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Made available in DSpace on 2020-12-12T02:23:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-04-01 Objective: To evaluate the maternal–fetal outcomes of CAB-induced pregnancies in patients with prolactinoma in a large cohort. Methods: The prevalence of tumor growth, miscarriage, preterm, low birth weight, congenital malformations and impairment in neuropsychological development in children among women treated with CAB were assessed in a Brazilian multicentre retrospective observational study, Results: We included 194 women with a mean age of 31 (17–45) years, 43.6% presenting microadenomas and 56.4% macroadenomas, at prolactinoma diagnosis. In 233 pregnancies, CAB was withdrawn in 89%, after pregnancy confirmation. Symptoms related to tumor growth occurred in 25 cases, more frequently in macroadenomas. The overall miscarriage rate was 11%, although higher in the subgroup of patients with CAB maintainance after pregnancy confirmation (38% vs. 7.5%). Amongst the live-birth deliveries, preterm occurred in 12%, low birth weight in 6% and congenital malformations in 4.3%. Neuropsychological development impairment was reported in 7% of cases. Conclusions: Our findings confirm previous results of safety in maternal and fetal outcomes in CAB-induced pregnancies; nevertheless, CAB maintenance after pregnancy confirmation was associated with higher miscarriage rate; result that must be further confirmed. Division of Endocrinology and Metabolism Hospital das Clinicas Neuroendocrine Unit University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, no 155, 8° andar, bloco 3 (Endocrinologia) Division of Neurosurgery Institute of Psychiatry University of Sao Paulo Medical School Federal University of Rio de Janeiro University of Sao Paulo Medical School of Ribeirao Preto Federal University of Pernambuco Federal University of Ceara Escola Paulista de Medicina Universidade Federal de São Paulo State University of Campinas Endocrine Division (SEMPR) Department of Internal Medicine Federal University of Parana Irmandade da Santa Casa de Misericórdia de São Paulo Division of Endocrinology Hospital de Clinicas de Porto Alegre (UFRGS) Institute of Medical Assistance to the State Public Hospital São Paulo State University (UNESP) Medical School Federal University of Minas Gerais Disciplina de Obstetrícia Departamento de Obstetrícia e Ginecologia Faculdade de Medicina (FMUSP) Universidade de São Paulo São Paulo State University (UNESP) Medical School

Acromegaly is a rare and underdiagnosed disorder caused, in more than 95% of cases, by a growth hormone (GH)-secreting pituitary adenoma. The GH hypersecretion leads to overproduction of insulin-like growth factor 1 (IGF-1) which results in a multisystem disease characterized by somatic overgrowth, multiple comorbidities, physical disfigurement, and increased mortality. This article aims to review the clinical features of acromegaly at diagnosis. Acromegaly affects both males and females equally and the average age at diagnosis ranges from 40 to 50 years (up to 5% of cases

An appropriate diagnostic evaluation is essential for the most appropriate treatment to be performed. Currently, macroprolactinemia is the third most frequent cause of nonphysiological hyperprolactinemia after drugs and prolactinomas. Up to 40% of macroprolactinemic patients may present with hypogonadism symptoms, infertility, and/or galactorrhea. Thus, the screening for macroprolactin is indicated not only for asymptomatic subjects but also for those without an obvious cause for their prolactin (PRL) elevation. Before submitting patients to macroprolactin screening and pituitary magnetic resonance imaging, one should rule out pregnancy, drug-induced hyperprolactinemia, primary hypothyroidism, and renal failure. The magnitude of PRL elevation can be useful in determining the etiology of hyperprolactinemia. PRL values >250 ng/mL are highly suggestive of prolactinomas and virtually exclude nonfunctioning pituitary adenomas (NFPAs) and other sellar masses as the etiology of hyperprolactinemia. However, they can also be found in subjects with macroprolactinemia, drug-induced hyper­prolactinemia or chronic renal failure. By contrast, most patients with NFPAs, drug-induced hyperprolactinemia, macroprolactinemia, or systemic diseases present with PRL levels

