Navegando por Assunto "Endocrinopatia"
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Item Análise da dose de levotiroxina nos diversos tipos de hipotireoidismo atendidos no ambulatório de tireoide do Centro de Especialidades Médicas do CESUPA (CEMEC)(Centro Universitário do Estado do Pará, 2019) Silva, Lucas Ivanilson Guedes Henriques; Valente, Ana Augusta Motta Oliveira; Neves, Dilma Costa de Oliveira; http://lattes.cnpq.br/7230812534416350; http://lattes.cnpq.br/0439088319200326Introduction: Hypothyroidism is an endocrinopathy with a prevalence of 0.3% to 4.6% in the population, and its treatment is hormone replacement with levothyroxine (LT4) at an initial dose of 1.6 to 1.8 mcg / kg / day, however, it is known that the type of hypothyroidism may influence the amount of LT4 to be administered to the patient. Objectives: To analyze the dose of levothyroxine (LT4) used in the various types of hypothyroidism. Material and Method: It was a cross-sectional, descriptive and quantitative study based on the data collection of medical records of patients with hypothyroidism, attended, in the period from 2015 to 2018, in the Thyroid Ambulatory of the Center of Medical Specialties of CESUPA (CEMEC). The variables analyzed were age, sex, weight, type of hypothyroidism, levothyroxine dose, TSH and free T4 value recorded at the last visit, symptoms, comorbidities and use of other medications. Results: 187 medical records of patients with hypothyroidism were analyzed, with a predominance of women (97.9%) between 21-44 years of age. The most prevalent cause of hypothyroidism was total thyroidectomy and the highest mean levothyroxine dose was in this group. Among men, the postoperative period was predominant in adult patients (2). In most patients, there was no record of cardiovascular and gastrointestinal related comorbidities that could affect LT4 dose. There was also no significant statistical difference (p = 0.5428) between the use of other drugs and the absence of comorbidities and the age groups of the patients. Disabsortive disease was the comorbidity found that altered LT-4 replacement by age range. The highest mean doses of levothyroxine were recorded in patients with total thyroidectomy hypothyroidism. No significant statistical difference was observed between the averages and medians of the levothyroxine doses and the age ranges of the patients. The medications that may change the dose of LT4 most encountered were calcium, metformin and estrogens. The most controlled patients (within the TSH target) were those with an autoimmune cause. Conclusion: No type influence of hypothyroidism was observed on the dose of levothyroxine.Item 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/9386935778704228Introduction: 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.Item Endocrinopatias em pacientes oncológicos tratados com imunobiológicos(Centro Universitário do Estado do Pará, 2021) Rodrigues, Márcia Maine Cardoso; Alves, Matheus Sousa; Caldato, Milena Coelho Fernandes; http://lattes.cnpq.br/9477878606835309Introduction: Immunotherapy consolidates immuno-oncology as an important therapeutic component in the fight against several types of cancer. They are drugs that modulate the immune system, enabling an adequate response to the disease and avoiding mechanisms of tumor evasion. Among the drugs most used in this immunotherapy, there are monoclonal antibodies that inhibit CTLA- 4 and PD-1 inhibitors. However, its own mechanisms of action predispose to imbalance in the regulation of immunological pathways, constituting an important adverse effect of this therapy, resulting in immune-mediated toxicity to organs and tissues, which manifests itself in gastrointestinal, hepatic, cutaneous and endocrine alterations, such as hypophysitis, thyroid diseases, primary adrenal insufficiency and type 1 diabetes mellitus. Objectives: To describe endocrine and metabolic abnormalities found during the use of immunotherapy to oncological diseases. Methodology: Medical records of cancer patients with more than eighteen years old in immunotherapy were selected in two oncology services in the city of Belém - Pará. Data were collected from June 2020 to March 2021, using questionnaires developed by the researchers of this study, containing the following variables aimed to identify endocrine abnormalities in this population: age; sex; diagnosis; immunobiological in use; time of treatment; frequently reported symptoms; dosage of LH, FSH, estradiol, testosterone, prolactin, TSH, free T4, ACTH, cortisol, IGF-1, GH, fasting glucose level, sodium and potassium. Results: In the two oncology services participating in this research, twenty- seven patients were using immune checkpoint inhibitors and had their medical records analyzed. However, only five medical records met the necessary inclusion criteria for this study. In this series of cases, the patients were on immunotherapy with pembrolizumab and nivolumab, for periods varying between 8 and 144 weeks. Of these, only two had clinical complaints that could be related to signs of endocrinopathies. In the analysis of laboratory tests, one patient presented changes in thyroid hormones, three patients presented changes in the gonadal axis and three patients presented changes in blood glucose. Conclusion: The clinical pattern suggestive of endocrinopathies did not appear uniformly in all exposed cases, even diverging from the pattern classically reported in previous studies. In this study, among the evaluated patients were found: glycemic alterations, thyroid dysfunction, increased levels of gonadotropins and increased estradiol. Among these, only thyroid dysfunction is commonly reported in the literature. It is essential that the clinical team responsible for the therapeutic follow-up of these patients adequately follow the recommendations for the early identification of immunomediated adverse events related to the endocrine system.Item 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/9477878606835309Introduction: 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.