University of Coimbra, Coimbra 3000-075, Portugal
| | - Adriana Gaspar da Rocha
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Public Health Unit, ACeS Baixo Mondego, Coimbra 3040-006, Portugal
| | - Rui Batista
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Medical Faculty, University of Porto, Porto 4200-319, Portugal
| | - João Vinagre
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Institute of Biomedical Sciences of Abel Salazar, University of Porto, Porto 4050-313, Portugal
| | - Maria João Martins
- Department of Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Gracinda Costa
- Department of Nuclear Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Cristina Ribeiro
- Department of Endocrinology, Diabetes, and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes, and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Valeriano Leite
- Unit for Investigation of Molecular Pathobiology, Portuguese Institute of Oncology-Lisbon Center, Lisbon 1099-023, Portugal
- Faculty of Medical Sciences, University of Lisbon, Lisbon 1169-056, Portugal
- Department of Endocrinology, Portuguese Institute of Oncology-Lisbon Center, Lisbon 1099-023, Portugal
| | - Cláudia Lobo
- Department of Pathology, Portuguese Institute of Oncology-Porto Center, Porto 4200-072, Portugal
| | - José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Servizo Galego de Saúde (SERGAS), Medical Faculty, University of Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Bruno Cavadas
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
| | - Luísa Pereira
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Medical Faculty, University of Porto, Porto 4200-319, Portugal
| | - Manuel Sobrinho-Simões
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto 4200-319, Portugal
- Department of Pathology, Hospital São João, Porto 4200-319, Portugal
| | - Paula Soares
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto 4200-319, Portugal
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Machado D, Coelho A, Paula A, Caramelo F, Carrilho F, Barros L, Batista C, Melo M, Ferreira MM, Carrilho E. [Prevalence of Dental Caries in Patients with Type 1 Diabetes Mellitus Treated with Multiple Insulin Injections and that of Individuals without Diabetes]. ACTA MEDICA PORT 2017; 30:402-408. [PMID: 28865505 DOI: 10.20344/amp.8050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 02/17/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In addition to macro and microvascular complications that are associated with the disease, hyperglycaemia is also a risk factor for several oral complications. The aim of this study is to establish a relationship between dental caries in patients with type 1 diabetes mellitus treated with multiple insulin injections and that of individuals without diabetes. It is also an aim to characterize the oral hygiene habits of this population. MATERIAL AND METHODS An observational clinical study of analytical and cross-sectional nature was conducted. Thirty patients with type 1 diabetes mellitus and 30 individuals without diabetes were observed and questioned about information regarding their medical history. Oral examination was conducted according to the standards of the World Health Organization and ICDAS was used for caries detection. Statistical analysis was performed and the significance level was set at 5%. RESULTS Patients with diabetes mellitus showed similar caries levels to that of individuals without diabetes. Patients with diabetes mellitus had a higher dental plaque index. Only 10% of the patients having episodes of nocturnal hypoglycaemia brush their teeth after glucose intake. DISCUSSION Although there's some controversy in the literature regarding the prevalence of caries in patients with diabetes mellitus, the results are in agreement with a great number of studies. However, patients with diabetes mellitus have a higher plaque index which can be associated with a higher risk for developing certain oral pathologies. CONCLUSION No statistically significant association was found between type 1 diabetes mellitus and dental caries.
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Affiliation(s)
- Diogo Machado
- Área de Medicina Dentária. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Ana Coelho
- Área de Medicina Dentária. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Anabela Paula
- Área de Medicina Dentária. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Francisco Caramelo
- Serviço de Bioestatística e Informática Médica. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Francisco Carrilho
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Luísa Barros
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Carla Batista
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Miguel Melo
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Manuel Marques Ferreira
- Área de Medicina Dentária. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal. Instituto Biomédico de Investigação de Luz e Imagem. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Eunice Carrilho
- Área de Medicina Dentária. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal. Instituto Biomédico de Investigação de Luz e Imagem. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
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Abstract
Agranulocytosis is a rare but serious complication of antithyroid drug therapy, and an up-to-date understanding of this topic is important. Both direct toxicity and immune-mediated responses have been described as possible mechanisms. Some major susceptibility loci have recently been identified, which may lead the diagnosis of agranulocytosis into a genomic era. Onset is acute and patients present with symptoms and signs of infection together with high fever. Clinical suspicion is pivotal and should prompt blood sampling. An absolute neutrophil count of <500/μl in the presence of antithyroid drugs establishes the diagnosis. The causative drug should immediately be stopped to prevent further damage. Treatment includes broad-spectrum antibiotics and granulocyte-colony stimulation factor in selected patients. Later, patients will need definitive treatment for hyperthyroidism, usually with radioactive iodine or surgery. The best way to avoid the mortality associated with antithyroid drug-induced agranulocytosis is patient education.
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Affiliation(s)
- Nuno Vicente
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Luís Cardoso
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Luísa Barros
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
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de Sousa Lages A, Paiva I, Oliveira P, Portela F, Carrilho F. Endoscopic ultrasound-guided ethanol ablation therapy for pancreatic insulinoma: an unusual strategy. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM160145. [PMID: 28458908 PMCID: PMC5404710 DOI: 10.1530/edm-16-0145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/24/2017] [Indexed: 12/13/2022] Open
Abstract
Summary Insulinomas are the most frequent cause of hyperinsulinaemic hypoglycaemia. Although surgical enucleation is the standard treatment, a few other options are available to high-risk patients who are elderly or present with co-morbidities. We present a case report of an 89-year-old female patient who was admitted to the emergency department due to recurrent hypoglycaemia, especially during fasting. Laboratory work-up raised the suspicion of hyperinsulinaemic hypoglycaemia, and abdominal CT scan revealed a 12 mm nodular hypervascular lesion of the pancreatic body suggestive of neuroendocrine tumour. The patient was not considered a suitable candidate for surgery, and medical therapy with diazoxide was poorly tolerated. Endoscopic ultrasound-guided ethanol ablation therapy was performed and a total of 0.6 mL of 95% ethanol was injected into the lesion by a transgastric approach; no complications were reported after the procedure. At 5 months of follow-up, no episodes of hypoglycaemia were reported, no diazoxide therapy was necessary, and revaluation abdominal CT scan revealed a pancreatic nodular lesion with a size involution of about half of its original volume. The patient is regularly followed-up at the endocrinology clinic and shows a significant improvement in her wellbeing and quality of life. Learning points:
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Affiliation(s)
| | - Isabel Paiva
- Departments of Endocrinology, Diabetes and Metabolism
| | | | - Francisco Portela
- Departments of Gastroenterology, Coimbra Hospital and University Center, Coimbra, Portugal
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Melo M, Vicente N, Ventura M, Gaspar Da Rocha A, Soares P, Carrilho F. The role of ablative treatment in differentiated thyroid cancer management. Expert Rev Endocrinol Metab 2017; 12:109-116. [PMID: 30063427 DOI: 10.1080/17446651.2017.1289839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The role of ablative treatment in differentiated thyroid cancer management has been evolving over the years. After its introduction in clinical practice, the use of postsurgical radioiodine treatment was generalized to almost every patient with differentiated thyroid cancer, with the exception of unifocal microcarcinomas. However, in the last decade several studies questioned its benefit in low- and intermediate-risk patients. Areas covered: In this review we discuss the role of postsurgical radioiodine treatment at the present time. Expert commentary: Although there is general consensus about the recommendation for very low-risk (microcarcinomas) and high-risk patients - no indication for routine postoperative radioiodine and clear indication for radioiodine treatment, respectively, the recommendation for low- and intermediate-risk patients is still under debate. The most recent guidelines from the American Thyroid Association make a statement against routine postoperative radioiodine in both low- and intermediate-risk cases, recommending an individualized approach that takes into consideration the risk of disease persistence or recurrence after surgery. We consider that these recommendations are in accordance with the best evidence available today, and we would like to emphasize that radioiodine is generally favored for most intermediate-risk patients, especially in the presence of extensive lymph node disease or older age.
