Enfermedad de Cushing en el embarazo y uso de cabergolina

Introducción: La enfermedad de Cushing (EC) es rara durante el embarazo y se asocia con complicaciones maternas y fetales significativas. El objetivo fue reportar el caso de una paciente con EC que logró embarazo y parto sin complicaciones tras el tratamiento con dosis bajas de cabergolina. Métodos: Mujer de 29 años con diagnóstico de EC (macroadenoma secretor de ACTH que produce desplazamiento del quiasma óptico, infiltra el seno cavernoso derecho y engloba la arteria carótida interna). Se somete a cirugía transesfenoidal con resección tumoral incompleta. Luego de un año de estabilidad clínica, reaparecen los síntomas por lo que se instaura tratamiento médico con cabergolina. Durante el tratamiento la paciente concibe embarazo y se suspende la medicación. Resultados: En el primer trimestre, los parámetros clínicos y bioquímicos indican EC activa, por lo que se decide reinstaurar Cabergolina a dosis bajas durante el resto de la gestación. Con el agonista dopaminérgico se alcanza normalizar parámetros clínicos y de laboratorio y la paciente dio a luz una niña sana a las 38 semanas, dentro de percentiles normales y sin complicaciones. Conclusión: El embarazo es un evento raro en pacientes con EC. Sin embargo, las consecuencias de la exposición materno-fetal al hipercortisolismo pueden ser graves. Nuestra experiencia con el uso de cabergolina a dosis bajas en una embarazada con EC, aporta datos favorables a los escasos reportes bibliográficos existentes, sumando evidencia sobre el perfil de seguridad del fármaco en esta población de pacientes.

Ultrastructural and molecular evidence of macroautophagy in functioning PitNETs and experimental pituitary tumors

INTRODUCTION

Macroautophagy is a lysosome-mediated degradation process that controls the quality of cytoplasmic components and organelles, with its regulation depending on autophagy-related proteins (Atg) and with Beclin1/Atg6 and microtubule-associated protein light chain 3 (LC3/Atg8) being key players in the mammalian autophagy. As reports on this mechanism in the field of pituitary neuropathology and neuroendocrinology are scarce, our study analyzed the ultrastructural signs of macroautophagy and the expression of Beclin1 and LC3 proteins in human functioning PitNETs and in experimental pituitary tumors.

METHODS

a group of functioning humans PitNETs and an experimental lactotroph model in rats of the F344 strain stimulated with oestradiol benzoate (BE) were used. Ultrastructural and molecular evidence of the macroautophagic process was evaluated using different techniques.

RESULTS

In functioning PitNETs cohort, 60% exhibited evidence of macroautophagy, with a significant difference found for Beclin1 and LC3 between macro and micro PitNETs (p < 0.05). In the experimental model, the expression of both Beclin1 and LC3 proteins was immunopositive in normal and tumoral glands when analyzed by immunofluorescence, western blot and immunohistochemistry. In the experimental model, protein expression was associated with increased glandular size and weight.

CONCLUSIONS

Our study revealed evidence of macroautophagy at the pituitary level and the important role of Beclin1 and LC3 in the progression of functioning PitNETs, implying that this mechanism participate in regulating pituitary cell growth.

[Pituitary tumors: 10 years of experience]

INTRODUCTION

Pituitary tumors comprise a quarter of the intracranial neoplasms and the adenomas represent the highest percentage of them. They are benign, but they can be invasive and they have an impact in morbidity and mortality.

OBJECTIVE

To analyze the clinical features of pituitary adenomas tumors, and create a computerized registry to improve strategies for diagnosis and monitoring of these patients.

METHODS

A retrospective, descriptive analysis of 102 medical records of a total of 191 patients who attended the endocrinology service from 2003 to 2014 .The variables were analyzed by the corresponding descriptive statistics. The SPSS 11.5 was used.

RESULTS

63% were women, and (74.4%) had age from 25-60 years. 54% were nonfunctioning adenomas, 28% to prolactinomas, 11.8% and 6.2% somatotropinomas corticotropinomas. In all types the female group was predominant, except nonfunctioning. Of the nonfunctioning adenomas 79% were macroadenomas, prolactinomas 52% were microadenomas and surgery was performed in 37% of them. The somatotropinomas, 80% were macroadenomas, 80% of patients and 40% radiotherapy was operated. In corticotropinomas, both micro and macroadenomas were submitted by the same percentage (50%) and all of them underwent surgery.

CONCLUSION

The findings are consistent with the literature in terms of frequency and age of onset of adenomas. We suggest the development of a registry to optimize the monitoring and treatment of patients, research and scientific publication.