La diabetes mellitus es un problema de salud publica en constante ascenso en la mayor parte del mundo. Latino-America (LA) presenta una prevalencia elevada de diabetes mellitus tipo 2 (DM2), en la poblacion mayor de 20 anos y fluctua entre 8 y 10%. Esta prevalencia se ha incrementado acorde con el patron epidemiologico mundial; sin embargo, es particularmente elevada en LA por las caracteristicas geneticas de la poblacion, habitos de alimentacion inadecuados y sedentarismo que, vinculados con el sindrome metabolico, han encontrado un ambiente favorable para su expresion con nuestro estilo de vida actual. La DM2 es una enfermedad cronica, degenerativa, progresiva pero controlable. En la actualidad se conocen algunos mecanismos fisiopatologicos que se manifiestan en diferentes etapas de su historia natural. Dentro de este marco de referencia se desprende que la gran mayoria de los casos de DM2 se presentan en individuos que, durante un periodo variable de anos, posiblemente decadas, han cursado con alteraciones metabolicas que preceden y acompanan al estado de hiperglucemia persistente. En LA, la DM2 tiene un gran impacto en la economia del sistema de salud. Los pacientes con DM2 tienen hospitalizaciones mas prolongadas y es la segunda causa de mortalidad en pacientes hospitalizados

Latin America faces unique challenges in the treatment of type 2 diabetes mellitus. The Asociación Latinoamericana de Diabetes (Latin American Diabetes Association, ALAD) brought together medical associations in 17 countries in Latin America to produce a consensus statement regarding the treatment of type 2 diabetes. The goal of the document is to provide practical recommendations that will guide clinicians through a simple decision-making process for managing patients. The cornerstone elements for therapeutic decision making are: severity of hyperglycemia, clinical condition of the patient (stable or with metabolic decompensation), and body mass index. The consensus includes a section devoted specifically to patients with obesity. Information is presented as highly-relevant clinical questions. The algorithm is based on the scientific recommendations of the 2006 ALAD guidelines (a document prepared using an evidence-based approach) and data from recent randomized controlled studiesAmérica Latina se enfrenta a algunos retos excepcionales en el tratamiento de la diabetes mellitus tipo 2. La Asociación Latinoamericana de Diabetes (ALAD) reunió a las asociaciones médicas de 17 países latinoamericanos con el fin de producir una declaración de consenso sobre el tratamiento de la diabetes tipo 2. El objetivo de ese documento es brindar recomendaciones prácticas que guíen a los médicos a lo largo de un sencillo proceso decisorio para el tratamiento de los pacientes. Los elementos fundamentales para la toma de decisiones terapéuticas son la gravedad de la hiperglucemia, el estado clínico del paciente (estable o con descompensación metabólica) y el índice de masa corporal. El documento contiene un apartado dedicado específicamente a los pacientes obesos y la información se presenta en forma de preguntas clínicas sumamente pertinentes. El algoritmo se basa en las recomendaciones científicas de las directrices de la ALAD del año 2006 (documento preparado con un método basado en datos probatorios) y en datos obtenidos de estudios controlados aleatorizados recientes

The association of polymorphisms affecting lipid metabolism with the risk of myocardial infarction (MI) in type 2 diabetes mellitus was investigated. The Genetics, Outcomes and Lipids in type 2 Diabetes (GOLD) Study is a prospective, multicenter study, conducted on 990 patients presenting diabetes and MI (n = 386), or diabetes without previous manifestation of stroke, peripheral or coronary arterial disease (n = 604), recruited from 27 institutions in Brazil. APO A1 (A/G −75 and C/T +83) and APO C3 (C/G 3’UTR) non-coding sequences, CETP (Taq 1B), LPL (D9N), APO E (ɛ2, ɛ3, ɛ4,), PON-1 (Q192R), and two LCAT variants Arg147 → Trp and Tyr171 → Stop were tested by PCR-RFLP. There was a higher prevalence of LPL DN genotype (19% vs.12%, p = 0.03) and a higher frequency of the N allele (11% vs. 7%) among subjects with MI when compared to controls, with an odds ratio of MI for carriers of 9N allele of 2.46 (95% CI = 1.79–3.39, p

Cushing's syndrome (CS) during pregnancy is a rare condition with fewer than 150 cases reported in the literature. Adrenal adenomas were found to be the commonest cause, followed by Cushing's disease. The gestation dramatically affects the maternal hypothalamic-pituitary-adrenal axis, resulting in increased hepatic production of corticosteroid-binding globulin (CBG), increased levels of serum, salivary and urinary free cortisol, lack of suppression of cortisol levels after dexamethasone administration and placental production of CRH and ACTH. Moreover, a blunted response of ACTH and cortisol to exogenous CRH may also occur. Therefore, the diagnosis of CS during pregnancy is much more difficult. Misdiagnosis of CS is also common, as the syndrome may be easily confused with preeclampsia or gestational diabetes. Because CS during pregnancy is usually associated with severe maternal and fetal complications, its early diagnosis and treatment are critical. Surgery is the treatment of choice for CS in pregnancy, except perhaps in the late third trimester, with medical therapy being a second choice. There does not seem to be a rationale for supportive treatment alone.

