PDF | On Jan 1, , Gilberto Paz-Filho and others published Paz-Filho G, Graf H. Follow-up of differentiated thyroid cancer. In: Vilar L, ed. Endocrinologia. PDF | On Jan 1, , Hans Graf and others published Graf H, Paz-Filho G. Treatment of medullary thyroid cancer. In: Vilar L, ed. Endocrinologia Clínica. 5th Ed. 9 Serviço de Endocrinologia, Hospital. Universitário 11 Unidade de Neuroendocrinologia,. Instituto Estadual do Cérebro Lucio Vilar. Hospital das Clínicas.
|Language:||English, Spanish, Dutch|
|Genre:||Health & Fitness|
|ePub File Size:||24.49 MB|
|PDF File Size:||12.22 MB|
|Distribution:||Free* [*Regsitration Required]|
Veja grátis o arquivo Vilar Endocrinologia cl caite.info enviado para a disciplina de Medicina Categoria: Outros - 23 - Veja grátis o arquivo Vilar Endocrinologia cl caite.info enviado para a disciplina de Medicina Categoria: Outros - 28 - Endocrinologia Clínica - Vilar - 5ed. Uploaded by Download as PDF or read online from Scribd .. Clínica Vol.2 - AVE e Síndromes Neurológicas - pdf.
A comparison of cabergoline and bromocriptine on the risk of valvular heart disease in patients with prolactinomas. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly— update. Recurrence of hyperprolactinemia after selective transsphenoidal adenomectomy in women with prolactinoma. Patients who are candidates for treatment with CPAP should undergo a thorough anamnesis, especially if they have macroglossia associated with stiffness of facial tissues. Endocr Pract. Prolactinomas resistant to standard doses of cabergoline:
Presse Med. Prospective study of high-dose cabergoline treatment of prolactinomas in patients. Characterization of resistance to the prolactin-lowering effects of cabergoline in macroprolactinomas: Bromocriptine as primary therapy for prolactin-secreting macroadenomas: Macroprolactinoma shrinkage during cabergoline treatment is greater in naive patients than in patients pretreated with other dopamine agonists: Diagnosis and management of hyperprolactinemia: J Endocrinol Invest.
Genes differentially expressed in prolactinomas responsive and resistant to dopamine agonists.
Resistance to dopamine agonists in prolactinoma is correlated with reduction of dopamine D2 receptor long isoform mRNA levels. J Neurooncol. J Neuroendocrinol. MicroRNA expression profile of bromocriptine-resistant prolactinomas. Mol Cell Endocrinol. Dopamine D2 receptor gene polymorphisms and response to cabergoline therapy in patients with prolactin-secreting pituitary adenomas. Pharmacogenetics J. Long-term natural course of pituitary tumors in patients with MEN1: Clinical characteristics and therapeutic responses in patients with germ-line AIP mutations and pituitary adenomas: Olafsdottir A, Schlechte J.
Management of resistant prolactinomas. Nature Clin Pract Endocrinol Metab. Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment. The treatment of GH-secreting pituitary adenoma aims to normalize the values of the altered biochemical markers, to eliminate or control the associated tumor without damaging the pituitary function and to eliminate the signs and symptoms [ 9 ].
Currently, treatment comprises a combination of medical and surgical therapy.
Three types of drugs are available: The cure rates achieved using transsphenoidal surgery differ significantly depending on the size of the tumor and the experience of the neurosurgeon. The association between acromegaly and OSAS has been reported previously [ 15 , 16 ]. Seventy-three percent of patients with acromegaly present enlarged goiters and a high prevalence of type II diabetes [ 15 , 17 ], but the size of the thyroid and the glucose metabolism are not sufficient to explain the association between acromegaly and OSAS.
To rule out subclinical disease in patients suffering from sleep apnea, especially in those who are not overweight, an analytical hormonal profile is required. Our study raises important questions about the application of different types of oronasal or nasal face masks for CPAP treatment and the presence of progressive dental malocclusion in these patients.
To date, few studies have discussed the link between these two variables. The limited evidence available shows an association between prolonged use of the nasal mask and progressive occlusal and lateral variations in lateral and anterior sections, and suggests that the mask may also be the cause of open bite [ 22 ].
Pneumologists and sleep disorder specialists should be alert to the possibility of acromegaly in OSAS patients. Dental, oral and maxillofacial specialists should also be able to recognize specific local signs not only tongue volume that are suggestive of acromegaly.
Patients who are candidates for treatment with CPAP should undergo a thorough anamnesis, especially if they have macroglossia associated with stiffness of facial tissues. It is important to ask patients about the growth of hands, feet, nose, and the sensation of distended and globular abdomen due to generalized visceromegaly.
Patients with acromegaly may also experience growth in both prostate and colon leading to slow intestinal transit, constipation and difficulty urinating. Some studies show a higher prevalence of intestinal polyps and colon cancer [ 23 ]. In acromegaly, the trend towards mandibular growth involves protrusion and widening which, together with the macroglossia, causes the malocclusion and diastema observed.
