Trabalho de Conclusão de Curso - TCC

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Navegando Trabalho de Conclusão de Curso - TCC por Assunto "Acromegalia"

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    A influência dos níveis séricos de IGF-1 no perfil lipídico e glicêmico de acromegálicos em um Centro de Especialidades Médicas no Pará
    (Centro Universitário do Estado do Pará, 2021) Pereira, Caroline de Oliveira; Ferraz, Louise Paiva; Bastos, Fabíola de Arruda; Caldato, Milena Coelho Fernandes; http://lattes.cnpq.br/9477878606835309; http://lattes.cnpq.br/9386935778704228
    Introduction: Acromegaly is an insidious and rare disease, associated with a high mortality rate, which results from the pathological autonomous overproduction of growth hormone (GH) and the subsequent increase in insulin-like growth factor-1 (IGF-1) levels. Chronic hypersecretion of these hormones causes several metabolic changes, among which we can highlight lipolysis, atherosclerotic processes, hyperinsulinemia, gluconeogenesis and peripheral insulin resistance. These changes in lipid and glycemic metabolism are related to an increased risk of cardiovascular events in acromegalic patients, being today the second most common cause of mortality in these patients. As a result, it is necessary to assess whether the control of the disease also corresponds to a better metabolic control of these patients, resulting in a lower cardiovascular risk and a lower mortality rate. Objectives: To evaluate the influence of IGF-1 levels on the lipid and glycemic profile of acromegalic patients treated at the Cesupa Medical Specialties Center. Methodology: This is an epidemiological, cross-sectional and descriptive study, based on an exploratory analysis of the medical records of the Endocrinology Service of the Cesupa Medical Specialties Center (CEMEC) from August 2019 to June 2020. Results: When comparing acromegaly activity in the first and last consultation, it was found that there was an increase in disease control, from 22.2% to 71.1%. As for the glycemic profile, the glycemia of diabetic acromegalic patients was statistically higher than that of non-diabetics, both in the first assessment (Mean ± SD: 135.8 ± 59.4 vs 95.1 ± 15.2; P <0.001), and in the latter (Mean ± SD: 98.6 ± 13.2 vs 84.0 ± 11.1; P <0.001). When observing diabetic acromegalic patients, there was a significant decrease in the levels of IGF-1 (mean ± SD: 480.9 ± 250.5 vs 189.5 ± 91.5, P <0.001) and IGF-1 by LSN ( mean ± SD: 1.8 ± 1.0 vs 1.0 ± 0.6, P <0.001), when comparing the two assessments. It was possible to observe, comparing the laboratory parameters between the first and last evaluation, that in the uncontrolled acromegaly at the end (n = 13), there was a decrease in the total cholesterol levels (Mean ± SD: 179.3 ± 30.0 vs 155, 9 ± 28.8; P = 0.018) and, significant increase in HDL (Mean ± SD: 46.8 ± 14.3 vs 53.3 ± 7.9; P = 0.048). For patients with controlled acromegaly at the end (n = 32), there was a significant increase in the HDL level (Mean ± SD: 46.3 ± 26.0 vs 58.0 ± 24.2; P = 0.003) and a decrease in levels of IGF-1, GH, total cholesterol, LDL and TG. Conclusion: These results suggest that most of the acromegalics under study had control of the disease by reducing the levels of IGF-1, evidencing success in their therapeutic conduct. Concomitantly, the majority also obtained improvement in the levels of glucose, glycated hemoglobin, total cholesterol and HDL. This suggests that controlling disease activity is one of the most important interventions for reducing cardiovascular risk in these patients.