Diabetes mellitus do tipo 2 (DM2) é uma doença metabólica complexa, multifatorial e de presença global, que afeta a qualidade e o estilo de vida dos acometidos, podendo levar a uma redução pronunciada na expectativa de vida dessa população. Portadores de diabetes podem ter uma redução de 15 ou mais anos de vida, com a grande maioria morrendo em decorrência das complicações cardiovasculares. Faz-se necessário o estabelecimento de estratégias efetivas para a redução do impacto do DM2 para os próximos anos. Para isso, urge a necessidade de maior atenção no tocante às estratégias de prevenção, sobretudo para as populações de maior risco de desenvolvimento da doença. Nesse contexto, os portadores de tolerância diminuída à glicose (TDG) e glicemia de jejum alterada (GJA) devem, cada vez mais, ser alvos de estratégias de intervenção na busca de minimização de risco para o diabetes, devendo para isso terem direcionamento para a efetivação de mudanças comportamentais (fatores dietoterápicos e prática de atividade física) e, quando necessário e aprovado, o uso de agentes farmacológicos. Estudos conduzidos pelo mundo têm confirmado a eficácia do uso de estratégias comportamentais e mesmo do uso de agentes farmacológicos para a prevenção de DM2.

INTRODUÇÃO: O diabetes melito (DM) constitui problema de saúde pública no Brasil. Este estudo teve por objetivo investigar a prevalência de DM, sua relação com características sociodemográficas e outros fatores de risco cardiovascular em uma população adulta do sertão de Pernambuco/Brasil. SUJEITOS E MÉTODOS: Foi conduzido em 2008/2009 estudo transversal na população adulta e urbana do Distrito de Canaã, município de Triunfo, sertão de Pernambuco/Brasil. Amostra representativa constituída por 198 indivíduos com idade média de 57,7 anos foi aleatoriamente selecionada, em que 80,0% tinham apenas o ensino fundamental, e 81,3% tinham renda mensal inferior a um salário-mínimo. RESULTADOS: Foi encontrada prevalência de 13,6% de DM e de 7,6% de disglicemia (6,6% de glicemia de jejum alterada e 1,0% de tolerância diminuída à glicose). Dos diabéticos, 24,0% não tinham diagnóstico. Nos diabéticos, 87,5% apresentavam síndrome metabólica (SM) e 68,0% eram hipertensos. Houve associação positiva e significativa entre DM e IMC e entre DM e SM. CONCLUSÃO: Foi encontrada elevada prevalência de DM nessa população adulta urbana do sertão nordestino. Esses resultados assim como a sua associação com obesidade e síndrome metabólica indicam a necessidade de ações mais efetivas na prevenção dessas enfermidades. BACKGROUND: Diabetes mellitus (DM) is a public health problem in Brazil. The objective of this study was to investigate the prevalence of DM and its relation with socio-demographic features and other cardiovascular risk factors in a adult population from the wilderness of Pernambuco, Brazil. SUBJECTS AND METHODS: In 2008/2009 a cross-sectional study in the adult urban population of Canãa district, city of Triunfo, in the wilderness of Pernambuco/Brazil was conducted. A representative sample of 198 individuals, with average age of 57.7 years, 80% with primary education and 81.3% with a monthly income of less than 1 minimum wage was randomly selected. RESULTS: A prevalence of diabetes of 13.6% and 7.6% of disglycemia (6.6% of impaired fasting glycemia, and 1.0% of impaired glucose tolerance) was found. Among those with diabetes, 24% had no prior diagnosis. Among diabetics, metabolic syndrome (MS) and arterial hypertension (AH) were diagnosed in 87.5% and 68%, respectively. Besides these, there was a positive and significant association between DM and BMI, and between DM and MS. CONCLUSION: These data demonstrate a high prevalence of DM in the adult urban population from the wilderness of Pernambuco/Brazil. These results as well as their association with obesity and MS, indicate that more effective interventions are necessary for the prevention of these diseases also outside principal urban centers.