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Affiliation(s)
- Miguel Melo
- a Department of Endocrinology, Diabetes and Metabolism , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
- b i3S - Instituto de Investigação e Inovação em Saúde , University of Porto , Porto , Portugal
- c Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP) , Porto , Portugal
- d University Clinic of Endocrinology, Diabetes and Metabolism, Faculty of Medicine , University of Coimbra , Coimbra , Portugal
| | - Nuno Vicente
- a Department of Endocrinology, Diabetes and Metabolism , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
| | - Mara Ventura
- a Department of Endocrinology, Diabetes and Metabolism , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
| | - Adriana Gaspar Da Rocha
- b i3S - Instituto de Investigação e Inovação em Saúde , University of Porto , Porto , Portugal
- c Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP) , Porto , Portugal
| | - Paula Soares
- b i3S - Instituto de Investigação e Inovação em Saúde , University of Porto , Porto , Portugal
- c Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP) , Porto , Portugal
- e Department of Pathology and Oncology, Medical Faculty , University of Porto , Porto , Portugal
| | - Francisco Carrilho
- a Department of Endocrinology, Diabetes and Metabolism , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
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Cardoso L, Vicente N, Rodrigues D, Gomes L, Carrilho F. Controversies in the management of hyperglycaemic emergencies in adults with diabetes. Metabolism 2017; 68:43-54. [PMID: 28183452 DOI: 10.1016/j.metabol.2016.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/15/2016] [Accepted: 11/22/2016] [Indexed: 01/22/2023]
Abstract
Hyperglycaemic emergencies are associated with significant morbi-mortality and healthcare costs. Management consists on fluid replacement, insulin therapy, and electrolyte correction. However, some areas of patient management remain debatable. In patients without respiratory failure or haemodynamic instability, arterial and venous pH and bicarbonate measurements are comparable. Fluid choice varies upon replenishment phase and patient's condition. If patient is severely hypovolaemic, normal saline solution should be the first option. However, if patient has mild/moderate dehydration, fluid choice must take in consideration sodium concentration. Insulin therapy should be guided by β-hydroxybutyrate normalization and not by blood glucose. Variations of conventional insulin infusion protocols emerged recently. Priming dose of insulin may not be required, and fixed rate insulin infusion represents the best option to suppress hepatic glucose production, ketogenesis, and lipolysis. Concomitant administration of basal insulin analogues with regular insulin infusion accelerates ketoacidosis resolution and prevents rebound hyperglycaemia. Simpler protocols using subcutaneous rapid-acting insulin analogues for mild/moderate diabetic ketoacidosis treatment have proven to be safe and effective, but further studies are required to confirm these results. Treatment with bicarbonate, phosphate, and low-molecular-weight heparin is still disputable, and randomized controlled trials are urgently needed to optimize patient management and decrease the morbi-mortality of hyperglycaemic emergencies.
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Affiliation(s)
- Luís Cardoso
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Nuno Vicente
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Dírcea Rodrigues
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Leonor Gomes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Ventura M, Melo M, Carrilho F. Selenium and Thyroid Disease: From Pathophysiology to Treatment. Int J Endocrinol 2017; 2017:1297658. [PMID: 28255299 PMCID: PMC5307254 DOI: 10.1155/2017/1297658] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/31/2016] [Accepted: 11/17/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction. Selenium is a micronutrient embedded in several proteins. In adults, the thyroid is the organ with the highest amount of selenium per gram of tissue. Selenium levels in the body depend on the characteristics of the population and its diet, geographic area, and soil composition. In the thyroid, selenium is required for the antioxidant function and for the metabolism of thyroid hormones. Methods. We performed a review of the literature on selenium's role in thyroid function using PubMed/MEDLINE. Results. Regarding thyroid pathology, selenium intake has been particularly associated with autoimmune disorders. The literature suggests that selenium supplementation of patients with autoimmune thyroiditis is associated with a reduction in antithyroperoxidase antibody levels, improved thyroid ultrasound features, and improved quality of life. Selenium supplementation in Graves' orbitopathy is associated with an improvement of quality of life and eye involvement, as well as delayed progression of ocular disorders. The organic form of selenium seems to be the preferable formulation for supplementation or treatment. Conclusion. Maintaining a physiological concentration of selenium is a prerequisite to prevent thyroid disease and preserve overall health. Supplementation with the organic form is more effective, and patients with autoimmune thyroiditis seem to have benefits in immunological mechanisms. Selenium supplementation proved to be clinically beneficial in patients with mild to moderate Graves' orbitopathy.
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Affiliation(s)
- Mara Ventura
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- *Miguel Melo:
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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de Sousa Lages A, Bastos M, Oliveira P, Carrilho F. Diffuse large B-cell lymphoma of the adrenal gland: a rare cause of primary adrenal insufficiency. BMJ Case Rep 2016; 2016:bcr-2016-214920. [PMID: 26994055 DOI: 10.1136/bcr-2016-214920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Although it is a rare entity, primary lymphoma of the adrenal gland should be considered in the differential diagnosis of bilateral nodular adrenal lesions, particularly when there is evidence of associated adrenal insufficiency. We describe the case of an 83-year-old woman admitted to the emergency department due to a month's history of asthenia, weight loss, anorexia and nausea. Abdominopelvic CT showed bilateral nodular lesions of adrenal glands and a stimulation test with tetracosactide was compatible with primary adrenal insufficiency. CT-guided biopsy of the left adrenal gland was performed, and histopathological results were consistent with diffuse large B-cell lymphoma. Positron emission tomography (18)F-fluorodeoxyglucose detected two intensely hypermetabolic lesions limited to both adrenal glands. Replacement therapy with hydrocortisone 15 mg/day and fludrocortisone 0.1 mg/day was promptly started and chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone was initiated after haematology-oncology consultation.
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Affiliation(s)
- Adriana de Sousa Lages
- Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Bastos
- Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Patrícia Oliveira
- Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Guelho D, Paiva I, Vieira A, Carrilho F. Adrenocortical carcinoma: Retrospective analysis of the last 22 years. ACTA ACUST UNITED AC 2016; 63:212-9. [PMID: 26969077 DOI: 10.1016/j.endonu.2015.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. The clinical experience acquired, even from a small number of cases, has improved understanding of this condition. The purpose of this study is to characterize patients with ACC followed up at a Portuguese reference center over the past 22 years. METHODS Retrospective analysis of clinical records of patients with histopathological diagnosis of ACC followed up from 1992 to 2014. RESULTS The study sample consisted of 22 patients, 20 of them female. Eleven patients were in stage II, four in stage III, and five in stage IV; 13 patients had functioning lesions. Adrenalectomy was performed in 20 patients, with complete tumor resection in 90% of the cases. During follow-up, eight patients experienced recurrence of local disease, and 12 distant metastases. Fourteen patients received mitotane, 35.7% (n=5) as adjuvant therapy and 64.3% (n=9) after recurrence; therapeutic plasma mitotane levels were achieved in 70% of patients. Stage III patients who received adjuvant therapy had longer survival time (13.5 vs. 2.5 months). Two patients were given chemotherapy associated to mitotane. Median survival was 11 months (0-257 months); it was slightly longer in younger patients or patients with non-functioning tumors. Six patients are still alive, four of them with no evidence of disease. CONCLUSION Despite the overall poor prognosis, some patients with ACC may have a long survival time. Although complete tumor removal remains the only potentially curative treatment, diagnosis at a younger age, presence of non-functioning tumors, and mitotane treatment also seemed to be associated to longer survival in our patients.