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    Avaliação da morfologia e função tireoidiana nos pacientes acromegálicos atendidos no Centro de Especialidades Médicas do CESUPA (CEMEC)
    (Centro Universitário do Estado do Pará, 2019) Ribeiro, Bruna Dias da Costa; Rodrigues, Silvana da Silva; Bastos, Fabíola de Arruda; Caldato, Milena Coelho Fernandes; http://lattes.cnpq.br/9477878606835309; http://lattes.cnpq.br/9386935778704228
    Introduction: Acromegaly is a chronic and multisystemic desease, has an insidious onset, and is debilitating. Results from hypersecretion of Growth Hormone and Insulin Growth Factor. The mortality rate is up to 3.5 times larger than the unaffected population due to mainly associated comorbidities and the late character of its diagnosis. Among the proved associations, it’s important to give attention to thyroid functional modifications and it’s morphology, due to evolution of these modifications until the appearance of thyroid neoplasms. Objective: Evaluate thyroid morphology and thyroid functional disorders in acromegalic patients attended at the “Centro de Especialidades Médicas (CEMEC) – CESUPA”, on the Pituitary and Adrenal abulatory. Methodology: Epidemiological, cross-sectional and retrospective study. Data were collected from the acromegalics patient’s medical records, enrolled at the Pituitary and Adrenal abulatory, at CEMEC until June 2019, with a total of 59 patients. Results: Most of the acromegalic patients treated at CEMEC presented pituitary macroadenoma (83.1%) in the initial evaluation. Among the altered laboratory results of TSH (first evaluation 17 and last evaluation 7), the majority presented values below normal in both the first (n = 15) and the last evaluation (n = 6). Thyroxine altered values were also analyzed (first evaluation n=10 and last evaluation n=8), and there was a higher occurrence of results below normality in the first evaluation (n = 7) and equality between values below and above normality in the final evaluation, however without statistically significant results (p = 0.9849). Evaluating the presence of thyroid nodules with gender and time of disease, there was no statistically significant difference (respectively p = 0.9426 and p = 0.4115), however, the relation was significant when related to age group, with a higher frequency between 70 and 79 years. years old (* p = 0.0435). Furthermore, it was evidenced that there was no statistically significant relation between the IGF-1 LSN values and the occurrence of thyroid nodules in the first and final evaluations (respectively p = 0.5834 and p = 0.9514). There was also no statistically significant relationship when analyzing mean GH values and nodule occurrence at the first and last assessment (p = 0.7197 and 0.6831).Conclusion: In the thyroid ultrasonography, most of the nodules found in the first and final evaluation had the following characteristics: localization in the right, single, hypoechoic sludge, with solid content and regular contours. The characteristics found weren’t suggestive of malignancy. Although acromegaly treatment control is unrelated to the occurrence of nodules, it is extremely important to follow up these possible modifications to improve the life expectancy of these patients and the early detection of potentially malignant lesions.
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    Prevalência de câncer em pacientes acromegálicos atendidos no Centro de Especialidades Médicas do CESUPA
    (Centro Universitário do Estado do Pará, 2020) Diniz, Beatriz Abdelnor Hanna Piqueira; Abreu, Joyce Cangussu de; Caldato, Milena Coelho Fernandes; Bastos, Fabíola de Arruda; http://lattes.cnpq.br/9386935778704228; http://lattes.cnpq.br/9477878606835309
    Introduction: Acromegaly is a rare, debilitating, slow-progressing and chronic endocrinopathy, resulting from pathological growth hormone (GH) hypersecretion and subsequent levels of insulin-like growth factor-1 (IGF-1). a moderate risk of cancer in acromegalic patients with uncontrolled disease and a greater association of acromegaly with colorectal, thyroid and, to a lesser extent, breast, kidney, prostate, bone cancer. As a result, an important current debate questions whether patients with acromegaly should undergo specific cancer screening and surveillance protocols. Objectives: To identify the prevalence of cancer in acromegalic patients treated at the Cesupa Medical Specialties Center. Methodology: This is an epidemiological, crosssectional and retrospective study, based on exploratory analysis of the medical records of the Endocrinology Service of the Cesupa Medical Specialties Center (CEMEC) - Belém/PA from October 2019 to October 2020.Results: The prevalence of cancer among acromegalic patients treated at