Latin America faces unique challenges in the treatment of type 2 diabetes mellitus. The Asociación Latinoamericana de Diabetes (Latin American Diabetes Association, ALAD) brought together medical associations in 17 countries in Latin America to produce a consensus statement regarding the treatment of type 2 diabetes. The goal of the document is to provide practical recommendations that will guide clinicians through a simple decision-making process for managing patients. The cornerstone elements for therapeutic decision making are: severity of hyperglycemia, clinical condition of the patient (stable or with metabolic decompensation), and body mass index. The consensus includes a section devoted specifically to patients with obesity. Information is presented as highly-relevant clinical questions. The algorithm is based on the scientific recommendations of the 2006 ALAD guidelines (a document prepared using an evidence-based approach) and data from recent randomized controlled studies.

Diabetes mellitus (DM) is a public health problem in Brazil. The objective of this study was to investigate the prevalence of DM and its relation with socio-demographic features and other cardiovascular risk factors in a adult population from the wilderness of Pernambuco, Brazil.In 2008/2009 a cross-sectional study in the adult urban population of Canãa district, city of Triunfo, in the wilderness of Pernambuco/Brazil was conducted. A representative sample of 198 individuals, with average age of 57.7 years, 80% with primary education and 81.3% with a monthly income of less than 1 minimum wage was randomly selected.A prevalence of diabetes of 13.6% and 7.6% of disglycemia (6.6% of impaired fasting glycemia, and 1.0% of impaired glucose tolerance) was found. Among those with diabetes, 24% had no prior diagnosis. Among diabetics, metabolic syndrome (MS) and arterial hypertension (AH) were diagnosed in 87.5% and 68%, respectively. Besides these, there was a positive and significant association between DM and BMI, and between DM and MS.These data demonstrate a high prevalence of DM in the adult urban population from the wilderness of Pernambuco/Brazil. These results as well as their association with obesity and MS, indicate that more effective interventions are necessary for the prevention of these diseases also outside principal urban centers.

Universidade Federal de São Paulo (UNIFESP) Hospital do Rim e Hipertensão Centro Integrado de Hipertensão e Metabologia Cardiovascular Sociedade Brasileira de Diabete/Medicina Laboratorial Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Fundação do ABC Faculdade de Medicina Federação Nacional das Associações e Entidades de Diabetes Associação Nacional de Assitência ao Diabético Universidade de Campinas Faculdade de Ciências Médicas Departamento de Clínica Médica Sociedade Brasileira de Endocrinologia e Metabologia Departamento de Diabetes Universidade Estadual do Rio de Janeiro Santa Casa de São Paulo Faculdade de Ciências Médicas Departamento de Ciências Fisiológicas Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial World Association of Societies of Pathology and Laboratory Medicine Associação Paulista de Medicina Total Laboratórios Universidade de São Paulo Faculdade de Medicina FMUSP Hospital das Clínicas Divisão de Laboratório Central Clínica do Fleury - Medicina e Saúde Universidade de Pernambuco Faculdade de Ciências Médicas SBEM Faculdade de Ciências Médicas de Minas Gerais SBD UNIFESP, Hospital do Rim e Hipertensão Centro Integrado de Hipertensão e Metabologia Cardiovascular UNIFESP, EPM SciELO