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Affiliation(s)
- Daniela Guelho
- Department of Endocrinology, Diabetes and Metabolism of Coimbra Hospital and University Centre,, Coimbra, Portugal.
| | - Isabel Paiva
- Department of Endocrinology, Diabetes and Metabolism of Coimbra Hospital and University Centre,, Coimbra, Portugal
| | - Alexandra Vieira
- Endocrinology, Department of Internal Medicine 2 of Leiria Hospital Centre, E.P.E., Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism of Coimbra Hospital and University Centre,, Coimbra, Portugal
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Guelho D, Ribeiro C, Melo M, Carrilho F. Long-term survival in a patient with brain metastases of papillary thyroid carcinoma. BMJ Case Rep 2016; 2016:bcr-2015-213824. [PMID: 26961557 DOI: 10.1136/bcr-2015-213824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 43-year-old woman who underwent total thyroidectomy with bilateral lymphadenectomy for a papillary thyroid carcinoma (PTC), solid variant (T4bN1bMx), with V600E BRAF mutation. After ablative therapy, she presented undetectable thyroglobulin (Tg) but progressively increasing anti-Tg antibodies (TgAbs). During follow-up, nodal, lung and brain metastases were identified. She was submitted to surgical excision of lung lesions, radiosurgery of brain metastases and five radioiodine treatments. The latest brain MRI showed no lesions, pulmonary CT showed stable micronodules and there was progressive reduction in TgAbs. This is a peculiar case of a PTC with lung and brain metastatic lesions detected through TgAbs. Initial histological and molecular study suggested a more aggressive clinical behaviour, which was eventually confirmed. Although PTC brain metastases are extremely rare and present poor prognosis, our patient presented a good response to treatment and longer survival than usually reported for similar cases.
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Affiliation(s)
- Daniela Guelho
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Centre, Coimbra, Portugal Faculty of Medicine of University of Coimbra, Coimbra, Portugal
| | - Cristina Ribeiro
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Miguel Melo
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Centre, Coimbra, Portugal Faculty of Medicine of University of Coimbra, Coimbra, Portugal
| | - Francisco Carrilho
- Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Centre, Coimbra, Portugal
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Infante JB, Alvelos MI, Bastos M, Carrilho F, Lemos MC. Complete androgen insensitivity syndrome caused by a novel splice donor site mutation and activation of a cryptic splice donor site in the androgen receptor gene. J Steroid Biochem Mol Biol 2016; 155:63-6. [PMID: 26435450 DOI: 10.1016/j.jsbmb.2015.09.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/26/2015] [Accepted: 09/28/2015] [Indexed: 01/01/2023]
Abstract
The androgen insensitivity syndrome is an X-linked recessive genetic disorder characterized by resistance to the actions of androgens in an individual with a male karyotype. We evaluated a 34-year-old female with primary amenorrhea and a 46,XY karyotype, with normal secondary sex characteristics, absence of uterus and ovaries, intra-abdominal testis, and elevated testosterone levels. Sequence analysis of the androgen receptor (AR) gene revealed a novel splice donor site mutation in intron 4 (c.2173+2T>C). RT-PCR analysis showed that this mutation resulted in the activation of a cryptic splice donor site located in the second half of exon 4 and in the synthesis of a shorter mRNA transcript and an in-frame deletion of 41 amino acids. This novel mutation associated with a rare mechanism of abnormal splicing further expands the spectrum of mutations associated with the androgen insensitivity syndrome and may contribute to the understanding of the molecular mechanisms involved in splicing defects.
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Affiliation(s)
- Joana B Infante
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Maria I Alvelos
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Margarida Bastos
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | - Francisco Carrilho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | - Manuel C Lemos
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal.
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Duarte JV, Pereira JMS, Quendera B, Raimundo M, Moreno C, Gomes L, Carrilho F, Castelo-Branco M. Early disrupted neurovascular coupling and changed event level hemodynamic response function in type 2 diabetes: an fMRI study. J Cereb Blood Flow Metab 2015; 35:1671-80. [PMID: 26058698 PMCID: PMC4640307 DOI: 10.1038/jcbfm.2015.106] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/19/2015] [Accepted: 04/24/2015] [Indexed: 11/09/2022]
Abstract
Type 2 diabetes (T2DM) patients develop vascular complications and have increased risk for neurophysiological impairment. Vascular pathophysiology may alter the blood flow regulation in cerebral microvasculature, affecting neurovascular coupling. Reduced fMRI signal can result from decreased neuronal activation or disrupted neurovascular coupling. The uncertainty about pathophysiological mechanisms (neurodegenerative, vascular, or both) underlying brain function impairments remains. In this cross-sectional study, we investigated if the hemodynamic response function (HRF) in lesion-free brains of patients is altered by measuring BOLD (Blood Oxygenation Level-Dependent) response to visual motion stimuli. We used a standard block design to examine the BOLD response and an event-related deconvolution approach. Importantly, the latter allowed for the first time to directly extract the true shape of HRF without any assumption and probe neurovascular coupling, using performance-matched stimuli. We discovered a change in HRF in early stages of diabetes. T2DM patients show significantly different fMRI response profiles. Our visual paradigm therefore demonstrated impaired neurovascular coupling in intact brain tissue. This implies that functional studies in T2DM require the definition of HRF, only achievable with deconvolution in event-related experiments. Further investigation of the mechanisms underlying impaired neurovascular coupling is needed to understand and potentially prevent the progression of brain function decrements in diabetes.
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Affiliation(s)
- João V Duarte
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ICNAS, University of Coimbra, Coimbra, Portugal
| | - João M S Pereira
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ICNAS, University of Coimbra, Coimbra, Portugal.,Laboratory of Biostatistics and Medical Informatics, Institute for Biomedical Imaging in Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Bruno Quendera
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ICNAS, University of Coimbra, Coimbra, Portugal
| | - Miguel Raimundo
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carolina Moreno
- Department of Endocrinology, University Hospital of Coimbra (CHUC), Coimbra, Portugal
| | - Leonor Gomes
- Department of Endocrinology, University Hospital of Coimbra (CHUC), Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, University Hospital of Coimbra (CHUC), Coimbra, Portugal
| | - Miguel Castelo-Branco
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ICNAS, University of Coimbra, Coimbra, Portugal.,Laboratory of Biostatistics and Medical Informatics, Institute for Biomedical Imaging in Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Guelho D, Paiva I, Batista C, Barros L, Carrilho F. A1c, glucose variability and hypoglycemia risk in patients with type 1 diabetes. MINERVA ENDOCRINOL 2014; 39:127-133. [PMID: 24736487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of this paper was to compare the predictive value of glycated hemoglobin (A1c) and glucose variability (GV) in the risk of hypoglycemia in patients with type 1 diabetes (T1D). METHODS Analysis of continuous glucose monitoring performed in 130 T1D patients with a diabetes background of 17.1±8.6 years, in intensive insulin therapy (49.8±17.9 UI per day). Mean interstitial glucose (in mg/dL), GV (standard deviation of mean glucose, in mg/dL), time per day spent in hypoglycemia (interstitial glucose ≤70 mg/dL, in %), and episodes of asymptomatic or nocturnal hypoglycemia, (hypoglycemia between midnight and 8 a.m., in %), were assessed. Patients were divided into two groups: group I (N.=84) with A1C≤7.5% and group II (N.=46) with A1C>7.5%. A statistical analysis was performed using SPSS, version 21.0®. RESULTS Group I presented a significantly lower mean glucose (139.2±25.9 vs. 173.1±33.2 mg/dL, P<0.05) and GV (58.4±18.8 vs. 70.3±18.6 mg/dL, P<0.05) and more hypoglycemia time (7.65±7.04 vs. 5.35±5.64%, P<0.05). The number of patients with nocturnal hypoglycemia was not significantly different in both groups (8.7 vs. 5.8%, P>0.05). Hypoglycemia time was positively correlated with GV (r=0.23, P=0.01) and negatively with A1C and mean glucose (r=-0.23 and r=-0.36; P=0.01). In multivariate analysis, GV and mean glucose were associated with hypoglycemia time (β=0.22 and β=-0.15, P<0.01, respectively), independent of A1c, diabetes duration and insulin dose; nocturnal hypoglycemia was only associated with mean glucose (OR=0.9, P<0.05) and was associated with a 16-fold increased risk of asymptomatic hypoglycemia (OR: 16.9, P<0.01). CONCLUSION Patients with high HbA1c still remain at risk of hypoglycemia. Glucose variability independently predicts daily time spent in hypoglycemia. At night, hypoglycemia only correlates with mean glucose, suggesting that daily fluctuations are probably due to inadequate meals insulin coverage. The potential of GV for predicting hypoglycemia time supports the inclusion of measures of GV into a global diabetes strategy.