CEMEC is 18.18%, 8 cases out of 44 patients.The proportion of men and women affected is the same (50%). It was evidenced that the patients have an average age equal to 68 years, with a variation of ± 13 years (σ = 12.79), with a minimum age of 46 years and a maximum age of 88 years. Patients had 6 different types of Ca, the most prevalent is Colon Cancer seen in 3 patients (38%), followed by 1 case of the other types of cancer: breast, prostate, lymphoma, thyroid and gastric. It was seen that the main comorbidity is high blood pressure (5; 75%), 1 (13%) patient has metastasized, 1 (13%) patient has a family history of Ca and 3 (38%) patients have a smoking history. Moreover, of the 4 patients (50%) who died, 3 were due to cancer. In the first evaluation, patients presented mean GH equal to 6.2, increasing to 8.7 in the final evaluation. Considering the number of patients who presented compensated IGN-1 LSN levels at the beginning and at the end of the segment performed at CEMEC, a 25% increase in the number of patients who started to have controlled serum levels of this hormone was observed. At Cemec, a proprietary screening protocol that includes colonoscopy and ultrasound of the thyroid for all patients diagnosed with Acromegaly.Conclusion: According to the clinical and epidemiological profile of these patients, most were decompensated at the beginning of the follow-up at the service, and after they started multimodal therapies including surgery, medications and radiotherapy when necessary.In the last record, most patients were compensated, showing the conduction of appropriate treatment within the clinic.It is agreed that the screening tests adopted at this service , one of the bare of paramount importance in the group, considering that colon and thyroid cancer are the most prevalent in acromegalic patients today, as well as having a greater scientific basis to justify such screening.This work is of great value for a more global clinical analysis of a complication of high morbidity and mortality among acromegalics, the cancer, inside one of the main reference centers of treatment for acromegaly in the North-Northeast Brazil.
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    Utilização da ferramenta AcroQoL na avaliação da qualidade de vida de pacientes acromegálicos acompanhados no Centro de Especialidades Médicas do Cesupa – CEMEC
    (Centro Universitário do Estado do Pará, 2022-11-07) Santos, Felipe Augusto Casseb dos; Bernardo, Paulo André Vieira de Carvalho; Caldato, Milena Coelho Fernandes; Bastos, Fabíola de Arruda; http://lattes.cnpq.br/9386935778704228; http://lattes.cnpq.br/9477878606835309; Rocha, Vanessa Campos Couto da; http://lattes.cnpq.br/1897095774561517; Carvalho, Ana Emília Vita; http://lattes.cnpq.br/1981562999898097
    Acromegaly is a rare chronic disease often caused by a GH-secreting pituitary tumor, and is associated with enlarged extremities, multiple organ dysfunction, physical limitations, decreased daily productivity, social isolation, and worsening quality of life. To evaluate the health-related quality of life in patients with acromegaly in a specialized outpatient clinic in the Amazon from January 2021 to August 2022. This is an observational and cross-sectional study with quantitative analysis, carried out at the Hypophysis and Adrenal Outpatient Clinic of the Centro de Especialidades Médicas do Centro Universitário do Estado do Pará (CEMEC - CESUPA), using the AcroQoL health-related quality of life questionnaire. Sociodemographic, clinical, and therapeutic data were correlated with the scores obtained, using specific statistical tests executed in Bioestat 5.5 software. Data were organized in Microsoft Excel 2010 software. Graphs and tables were constructed with the tools available in the Microsoft Word, Excel and GraphPad Prism 8.4.2 programs. Results with p ≤ 0.05 (two-sided) were considered statistically significant. Most of the patients in the sample were female with age ranging from 24 to 74 years. Most patients had pituitary macroadenomas and metabolic complications. Higher AcroQoL scores were observed in patients who were regular practitioners of physical activities; furthermore, there was no relationship between biochemical control of the disease and AcroQoL scores. Conclusion: In the present study, it was possible to realize the importance of using tools such as the AcroQoL to analyze health-related factors and their impacts on the quality of life of acromegalic patients. The findings of the study show the importance of stimulating the practice of physical activities and the adoption of healthy life habits. Evidencing the need for a multidisciplinary approach to achieve not only biochemical control but also an improvement in health-related quality of life.