The association of polymorphisms affecting lipid metabolism with the risk of myocardial infarction (MI) in type 2 diabetes mellitus was investigated. The Genetics, Outcomes and Lipids in type 2 Diabetes (GOLD) Study is a prospective, multicenter study, conducted on 990 patients presenting diabetes and MI (n=386), or diabetes without previous manifestation of stroke, peripheral or coronary arterial disease (n=604), recruited from 27 institutions in Brazil. APO A1 (A/G -75 and C/T +83) and APO C3 (C/G 3'UTR) non-coding sequences, CETP (Taq 1B), LPL (D9N), APO E (epsilon2, epsilon3, epsilon4,), PON-1 (Q192R), and two LCAT variants Arg(147)--Trp and Tyr(171)--Stop were tested by PCR-RFLP. There was a higher prevalence of LPL DN genotype (19% vs.12%, p=0.03) and a higher frequency of the N allele (11% vs. 7%) among subjects with MI when compared to controls, with an odds ratio of MI for carriers of 9N allele of 2.46 (95% CI=1.79-3.39, p0.0001). This association was present in men and women, in non-smokers and in hypertensive patients. A logistic regression model including gender, duration of diabetes, systolic blood pressure, HDL-C, left ventricle hypertrophy and D9N polymorphism showed that the latter still remained significantly associated with MI (OR=1.50, 95% CI=1.02-2.25, p=0.049). These findings suggest that D9N polymorphism can be a useful risk marker for myocardial infarction and that further potential candidate genes should be screened for exploratory analysis and for future therapeutic intervention in diabetes.

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) OBJETIVO: Discutir os aspectos atuais do tratamento com os antipsicóticos, levando-se em consideração o perfil de efeitos metabólicos, tais como ganho de peso, diabetes, dislipidemias e síndrome metabólica. Tais fatores aumentam o risco de doença cardiovascular, que é a principal causa de morte nos portadores de esquizofrenia. MÉTODO: Foi realizada uma reunião de consenso com psiquiatras especialistas em esquizofrenia e endocrinologistas, os quais, com base nas evidências provenientes de ampla revisão da literatura, elaboraram um documento com recomendações que auxiliam a prática clínica. RESULTADOS E CONCLUSÕES: A avaliação periódica dos efeitos adversos metabólicos em pacientes que fazem uso de antipsicóticos é fundamental para a prática clínica, especialmente nos caso de antipsicóticos de segunda geração. O equilíbrio entre eficácia e tolerabilidade deve ser cuidadosamente considerado em todas as etapas do tratamento. OBJECTIVE: To discuss current aspects of use of antipsychotics considering their metabolic side effects profile, which includes weight gain, dyslipidemias, diabetes and metabolic syndrome. Such metabolic effects increase the risk of mortality by cardiovascular disease, which is the leading cause of death among schizophrenic patients. METHOD: A consensus meeting was held, with participation of endocrinologists and psychiatrists specialists in schizophrenia and, based on a literature review, an article was elaborated emphasizing practical and helpful recommendations to clinicians. RESULTS AND CONCLUSIONS: Monitoring metabolic side effects is essential to patients taking antipsychotics, particularly in the case of second generation antipsychotics. Efficacy and tolerability should be carefully balanced in all phases of treatment. Universidade de São Paulo Instituto de Psiquiatria Hospital de Clínicas de Porto Alegre Serviço de Psiquiatria Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica Sociedade Brasileira de Diabetes Universidade Federal de São Paulo (UNIFESP) Sociedade Brasileira de Endocrinologia e Metabologia Universidade Federal de São Paulo, EPM, São Paulo, Brazil SciELO

To discuss current aspects of use of antipsychotics considering their metabolic side effects profile, which includes weight gain, dyslipidemias, diabetes and metabolic syndrome. Such metabolic effects increase the risk of mortality by cardiovascular disease, which is the leading cause of death among schizophrenic patients.A consensus meeting was held, with participation of endocrinologists and psychiatrists specialists in schizophrenia and, based on a literature review, an article was elaborated emphasizing practical and helpful recommendations to clinicians.Monitoring metabolic side effects is essential to patients taking antipsychotics, particularly in the case of second generation antipsychotics. Efficacy and tolerability should be carefully balanced in all phases of treatment.