In addition, it is usually accompanied by a hypertrophy of the laryngeal tissues that may cause alterations in the voice [ 11 ]. All these changes in the mouth, teeth, face and voice were identified in our patient. Although many patients with acromegaly are successfully operated on or treated and show improvement of their AHI, normalization is infrequent because many anatomical aspects are not reversed.
However, the favorable postsurgical evolution of this patient suggests that the OSAS could be attributed to macroglossia, subcutaneous stiffness of the submandibular area, and hypertrophy of the laryngeal tissues secondary to acromegaly. Significantly, after the removal of the pituitary adenoma and the ensuing reduction in the volume of orofacial soft tissue next to the airway, even though a second polysomnography was not performed after surgery the OSAS improved markedly and the desaturation data evolved favorably, with the result that the patient was able to abandon CPAP treatment.
Twelve months after tumor resection, the lateral cephalometric x-ray revealed a normalization of the morphology of the sella turcica. It also showed an improvement in the inclination of the maxillary incisors Fig.
These changes can probably be attributed to the reduction of the volume of the tongue and consequently to the fall in pressure exerted on the incisors. At present the patient reports far less difficulty speaking, chewing and swallowing. In summary, progressive dental malocclusion may be associated with a systemic disease, and the use of a nasal mask with premaxillary support may distort the diagnosis of acromegaly.
Only by raising awareness of acromegaly among specialists in different areas can the currently unacceptable delay in its diagnosis be reduced. A protocol that includes an oral examination and a hormone study should be applied both in patients suffering from sleep apnea and in patients with atypical progressive malocclusion associated with macroglossia. The authors thank Dr. Pilar Forcada Guiu and Dr.
None of the authors has direct or indirect affiliation with any organization with financial interest in the subject matter discussed in this manuscript.
Data sharing not applicable to this article as no datasets were generated or analysed during the current study. All the authors read and approved the final manuscript. The participant in this report signed the consent for publication of his personal data, including individual details and images, in this article. The authors declare that the patient has authorized the publication of the data included in this report; written informed consent was obtained from the patient for publication of this case report and any accompanying images.
A copy of the written consent is available for review by the Editor-in-chief of this journal. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Skip to main content Skip to sections.
Advertisement Hide. Download PDF. GH-secreting pituitary macroadenoma acromegaly associated with progressive dental malocclusion and refractory CPAP treatment. Open Access. First Online: Background A link between progressive dental malocclusion, the use of a continuous positive airway pressure mask and GH-secreting pituitary macroadenoma acromegaly has not been previously reported.
Case presentation A year-old caucasian man with no relevant medical history reported difficulty chewing food and perceived voice alteration during his annual periodontal check-up. Conclusion Progressive dental malocclusion may be associated with a systemic disease and the use of a nasal mask with premaxillary support may distort the diagnosis of acromegaly. Background In the case described here, a dental malocclusion was the starting point for the identification of an intracranial neoplasia which was concealed by the presence of obstructive sleep apnea syndrome OSAS and by the use of a nasal mask for continuous positive airway pressure CPAP treatment.
During the check-up with his periodontist, the mask was adjusted to assess the force exerted on the oral, dental and facial structures Fig. The patient associated the changes in mastication with the pressure exerted by the last nasal mask on the area of the premaxilla and the upper incisors over recent months. Open image in new window.
Exploration of the occlusion with the aid of an orthodontist revealed significant changes. An atypical left lateral and anterior open bite was observed, with major buccoversion of teeth 33, 34, 35, 36, along with a slight diastema of the lower incisors, without tooth mobility Fig. E; discussion E Extrapituitary acromegaly. N Engl J Med. Acromegaly due to secretion of growth hormone by an ectopic pancreatic islet-cell tumor.
Abuse of growth hormone by athletes. Nat Clin Pract Endocrinol Metab. Growth hormone-releasing hormone-producing tumors: Endocr Rev. Clinical characteristics and outcome of acromegaly induced by ectopic secretion of growth hormone-releasing hormone GHRH: Acromegaly due to ectopic secretion of GHRH by bronchial carcinoid in a patient with empty sella. J Endocrinol Invest. Molitch ME.
Clinical manifestations of acromegaly. Clin Endocrinol Metab. Hypothalamus and pituitary gland.
Basic and clinical endocrinology. New York: McGraw-Hill Companies, Evaluation of clinical and laboratorial features, as well as the response to the treatment, in 64 acromegalic patients. Arq Brasil Endocrinol Metab.
Prostatic hyperplasia: Glezer A, Bronstein MD. Pituitary apoplexy: Arch Endocrinol Metab. Spontaneous remission of acromegaly after pituitary apoplexy following head trauma. Growth hormone and the heart.
Clin Endocrinol Oxf.