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Affiliation(s)
- D Guelho
- Endocrinology, Diabetes and Metabolism Department Coimbra Hospital and University Centre Coimbra, Portugal -
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Melo M, da Rocha AG, Vinagre J, Batista R, Peixoto J, Tavares C, Celestino R, Almeida A, Salgado C, Eloy C, Castro P, Prazeres H, Lima J, Amaro T, Lobo C, Martins MJ, Moura M, Cavaco B, Leite V, Cameselle-Teijeiro JM, Carrilho F, Carvalheiro M, Máximo V, Sobrinho-Simões M, Soares P. TERT promoter mutations are a major indicator of poor outcome in differentiated thyroid carcinomas. J Clin Endocrinol Metab 2014; 99:E754-65. [PMID: 24476079 PMCID: PMC4191548 DOI: 10.1210/jc.2013-3734] [Citation(s) in RCA: 372] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Telomerase promoter mutations (TERT) were recently described in follicular cell-derived thyroid carcinomas (FCDTC) and seem to be more prevalent in aggressive cancers. OBJECTIVES We aimed to evaluate the frequency of TERT promoter mutations in thyroid lesions and to investigate the prognostic significance of such mutations in a large cohort of patients with differentiated thyroid carcinomas (DTCs). DESIGN This was a retrospective observational study. SETTING AND PATIENTS We studied 647 tumors and tumor-like lesions. A total of 469 patients with FCDTC treated and followed in five university hospitals were included. Mean follow-up (±SD) was 7.8 ± 5.8 years. MAIN OUTCOME MEASURES Predictive value of TERT promoter mutations for distant metastasization, disease persistence at the end of follow-up, and disease-specific mortality. RESULTS TERT promoter mutations were found in 7.5% of papillary carcinomas (PTCs), 17.1% of follicular carcinomas, 29.0% of poorly differentiated carcinomas, and 33.3% of anaplastic thyroid carcinomas. Patients with TERT-mutated tumors were older (P < .001) and had larger tumors (P = .002). In DTCs, TERT promoter mutations were significantly associated with distant metastases (P < .001) and higher stage (P < .001). Patients with DTC harboring TERT promoter mutations were submitted to more radioiodine treatments (P = .009) with higher cumulative dose (P = .004) and to more treatment modalities (P = .001). At the end of follow-up, patients with TERT-mutated DTCs were more prone to have persistent disease (P = .001). TERT promoter mutations were significantly associated with disease-specific mortality [in the whole FCDTC (P < .001)] in DTCs (P < .001), PTCs (P = .001), and follicular carcinomas (P < .001). After adjusting for age at diagnosis and gender, the hazard ratio was 10.35 (95% confidence interval 2.01-53.24; P = .005) in DTC and 23.81 (95% confidence interval 1.36-415.76; P = .03) in PTCs. CONCLUSIONS TERT promoter mutations are an indicator of clinically aggressive tumors, being correlated with worse outcome and disease-specific mortality in DTC. TERT promoter mutations have an independent prognostic value in DTC and, notably, in PTC.
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Affiliation(s)
- Miguel Melo
- Institute of Molecular Pathology and Immunology of the University of Porto (M.Me., A.G.d.R., J.V., R.B., J.P., C.T., R.C., A.A., C.S., C.E., P.C., H.P., J.L., V.M., M.S.-S., P.S.), 4200-465 Porto, Portugal; Medical Faculty, University of Porto (A.G.d.R., C.T.), 4200-139 Porto, Portugal; Institute of Biomedical Sciences of Abel Salazar, University of Porto (J.V., A.A.), 4050-313 Porto, Portugal; Department of Pathology and Oncology, Medical Faculty, University of Porto (J.L., V.M., M.S.-S., P.S.), 4200-139 Porto, Portugal; Departments of Endocrinology, Diabetes, and Metabolism (M.Me., F.C., M.C.) and Pathology (M.J.M.), University and Hospital Center of Coimbra, 3000-075 Coimbra, Portugal; Unit of Endocrinology (M.Me., M.C.), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; School of Allied Health Sciences, ESTSP - Escola Superior de Tecnologia da Saúde do Porto (R.C.), Polytechnic of Porto, 4400-330 Vila Nova de Gaia, Portugal; Portuguese Institute of Oncology (H.P.), Coimbra Center, 3000-075 Coimbra, Portugal; Department of Pathology (T.A.), Hospital Pedro Hispano, 4464-513 Matosinhos, Portugal; Department of Pathology (C.L.), Portuguese Institute of Oncology, Porto Center, 4200-072 Porto, Portugal; Center for Investigation of Molecular Pathobiology (M.Mo., B.C., V.L.) and Department of Endocrinology (V.L.), Portuguese Institute of Oncology, Lisbon Center, 1099-023 Lisbon, Portugal; Center for the Study of Chronic Diseases (M.Mo., B.C., V.L.), Faculty of Medical Sciences, University of Lisbon, 1099-085 Lisbon, Portugal; Department of Pathology (J.M.C.-T.), Clinical University Hospital, Servicio Gallego de Salud - SERGAS, Medical Faculty, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; and Department of Pathology (M.S.-S.), Hospital S. João, 4200-319 Porto, Portugal
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Guelho D, Paiva I, Carrilho F. Relação entre o Tratamento com Metformina e o Desenvolvimento de Hiperlactacidemia no Serviço de Urgência. ACTA MEDICA PORT 2014. [DOI: 10.20344/amp.4071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<strong>Introduction:</strong> In type 2 diabetic patients treated with metformin the development of hyperlactacidemia or even lactic acidosis seems to result from an acute precipitating event. This study aims to assess the prevalence and relative risk of hyperlactacidemia in diabetic patients admitted in the Emergency Room, the predictive factors for high lactate concentration and the influence of hyperlactacidemia in patients’ prognosis.<br /><strong>Material and Methods:</strong> Transversal observational study including patients observed between June and October 2012: 138 type 2 diabetics, 66 treated with metformin, and 83 non-diabetic patients. Studies’ variables: age, sex, cause of admition, blood pressure, drugs, personal history, analytical study (biochemistry and arterial blood gas analyses with lactate) and destination. Statistical analysis was performed using SPSS 21.0®.<br /><strong>Results:</strong> Mean lactate concentration and hyperlactacidemia prevalence were significantly higher in diabetic patients (2.1 ± 0.1mmol/L vs 1.1 ± 0.1mmol/L, p < 0.001 and 39.1% vs 3.6%, p < 0.001, respectively) and in those under metformin compared to other diabetics (2.7 ± 0.2 mmol/L vs 1.6 ± 0.1 mmol/L, p < 0.001 and 56.9% vs 23.3%, p < 0.001, respectively). Diabetics on metformin presented a 25-fold increased risk of hyperlactacidemia (OR = 25.10, p < 0.05). Creatinine was the only independent predictive factor for lactate<br />concentrations (B = 1.33, p < 0.05). Patients with hyperlactacidemia had 4.4 times higher odds of being hospitalized or dying (OR = 4.37, p < 0.05). When hospitalized, they had longer hospitalization periods (21.66 ± 5.86 days vs 13.68 ± 5.33 days, p < 0.001) and higher rate of deaths (12.5% (n = 4) vs 4.3% (n = 2), p < 0.05).<br /><strong>Conclusion:</strong> There was an increased risk of hyperlactacidemia in patients with type 2 diabetes, particularly for those under metformin. Serum creatinine represented the only independent associated factor of lactate concentration. The presence of hyperlactacidemia was associated with worse prognosis.