Avaliamos as características clínico-laboratoriais de 73 pacientes com síndrome de Cushing (SC) endógena, assim distribuídos: 46 (63%) com doença de Cushing (DC), 21 (28,7%) com tumores adrenais (TA) e 6 (8,2%) com a síndrome do ACTH ectópico (SAE). A freqüência de manifestações clássicas do hipercortisolismo foi similar, independentemente da etiologia da SC. Em 100% dos casos de SC, observaram-se níveis do cortisol sérico (CS) > 1,8 µg/dL após supressão com doses baixas de dexametasona (DMS), além de elevação do cortisol à meia-noite (sérico ou salivar). Contudo, o cortisol livre urinário foi normal em 11,5% dos pacientes. Os níveis de ACTH mostraram-se suprimidos nos pacientes com TA, normais ou elevados na DC e sempre elevados na SAE. No teste de supressão noturna com 8 mg de DMS, supressão do CS > 50% foi observada em 78,2% dos casos de DC e 33,3% dos casos de SAE, enquanto uma supressão > 80% foi exclusiva da DC. Após estímulo com CRH ou DDAVP, um incremento do ACTH > 35% aconteceu em 81% dos indivíduos com DC e em 16,6% daqueles com SAE, ao passo que um incremento do ACTH > 50% restringiu-se à DC. A combinação de incremento do ACTH > 35 e supressão do CS > 50% foi também exclusiva da DC. A ressonância magnética visualizou 100% dos macroadenomas e 59,4% dos microadenomas hipofisários nos casos de DC. Em 10 pacientes submetidos ao cateterismo bilateral do seio petroso inferior, um gradiente centro-periferia de ACTH > 3 pós-CRH ou DDAVP teve sensibilidade de 90% e especificidade de 100% para a doença de Cushing.

We studied clinical and laboratorial features of 73 patients with endogenous Cushing's syndrome, subdivided as follows: 46 (63%) with Cushing's disease (CD), 21 (28.7%) with an adrenal tumor and 6 (8.2%) with ectopic ACTH secretion (EAS). The rate of typical manifestations of hypercortisolism was similar regardless its etiology. In 100% of cases of Cushing's syndrome we observed serum cortisol levels greater than 1.8 microg/dL in low-dose dexamethasone (DMS) suppression tests, as well as elevation of serum or salivary midnight cortisol. However, urinary free cortisol was normal in 11.5% of patients. ACTH levels were suppressed in patients with adrenal tumors, normal or high in CD and always high in EAS. In the 8-mg overnight DMS suppression test, serum cortisol suppression50% was observed in 78.2% of cases of CD and in 33.3% of subjects with EAS, while an 80% suppression was only seen in CD. After stimulation with CRH or DDAVP an ACTH increase35% occurred in 81% of individuals with CD and 16.6% of those with EAS, while an ACTH increase50 achieved 100% specificity. Moreover, the combination of serum cortisol suppression50% and an ACTH increase35% in both tests only occurred in Cushing's disease. Pituitary magnetic resonance imaging identified 100% of macroadenomas and 59.4% of microadenomas in patients with CD. Among 10 patients that underwent bilateral inferior petrosal sinus sampling, a central-to-peripheral ACTH gradient3 after CRH or DDAVP had 90% sensitivity and 100% specificity for Cushing's disease.

Type 2 Diabetes mellitus (DM2) is a complex, multifactorial and worldwide metabolic disease that affects quality and lifestyle of patients. Patients with diabetes can have a 15-year or more reduction of lifetime and the high mortality is due to cardiovascular (CV) complications. Effective strategies for the reduction of the impact of DM2 on CV disorders for the next years and attention concerning to strategies of prevention, mainly for the populations with larger risk of developing the disease, are essential. In that context, impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) must suffer intervention strategies in order to minimize the risk for diabetes. Behavior modification (diet therapy and physical activity) must be stimulated, and pharmacological agents have to be used when indicated. Studies worldwide have been confirming the effectiveness of lifestyle strategies and even the use of pharmacological agents for the prevention of DM2.

This article reports the Brazilian Diabetes Society consensus statement on intensive insulin therapy and insulin pump therapy, arrived at during an update symposium held in 2003 for this specific purpose. The concepts underlying these modalities of diabetes treatment are outlined, their fundaments are given, and practical issues about their indications, feasibility, limits, techniques and cost-benefit relationships are analyzed. The techniques comprise the suggested self-monitoring schedules and the insulin doses, types, forms of administration and correction factors used in each modality of intensive treatment, for both type 1 and 2 diabetes. The roles of SBD in the implementation of these treatments and of the different professionals involved are discussed and commented. The conclusions are based on consensual answers to some orienting questions formulated during the symposium's presentation.