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Guelho D, Paiva I, Carrilho F. [Relation between metformin treatment and the development of hyperlactacidemia at the emergency room]. ACTA MEDICA PORT 2014; 27:196-203. [PMID: 24813487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 12/09/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION In type 2 diabetic patients treated with metformin the development of hyperlactacidemia or even lactic acidosis seems to result from an acute precipitating event. This study aims to assess the prevalence and relative risk of hyperlactacidemia in diabetic patients admitted in the Emergency Room, the predictive factors for high lactate concentration and the influence of hyperlactacidemia in patients' prognosis. MATERIAL AND METHODS Transversal observational study including patients observed between June and October 2012: 138 type 2 diabetics, 66 treated with metformin, and 83 non-diabetic patients. Studies' variables: age, sex, cause of admition, blood pressure, drugs, personal history, analytical study (biochemistry and arterial blood gas analyses with lactate) and destination. Statistical analysis was performed using SPSS 21.0(®). RESULTS Mean lactate concentration and hyperlactacidemia prevalence were significantly higher in diabetic patients (2.1 ± 0.1 mmol/L vs 1.1 ± 0.1 mmol/L, p < 0.001 and 39.1% vs 3.6%, p < 0.001, respectively) and in those under metformin compared to other diabetics (2.7 ± 0.2 mmol/L vs 1.6 ± 0.1 mmol/L, p < 0.001 and 56.9% vs 23.3%, p < 0.001, respectively). Diabetics on metformin presented a 25-fold increased risk of hyperlactacidemia (OR = 25.10, p < 0.05). Creatinine was the only independent predictive factor for lactate concentrations (B = 1.33, p < 0.05). Patients with hyperlactacidemia had 4.4 times higher odds of being hospitalized or dying (OR = 4.37, p < 0.05). When hospitalized, they had longer hospitalization periods (21.66 ± 5.86 days vs 13.68 ± 5.33 days, p < 0.001) and higher rate of deaths (12.5% (n = 4) vs 4.3% (n = 2), p < 0.05). CONCLUSION There was an increased risk of hyperlactacidemia in patients with type 2 diabetes, particularly for those under metformin. Serum creatinine represented the only independent associated factor of lactate concentration. The presence of hyperlactacidemia was associated with worse prognosis.
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Affiliation(s)
- Daniela Guelho
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal..
| | - Isabel Paiva
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal..
| | - Francisco Carrilho
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal..
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Gouveia S, Gomes L, Ribeiro C, Carrilho F. [Screening for autoimmune polyglandular syndrome in a cohort of patients with type 1 diabetes mellitus]. Arq Bras Endocrinol Metabol 2014; 57:733-8. [PMID: 24402020 DOI: 10.1590/s0004-27302013000900010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/01/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To characterize a cohort of patients with type 1 diabetes mellitus (T1DM) on the presence of other autoimmune disorders that could establish the diagnosis of autoimmune polyglandular syndrome (APS). SUBJECTS AND METHODS We included 151 patients with T1DM. The following clinical parameters were analyzed: gender, current age, disease duration, previous history of autoimmune disorders, and familial history for diabetes mellitus. Each patient was analyzed to detect autoimmune markers of thyroiditis, adrenocortical insufficiency, gastritis, and celiac disease, as well as possible associated dysfunctions. RESULTS A cohort with 51.7% males, average current age of 33.4 ± 13 years and disease duration of 14.4 ± 9.6 years was analyzed. Previous history of autoimmunity was found in 2%, and familial history for diabetes mellitus in 31.1% of the cohort. Frequency of autoimmune markers was 24% for thyroiditis, 9.4% for adrenocortical insufficiency, 17.2% for gastritis, and 2% for celiac disease. APS was diagnosed on 25.2% of the patients. APS and autoimmune thyroiditis risk was higher in females. Disease duration correlated directly with gastric autoantibodies, and inversely with positive islet cell, glutamic acid decarboxylase, and tyrosine phosphatase antibodies. We noticed a correlation between autoimmune markers for thyroiditis and gastritis, as well as between celiac disease and adrenocortical insufficiency. CONCLUSION Considering APS prevalence and prognosis, the need for APS screening in patients with T1DM is emphasized. Early diagnosis of other autoimmune disorders will enable us to adjust each patient treatment and follow-up.
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Ferreira MM, Carrilho E, Carrilho F. Diabetes Mellitus e sua Influência no Sucesso do Tratamento Endodôntico: Um Estudo Clínico Retrospetivo. ACTA MEDICA PORT 2014. [DOI: 10.20344/amp.2089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<strong>Introduction:</strong> Diabetes mellitus is an endocrine disease in which are involved the hormones produced by the islets of Langerhans. The diabetes mellitus can affect various functions of the immune system of the individual, predisposing them to chronic inflammation, progressive degradation of tissues and decreased tissue repair. The changes caused by this disease at the level of the oral cavity can highlight xerostomia, dysgeusia, periodontal alterations, increased susceptibility to infection and changes both in the dental pulp and periapical tissues.<br /><strong>Objectives:</strong> The aim of this study is to evaluate the influence of diabetes mellitus at the periapical tissues and the success of endodontic treatment in these patients.<br /><strong>Material and Methods:</strong> We analyzed 737 cases treated in consultation Area of Dental Medicine, which were made nonsurgical endodontic treatments, between the years 2003 and 2012. These were selected patients with diabetes mellitus, a total of 32, of whom 23 were willing to come to the consultation and to participate in this study. The data collected were analyzed using the Statistical Package for the Social Sciences, version 19, at a significance level of 5%.<br /><strong>Results:</strong> A total of 37 teeth in the test group and 25 in the control group. For the analyzed parameters related to the diagnosis pulp, mobility, fistula, pain on percussion horizontal and vertical evaluation of final restoration and the time interval between the query and the final restoration shutter and / or the control visit, there were no differences statistically significant (p > 0.05). Regarding the assessment of the success of endodontic treatment, this was 62% in the test group and 80% in the control group (p > 0.05).<br /><strong>Conclusions:</strong> The results of this study are inconclusive regarding the increasing prevalence of apical periodontitis in diabetic patients. Regarding the evaluation of the success of endodontic treatments examined it was found that the success rate in diabetic patients is lower, though not statistically significant. For this reason and given the limitations of this study, we cannot state that patients with diabetes mellitus have a greater predisposition to the development of periradicular lesions or that the success of endodontic treatment in these patients is compromised. It is important, however, that further studies are developed to characterize the pulp and periradicular<br />changes and to assess the prevalence of apical periodontitis and progression in patients with diabetes mellitus.
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Ferreira MM, Carrilho E, Carrilho F. [Diabetes mellitus and its influence on the success of endodontic treatment: a retrospective clinical study]. ACTA MEDICA PORT 2014; 27:15-22. [PMID: 24581189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/31/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Diabetes mellitus is an endocrine disease in which are involved the hormones produced by the islets of Langerhans. The diabetes mellitus can affect various functions of the immune system of the individual, predisposing them to chronic inflammation, progressive degradation of tissues and decreased tissue repair. The changes caused by this disease at the level of the oral cavity can highlight xerostomia, dysgeusia, periodontal alterations, increased susceptibility to infection and changes both in the dental pulp and periapical tissues. OBJECTIVES The aim of this study is to evaluate the influence of diabetes mellitus at the periapical tissues and the success of endodontic treatment in these patients. MATERIAL AND METHODS We analyzed 737 cases treated in consultation Area of Dental Medicine, which were made nonsurgical endodontic treatments, between the years 2003 and 2012. These were selected patients with diabetes mellitus, a total of 32, of whom 23 were willing to come to the consultation and to participate in this study. The data collected were analyzed using the Statistical Package for the Social Sciences, version 19, at a significance level of 5%. RESULTS A total of 37 teeth in the test group and 25 in the control group. For the analyzed parameters related to the diagnosis pulp, mobility, fistula, pain on percussion horizontal and vertical evaluation of final restoration and the time interval between the query and the final restoration shutter and / or the control visit, there were no differences statistically significant (p > 0.05). Regarding the assessment of the success of endodontic treatment, this was 62% in the test group and 80% in the control group (p > 0.05). CONCLUSIONS The results of this study are inconclusive regarding the increasing prevalence of apical periodontitis in diabetic patients. Regarding the evaluation of the success of endodontic treatments examined it was found that the success rate in diabetic patients is lower, though not statistically significant. For this reason and given the limitations of this study, we cannot state that patients with diabetes mellitus have a greater predisposition to the development of periradicular lesions or that the success of endodontic treatment in these patients is compromised. It is important, however, that further studies are developed to characterize the pulp and periradicular changes and to assess the prevalence of apical periodontitis and progression in patients with diabetes mellitus.
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Affiliation(s)
| | - Eunice Carrilho
- Faculdade de Medicina Dentária. Universidade de Coimbra. Coimbra. Portugal..
| | - Francisco Carrilho
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Alves M, Bastos M, Almeida Santos T, Carrilho F. [Gonadal function in Turner syndrome]. ACTA MEDICA PORT 2013; 26:655-663. [PMID: 24388251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 10/07/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Turner syndrome is characterized by the absence, total or partial, of one X chromosome in females, being one of the most frequent chromosomal abnormalities. Diagnosis is made by karyotype. Turner syndrome manifestations include primary hypogonadism, before or after puberty (gonadal dysgenesis). The degree and extent of gonadal disfunction are variable. OBJECTIVES We intended to assess clinical, karyotype, gonadal function and pelvic ultrasound characteristics in women with Turner syndrome. MATERIAL AND METHODS Retrospective study of patients with Turner syndrome followed in Endocrinology and Human Reproduction Departments of Hospitais da Universidade de Coimbra - Centro Hospitalar e Universitário de Coimbra, E.P.E. We evaluated the entire sample and considered group 1 (with spontaneous puberty and menarche) and group 2 (without spontaneous puberty). Parameters assessed: age at initial study, puberty (Tanner stages), karyotype, FSH, pelvic ultrasound (initial and after puberty), diagnostic laparoscopy and pubertal induction. Statistical Program: SPSS (20.0). RESULTS Global sample: 79 patients, 14.7 ± 6.6 years. No pubertal signs in 57.1%; 67.1% with primary amenorrhea and 6.6% with secondary amenorrhea. Karyotype: X monosomy-37.2%, mosaicism-37.2%, X structural changes-25.6%. Median FSH of 59.5 mIU/ mL. Initial ultrasound: normal uterus 34.2%, atrophic uterus 65.8%; normal ovaries 21.6%, atrophic ovaries 78.4%, ovarian follicles in 5.1%. Post-puberty ultrasound: normal uterus 67.9%, atrophic uterus 32.1%; normal ovaries 36.4%, atrophic ovaries 63.6%. Laparoscopy was performed in 16 (20.3%) patients, confirming the sonographic findings. Only two women with induced puberty became pregnant: one spontaneously, interrupted; another by donated oocytes, normal outcome. Group 1 (with spontaneous puberty and menarche): 20 (25.3%) patients, 16.1 ± 8.9 years. Tanner at baseline: M1-22.2%, M2-33.3%, M3-16.7%, M4-16.7%, M5-11.1%. Karyotype: mosaicism-65%, X structural changes-20%, X monosomy-15%. Median FSH of 7 mUI/mL. Initial ultrasound: normal uterus-72.2%, atrophic uterus 27.8%; normal ovaries 63.2%, atrophic ovaries 36.8%. Post-puberty ultrasound: normal uterus 100%; normal ovaries 72.7%, atrophic ovaries 27.3%. Group 2 (without spontaneous puberty): 59 (74.7%) patients, 14.0 ± 5.5 years. Tanner at baseline: M1-69.2%, M2-13.5%, M3-5.8%, M4-3.8%, M5-7.7%. Karyotype: X monosomy-43.9%, X structural changes-28.1% mosaicism-28.1%. Median FSH of 74 mUI/mL. Initial ultrasound: normal uterus 20.4%, atrophic uterus 79.6%; normal ovaries 7.4%, atrophic ovaries 92.6%. Post-puberty ultrasound: normal uterus 60.0%, atrophic uterus 40.0%; normal ovaries 27.3%, atrophic ovaries 72.7%. Pubertal induction at 16.1 ± 4.1 years, with bone age of 12.7 ± 1.6 years. Groups 1 and 2 differ significantly in karyotype (p = 0.010), median FSH (p < 0.001), and uterine and ovarian dimensions (p < 0.001). CONCLUSIONS Most patients had gonadal dysfunction and needed pubertal induction. Spontaneous puberty with menarche occurred in 25.3% of patients (predominantly mosaics). 43.9% of patients with pubertal induction had X monosomy. These patients fertility is compromised and, in some cases, we should refer to assisted reproductive specialist for pregnancy or fertility preservation.
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Affiliation(s)
- Márcia Alves
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra, EPE. Coimbra. Portugal
| | - Margarida Bastos
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra, EPE. Coimbra. Portugal
| | - Teresa Almeida Santos
- Serviço de Reprodução Humana. Centro Hospitalar e Universitário de Coimbra, EPE. Coimbra. Portugal
| | - Francisco Carrilho
- Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra, EPE. Coimbra. Portugal
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Melo M, Costa G, Ribeiro C, Carrilho F, Martins MJ, da Rocha AG, Sobrinho-Simões M, Carvalheiro M, Soares P. Stimulated thyroglobulin at recombinant human TSH-aided ablation predicts disease-free status one year later. J Clin Endocrinol Metab 2013; 98:4364-72. [PMID: 24037891 DOI: 10.1210/jc.2013-2267] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Thyroglobulin (Tg) levels measured at the time of remnant ablation after thyroid hormone withdrawal (THW) were shown to have prognostic value in predicting disease-free status. OBJECTIVES Our objectives were to determine whether stimulated Tg levels, measured at the time of remnant ablation performed under recombinant human TSH (rhTSH) stimulation, has value in predicting absence of detectable disease 1 year after radioiodine therapy and to compare the results obtained with this approach with a cohort of patients submitted to ablation after THW. DESIGN This was a prospective observational study. SETTING AND PATIENTS The study included 293 consecutive patients treated for a differentiated thyroid carcinoma with no initial evidence of distant metastasis. All patients were submitted to a total or near-total thyroidectomy, followed by ablation either under rhTSH (n = 151) or endogenous TSH stimulation (n = 142). Patients with positive Tg antibodies were excluded. MAIN OUTCOME MEASURES The predictive value of Tg at ablation was assessed by receiver operating characteristic curve analysis. RESULTS In the rhTSH group, 96 patients (73.3%) were considered disease-free at 1 year. Stimulated Tg at ablation after rhTSH was found to be an independent prognostic indicator of disease persistence 12 months later. The highest-accuracy cutoff value for absence of detectable disease was defined as 7.2 ng/mL, with a negative predictive value of 90%. In the THW group, Tg at ablation also proved to have independent predictive value. Using the same threshold (7.2 ng/mL), the negative predictive value of Tg was 95% in the THW group. CONCLUSIONS When rhTSH was used, stimulated Tg at ablation had independent predictive value for disease-free status 1 year later. A low stimulated Tg at rhTSH-aided ablation may be considered a favorable prognosis factor.
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Affiliation(s)
- Miguel Melo
- University Hospital of Coimbra, Department of Endocrinology, Diabetes and Metabolism, Praceta Mota Pinto, 3000-075 Coimbra, Portugal.
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Saraiva J, Ribeiro C, Melo M, Gomes L, Costa G, Carrilho F. Thyroid Carcinoma in Children and Young Adults: Retrospective Review of 19 Cases. ACTA MEDICA PORT 2013. [DOI: 10.20344/amp.1307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Thyroid carcinoma is rare in children and young adults. Most of management guidelines are based in data from adult population. Several controversies remain regarding the aggressiveness of clinical presentation and therapeutic approach.Objective: To evaluate all differentiated thyroid carcinoma patients with less than 20 years-old at presentation reflecting the experience of our unit in relation to diagnosis, treatment and follow-up of this clinical entity.Material and Methods: This is a retrospective review of clinical records of all children and young adults followed at Oncology Consultation of Department of Endocrinology of Centro Hospitalar e Universitário de Coimbra between 1996 and 2012.Results: Nineteen patients with mean age of 16 years old were followed, 13 girls and 6 boys. None of the patients had previous neck irradiation. A palpable cervical mass was the presenting complaint in 84.6%. FNA was performed in 15 patients and was diagnostic or suspicious of malignancy in 71.4%. Total thyroidectomy was performed in 18 cases (94.7%). Papillary carcinoma was identified in all. Vascular invasion and multicentry occurred in 21.1%. Mean tumor size was 2.5cm. Cervical lymph node involvement was diagnosed in 31.6% and distant metastases in 5.2%. The majority of patients (18 in 19) were classified as stage I disease. All patients received thyroxine suppressive therapy and postoperative radioiodine ablation was given to 84.2% (mean dose 85.7mCi). During mean follow-upof almost 6 years, 16 patients remain disease free.Conclusion: In our series, cervical lymph node and distant metastases rates were similar to that found in adult population. Overall prognosis was very good.