Este artigo relata a posição de consenso da Sociedade Brasileira de Diabetes sobre a insulinoterapia intensiva e a terapêutica com bombas de infusão de insulina, obtida durante simpósio de atualização realizado especificamente para esta finalidade, em 2003. Estas modalidades de tratamento do diabetes são aqui conceituadas, seus fundamentos são colocados, e os aspectos práticos de indicações, exeqüibilidade, limites, técnicas e relação custo-benefício são analisados. As técnicas envolvem os esquemas de auto-monitorização glicêmica sugeridos e as doses, tipos, formas de administração da insulina e fatores de cálculo utilizados em cada modalidade de tratamento intensivo, tanto no DM1 quanto no DM2. O papel da SBD na implementação dos tratamentos intensivos do diabetes e a atuação dos vários profissionais envolvidos são discutidos e comentados. Conclui-se com as respostas de consenso a questões orientadoras do tema, formuladas na apresentação do simpósio. This article reports the Brazilian Diabetes Society consensus statement on intensive insulin therapy and insulin pump therapy, arrived at during an update symposium held in 2003 for this specific purpose. The concepts underlying these modalities of diabetes treatment are outlined, their fundaments are given, and practical issues about their indications, feasibility, limits, techniques and cost-benefit relationships are analyzed. The techniques comprise the suggested self-monitoring schedules and the insulin doses, types, forms of administration and correction factors used in each modality of intensive treatment, for both type 1 and 2 diabetes. The roles of SBD in the implementation of these treatments and of the different professionals involved are discussed and commented. The conclusions are based on consensual answers to some orienting questions formulated during the symposium's presentation.

Foi estudada uma família consangüínea extensa (13 afetados, 8 mulheres e 5 homens) com uma forma variante de doença de Van Buchem ou um tipo de displasia óssea esclerosante não descrito anteriormente. O padrão de herança da doença sugerido nesta família é autossômico recessivo. As características clínicas mais importantes são baixa estatura e arqueamento dos membros inferiores, que já se faziam presentes ao nascimento. Na ocasião em que foram examinados, os indivíduos afetados vivos tinham idade variando entre 10 e 64 anos, todos apresentando redução na capacidade de deambulação, com três deles tendo perdido a capacidade de andar. Arqueamento dos membros inferiores, altos valores de fosfatase alcalina sérica e hipofosfatemia na avaliação laboratorial foram características presentes em todos os pacientes afetados estudados. O estudo radiológico destes pacientes mostrou padrão hiperostótico por todo o esqueleto, com predominância de envolvimento cortical. Esclerose do crânio, esclerose dos ossos longos, arqueamento lateral do fêmur e tíbia, bem como alargamento da mandíbula, foram achados significativos em todos os afetados radiografados.

Avaliamos o efeito da cabergolina (1 a 1,5mg duas vezes por semana, por 2 a 4 meses) em 9 pacientes acromegálicos em um estudo prospectivo, não andomizado. Normalização dos níveis de GH e IGF-1 ocorreu em 3 dos 9 pacientes avaliados (33%), em 3 dos 5 pacientes (60%) com tumores co-secretores de GH e prolactina, mas em nenhum daqueles sem hiperprolactinemia associada. As melhores respostas terapêuticas aconteceram nos pacientes cujos níveis pré-tratamento de GH e IGF-1 eram

OBJECTIVE: The objectives of this study are to estimate the prevalence of arterial hypertension (AH) in an adult population with a predominance of families with low education and income levels, in the hinterlands of Pernambuco, Brazil, and to analyze its association with other factors related to cardiovascular diseases (CVD). METHODS: A cross-sectional study in 2008/2009 was conducted with a sample of 198 subjects stratified by age, and representative of the urban adult population of the Canaã district of city of Triunfo, in the hinterlands of Pernambuco, Brazil. RESULTS: One hundred ninety eight individuals with average age of 57.7 years old (31 to 90 years-old), mainly women (65.6%), and with low income and education levels (81.3% with a monthly income of less than one minimum wage) were evaluated. Among these, 127 (64.1%) were identified as having AH, 54 (42.5%) of whom had no prior diagnosis. From those who were previously diagnosed, only 31.3% had good blood pressure control. Higher prevalence was observed in those individuals with lower incomes, higher body mass indexes (BMI), and those with metabolic syndrome (MS). CONCLUSION: These data demonstrated that there was a high prevalence of AH in the urban, low education and income levels adult population of Triunfo, strongly associated with lower income levels, elevated BMI, and the presence of MS; and a high prevalence of bad blood pressure control among the previously diagnosed cases. These results indicate that more effective interventions for early detection and adequate control of this disease and its comorbidities are necessary.