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Saraiva J, Ribeiro C, Melo M, Gomes L, Costa G, Carrilho F. Thyroid carcinoma in children and young adults: retrospective review of 19 cases. ACTA MEDICA PORT 2013; 26:578-582. [PMID: 24192098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/29/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Thyroid carcinoma is rare in children and young adults. Most of management guidelines are based in data from adult population. Several controversies remain regarding the aggressiveness of clinical presentation and therapeutic approach. OBJECTIVE To evaluate all differentiated thyroid carcinoma patients with less than 20 years-old at presentation reflecting the experience of our unit in relation to diagnosis, treatment and follow-up of this clinical entity. MATERIAL AND METHODS This is a retrospective review of clinical records of all children and young adults followed at Oncology Consultation of Department of Endocrinology of Centro Hospitalar e Universitário de Coimbra between 1996 and 2012. RESULTS Nineteen patients with mean age of 16 years old were followed, 13 girls and 6 boys. None of the patients had previous neck irradiation. A palpable cervical mass was the presenting complaint in 84.6%. FNA was performed in 15 patients and was diagnostic or suspicious of malignancy in 71.4%. Total thyroidectomy was performed in 18 cases (94.7%). Papillary carcinoma was identified in all. Vascular invasion and multicentry occurred in 21.1%. Mean tumor size was 2.5cm. Cervical lymph node involvement was diagnosed in 31.6% and distant metastases in 5.2%. The majority of patients (18 in 19) were classified as stage I disease. All patients received thyroxine suppressive therapy and postoperative radioiodine ablation was given to 84.2% (mean dose 85.7mCi). During mean follow-up of almost 6 years, 16 patients remain disease free. CONCLUSION In our series, cervical lymph node and distant metastases rates were similar to that found in adult population. Overall prognosis was very good.
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Affiliation(s)
- Joana Saraiva
- Departamento de Endocrinologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
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Guelho D, Barros L, Baptista C, Paiva I, Gouveis S, Saraiva J, Moreno C, Carrilho F. Predictive value of HbA1c and glucose fluctuations in hypoglycemia risk in patients with type 1 diabetes. ACTA ACUST UNITED AC 2013. [DOI: 10.1530/endoabs.32.p355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Silva MF, Sapisochin G, Strasser SI, Hewa-Geeganage S, Chen J, Wigg AJ, Jones R, Saraiva R, Kikuchi L, Carrilho F, Fontes PRO, Charco R. Liver resection and transplantation offer similar 5-year survival for Child-Pugh-Turcotte A HCC-patients with a single nodule up to 5 cm: a multicenter, exploratory analysis. Eur J Surg Oncol 2013; 39:386-95. [PMID: 23375469 DOI: 10.1016/j.ejso.2012.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/15/2012] [Accepted: 12/07/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM The current guideline of the American Association for the Study of Liver Diseases recommends liver resection for Child-Pugh-Turcotte A patients with a single hepatocellular carcinoma, total serum bilirubin ≤ 1 mg/dL and absence of significant portal hypertension. This subset of patients would have a long-term survival comparable to transplantation. The main aim of this study is to evaluate the survival rates in patients with a single nodule ≤ 5 cm following resection. METHODS Medical records of 105 Child-Pugh-Turcotte A patients who underwent liver resection between 1997 and 2009 were analyzed in 3 countries. RESULTS One, 3-, and 5-year survival rate was 97%, 83%, and 66%, respectively, and no variable that can be assessed prior to liver resection predicted survival probabilities. CONCLUSIONS Liver resection offers 5-year survival similar to transplantation for Child-Pugh-Turcotte A patients with hepatocellular carcinoma and a single nodule up to 5 cm, independently of any patient baseline characteristics.
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Affiliation(s)
- M F Silva
- Department of Gastroenterology, Flinders University, Adelaide, Australia.
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Santana Lopes M, Jácome de Castro J, Marcelino M, Oliveira MJ, Carrilho F, Limbert E. Iodo e Tiróide: O que o Clínico Deve Saber. ACTA MEDICA PORT 2012. [DOI: 10.20344/amp.44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The World Health Organization considers iodine deficiency as a major worldwide cause of mental and development diseases, estimating that about 13% of the world population is affected by diseases caused by iodine deficiency. Iodine is a trace element necessary for the synthesis of thyroid hormones which, since it cannot be formed by the organism, must be taken regularly with food. Fish and shellfish are generally a good source, because the ocean contains a considerable amount of iodine. On the contrary, plants which grow in iodine-deficient soils are poor in this element, as well as meat and other animal products fed in plants low in iodine. Salt is the best way for iodine supplementation. Cooking the food with iodized salt is a desirable practice because it guarantees the presence of this element. There are also other methods to provide iodine to the general population, such as adding iodine to drinking water or taking supplements of iodine. In pregnancy is recommended iodine supplementation, except in patients with known thyroid disorders. Iodine is an essential component of thyroid hormones (T4 and T3). Inadequate iodine intake leads to inadequate thyroid hormone production. The most important consequences of iodine deficiency, in the general population are goiter and hypothyroidism, and in the severe cases, mental retardation, cretinism and increased neo-natal and infant mortality. The International Council for the Control of Iodine Deficiency Disorders (ICCIDD) formed in 1985, with the only aim of achieving optimal iodine nutrition in the world, in cooperation with UNICEF and WHO. In Portugal, recent studies show significant deficiencies in pregnancy and The Portuguese Society of Endocrinology Diabetes and Metabolism, in partnership with General Directorate of Health, proposed an iodine supplementation during pregnancy with 150-200μg/day.
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Santana Lopes M, Jácome de Castro J, Marcelino M, Oliveira MJ, Carrilho F, Limbert E. [Iodine and thyroid: what a clinic should know]. ACTA MEDICA PORT 2012; 25:174-178. [PMID: 23069238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 06/12/2012] [Indexed: 06/01/2023]
Abstract
The World Health Organization considers iodine deficiency as a major worldwide cause of mental and development diseases, estimating that about 13% of the world population is affected by diseases caused by iodine deficiency. Iodine is a trace element necessary for the synthesis of thyroid hormones which, since it cannot be formed by the organism, must be taken regularly with food. Fish and shellfish are generally a good source, because the ocean contains a considerable amount of iodine. On the contrary, plants which grow in iodine-deficient soils are poor in this element, as well as meat and other animal products fed in plants low in iodine. Salt is the best way for iodine supplementation. Cooking the food with iodized salt is a desirable practice because it guarantees the presence of this element. There are also other methods to provide iodine to the general population, such as adding iodine to drinking water or taking supplements of iodine. In pregnancy is recommended iodine supplementation, except in patients with known thyroid disorders. Iodine is an essential component of thyroid hormones (T4 and T3). Inadequate iodine intake leads to inadequate thyroid hormone production. The most important consequences of iodine deficiency, in the general population are goiter and hypothyroidism, and in the severe cases, mental retardation, cretinism and increased neo-natal and infant mortality. The International Council for the Control of Iodine Deficiency Disorders (ICCIDD) formed in 1985, with the only aim of achieving optimal iodine nutrition in the world, in cooperation with UNICEF and WHO. In Portugal, recent studies show significant deficiencies in pregnancy and The Portuguese Society of Endocrinology Diabetes and Metabolism, in partnership with General Directorate of Health, proposed an iodine supplementation during pregnancy with 150-200µg/day.
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Affiliation(s)
- Maria Santana Lopes
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo, Lisboa, Portugal
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Limbert E, Prazeres S, São Pedro M, Madureira D, Miranda A, Ribeiro M, Carrilho F, Jácome de Castro J, Lopes MS, Cardoso J, Carvalho A, Oliveira MJ, Reguengo H, Borges F. [Iodine intake in Portuguese school children]. ACTA MEDICA PORT 2012; 25:29-36. [PMID: 22883246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 05/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate iodine intake in portuguese school children in order to inform health authorities of eventual measures to be implemented. INTRODUCTION Iodine is the key element for thyroid hormone synthesis and its deficiency even mild, as found in other European countries, may have deleterious effects in pregnancy resulting in cognitive problems of offsprings. In Portugal there are no recent data on iodine intake in schoolchildren. POPULATION AND METHODS 3680 children aged 6-12 years of both sexes, from 78 different schools were studied. Iodine intake was evaluated trough urine iodine (UI) determinations using a colorimetic method. RESULTS The global median UI value was 105.5 µg/L; the percentage of children with UI <100 µg/L was 47.1%, corresponding to 41% of the studied schools. The percentage of values <50 µg/L was 11.8%. The male gender, the south region of the country and the distribution of milk in school were significantly linked with a higher iodine elimination. DISCUSSION Our global results point to a borderline/ mildly insufficient iodine intake in the portuguese school population. However 47% of the children had UI under 100 µg /L. The comparison of our results with the available data from 30 years ago, point to a considerable improvement, due to silent prophylaxis. Male gender, geographical area and milk distribution influenced positively iodine intake.The importance of milk has been referred in numerous papers. CONCLUSIONS The study of UI in the Portuguese school population points to a borderline iodine intake. However, in 47% of children iodine intake was inadequate. Compared with data from the eighties, a considerable increase in iodine elimination was found. Taking into account the potencial deleterious effects of inadequate iodine intake, a global prophylaxis with salt iodization has to be considered.
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Affiliation(s)
- Edward Limbert
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa de Francisco Gentil, Portugal
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Vieira A, Paiva S, Baptista C, Ruas L, Silva J, Gonçalves J, Carrilho F, Carvalheiro M. Hiperplasia congénita da suprarenal de expressão tardia por deficiência de 21-hidroxilase: revisão da literatura e estudo genético preconcepção de cinco casais. ACTA MEDICA PORT 2011. [DOI: 10.20344/amp.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The deficiency of the enzyme 21-hydroxylase (21-HO) is responsible for about 90% to 95% of all cases of congenital adrenal hyperplasia (HCSR). This disorder is one of the most frequent hereditary illnesses of autosomal recessive trait. The illness can be presented in two clinical forms: 1 - classic, subdivided in saltwasting form and simple virilizing form; 2 - nonclassic or late-onset. The severity of the illness is correlated with the degree of enzymatic activity of 21-HO, which depends on the type of mutation that occurs in gene CYP21A2. The late onset congenital adrenal hyperplasia is that one where the enzymatic blockade is less intense. The clinical is variable: precocious pubarche, polycystic ovaries, hirsutism, oligoamenorrhea, acne and infertility. Gold standard for the diagnosis of late onset congenital adrenal hyperplasia consists on the test of the tetracosactide, considering itself diagnostic positive when 17-hidroxiprogesterona (17-OHP) is higher of 10-15 ng per mL. Many patients don't need treatment; however, if necessary, such a treatment essentially consists on the Administration of glucocorticoids and antiandrogens. Considering that affected individuals and the carriers may have a severe mutation in CYP21A2, they can have descendents with the classic form (if their partner is also a carrier of a severe mutation), it is mandatory the genetic study of the couple. The authors illustrate the importance of this genetic study through five clinical cases, whose common link is the desire to have children, as well as the presence on the feminine element of late onset congenital adrenal hyperplasia. The genetic study of the couple allows adequate pre-conception counseling and also prevents the use of corticoids throughout the pregnancy (if there's no risk of descendents being affected with the classic form). This aspect must be had in account in programming the pregnancy, in order to prevent therapeutics and unnecessary distrusts.
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Catorze N, Pessoa L, Hazima MA, Carrilho F. Stroke and thrombolysis: an old disease with a new approach. Crit Care 2011. [PMCID: PMC3066992 DOI: 10.1186/cc9738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Vieira A, Paiva S, Baptista C, Ruas L, Silva J, Gonçalves J, Carrilho F, Carvalheiro M. [Late onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency: revision of literature and preconception genetic study of five couples]. ACTA MEDICA PORT 2011; 24:99-110. [PMID: 21672447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 09/30/2009] [Indexed: 05/30/2023]
Abstract
The deficiency of the enzyme 21-hydroxylase (21-HO) is responsible for about 90% to 95% of all cases of congenital adrenal hyperplasia (HCSR). This disorder is one of the most frequent hereditary illnesses of autosomal recessive trait. The illness can be presented in two clinical forms: 1 - classic, subdivided in saltwasting form and simple virilizing form; 2 - nonclassic or late-onset. The severity of the illness is correlated with the degree of enzymatic activity of 21-HO, which depends on the type of mutation that occurs in gene CYP21A2. The late onset congenital adrenal hyperplasia is that one where the enzymatic blockade is less intense. The clinical is variable: precocious pubarche, polycystic ovaries, hirsutism, oligoamenorrhea, acne and infertility. Gold standard for the diagnosis of late onset congenital adrenal hyperplasia consists on the test of the tetracosactide, considering itself diagnostic positive when 17-hidroxiprogesterona (17-OHP) is higher of 10-15 ng per mL. Many patients don't need treatment; however, if necessary, such a treatment essentially consists on the Administration of glucocorticoids and antiandrogens. Considering that affected individuals and the carriers may have a severe mutation in CYP21A2, they can have descendents with the classic form (if their partner is also a carrier of a severe mutation), it is mandatory the genetic study of the couple. The authors illustrate the importance of this genetic study through five clinical cases, whose common link is the desire to have children, as well as the presence on the feminine element of late onset congenital adrenal hyperplasia. The genetic study of the couple allows adequate pre-conception counseling and also prevents the use of corticoids throughout the pregnancy (if there's no risk of descendents being affected with the classic form). This aspect must be had in account in programming the pregnancy, in order to prevent therapeutics and unnecessary distrusts.
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Affiliation(s)
- Alexandra Vieira
- Serviço de Endocrinologia, Diabetes e Metabolismo, Hospitais da Universidade de Coimbra, Portugal
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Limbert E, Prazeres S, São Pedro M, Madureira D, Miranda A, Ribeiro M, Jacome de Castro J, Carrilho F, Oliveira MJ, Reguengo H, Borges F. Iodine intake in Portuguese pregnant women: results of a countrywide study. Eur J Endocrinol 2010; 163:631-5. [PMID: 20643757 DOI: 10.1530/eje-10-0449] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Iodine is the key element for thyroid hormone synthesis, and its deficiency, even moderate, is harmful in pregnancy, when needs are increased, because of its potential deleterious effects on fetal brain development. In Portugal, no recent data on iodine intake exists. The objective of this countrywide study was to analyze iodine status in pregnant Portuguese women in order to propose adequate measures to the health authorities. SUBJECTS AND METHODS Using a fast colorimetric method, urine iodine concentration (UIC) was evaluated in 3631 pregnant women followed in 17 maternity hospitals from hinterland and coastal areas in Continental Portugal and the Portuguese islands of Açores and Madeira. RESULTS Median UIC value was 84.9 μg/l (range 67.6-124.1) in Continental Portugal, 69.5 μg/l in Madeira, and 50.0 μg/l in Açores. The percentage of satisfactory values (>150 μg/l) was 16.8, ranging from 8.8 to 34.1 in the Continent, and being 8.2 in Madeira and 2.3 in Açores. The percentage of values below 50 μg/l was 23.7, ranging from 14.0 to 37.4 in the Continent, 33.7 in Madeira, and 50.0 in Açores. CONCLUSIONS Our results point to an inadequate iodine intake in pregnant women assisted in most Portuguese maternity hospitals. Considering the potential deleterious effects of inadequate iodine supply in pregnancy, iodine supplementation is strongly recommended in this period of life.
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Affiliation(s)
- E Limbert
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa de Francisco Gentil, Rua Professor Lima Basto, Lisboa, Portugal.
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