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A relevância e a abordagem consistente dos temas reunidos no Guia Prático em Osteometabolismo asseguraram a publicação dessa nova edição. Preparada pelos membros do Departamento de Metabolismo Ósseo e Mineral da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) e por seus colaboradores, oferece uma visão ainda mais detalhada sobre condições enfrentadas diariamente por clínicos e especialistas, como diabetes mellitus, osteoporose, hipertireoidismo e hipoparatireoidismo. Com isso, o guia mantém a sua condição como material de consulta e referência para profissionais da Endocrinologia e áreas relacionadas.

Desenvolvido pelo Departamento de Endocrinologia Feminina, Andrologia e Transgeneridade (DEFAT) da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), este é um volume que em 31 capítulos traz desde conceitos básicos de anatomia e fisiologia até aspectos diagnósticos, éticos e terapêuticos das principais condições ligadas à incongruência de gênero, andrologia e saúde da mulher. Todo o conteúdo foi preparado por especialistas de renome nacional e internacional, partindo de seu conhecimento médico e experiência profissional para prestar uma contribuição científica apresentada em linguagem objetiva e reforçada por recursos como tabelas, gráficos, algoritmos e representações esquemáticas. Como o próprio nome sugere, trata-se de um guia prático que se propõe servir de referência marcante nas áreas por ele contempladas, abastecido de informações alicerçadas na ética e nas últimas evidências médico-científicas.

Cuidadosamente preparado em parceria com a Comissão de Endocrinologia do Esporte e Exercício da Sociedade Brasileira de Endocrinologia e Metabologia, esse é um livro que reúne os principais especialistas em fisiologia e fisiopatologia em ambas as áreas. Sucesso de vendas em sua 1ª edição, o guia ganha uma 2ª edição totalmente revista e atualizada, contemplando conteúdos inéditos sobre anabolizantes, ética médica e a inter-relação entre nutrição, atividade física e suplementação no contexto da pandemia de COVID-19. Os 30 capítulos desse novo volume mantêm não apenas a linguagem acessível e objetiva da edição de estreia, como também o propósito de servir de fonte de informações de alto nível científico para a prevenção de doenças e melhoria da qualidade de vida da população.

This study aimed to evaluate the effect of pioglitazone on brown adipose tissue function and hypothalamic gliosis in humans. Brown adipose tissue and the hypothalamus are regarded as important potential pharmacological targets to metabolic diseases, and defining the impact of current therapies on their structure and/or function could provide therapeutic advance in this field. Six patients with type 2 diabetes were treated for 24 weeks with pioglitazone 30 mg/day as an add-on therapy. Brown adipose tissue glucose uptake and volume were determined using 18F-FDG PET/CT scans; hypothalamic gliosis was determined using MRI scans; blood was collected for hormone and biochemistry measurements. All tests were performed at inclusion and six months after pioglitazone introduction. Pioglitazone treatment led to a significant 3% body mass increase. There were neither changes in cold-induced brown adipose tissue glucose uptake and volume nor changes in hypothalamic gliosis. This is a proof-of-concept study that provides clinical evidence for a lack of action of a thiazolidinedione, pioglitazone, to promote homogeneous and measurable changes in brown adipose tissue volume and also in hypothalamic gliosis after 6 months of treatment.

The prevalence of obesity has grown exponentially over the last several decades. Research has linked male obesity to changes in the gonadal axis, which can induce functional hypogonadism. Bariatric surgery provides sustained weight loss and metabolic improvement. This was a retrospective cohort study to evaluate the male gonadal axis and metabolic profiles of obese individuals during the bariatric pre- and post-operative periods while comparing them to a normal body mass index (BMI) group. Twenty-nine obese men, who underwent bariatric surgery between 2012 and 2016 at the Federal University of Santa Catarina Hospital and a control group (CG) of 29 age-matched men with normal BMI, were analyzed. Bariatric pre- and 6-month post-operative data were compared with the CG. The study group (G1) presented an average age, weight, and BMI of 42.8 ± 9.5 years, 155.2 ± 25.8 kg, and 50.6 ± 7.1 kg/m2, respectively. The pre-operative total testosterone (TT) G1 values were different from the CG (229.5 ± 96.4 versus 461.5 ± 170.8 ng/dL, p

Surgical treatment of obesity leads to weight loss and metabolic improvement, but it is unclear if the response differs between patients with and without type 2 diabetes. Retrospective cohort study comparing weight loss and metabolic outcomes between patients with and without type 2 diabetes, matched for body mass index (BMI), gender and age, 12 months after Roux-en-Y gastric bypass. Forty-eight patients with type 2 diabetes (D) and 48 without type 2 diabetes (ND) were evaluated, 87.5% female, mean age 42.2 ± 0.9 years. The mean baseline weight and BMI of the D and ND groups were, respectively, 120.3 ± 21.6 vs 123.7 ± 20.8 kg (P = .45) and 47.2 ± 7.5 vs 47.2 ± 6.9 kg/m2 (P = .70). After 12 months, there was no significant difference in weight (40.4 ± 16.9 vs 44.1 ± 12.2 kg, P = .28) and BMI (15.8 ± 6.5 vs 16.9 ± 4.5 kg/m2 , P = .26) variation between groups. The parameters that presented significant variation were (D vs ND): fasting blood glucose (41.6 ± 43.0 vs 12.7 ± 17.2 mg/dL, P

BACKGROUND/OBJECTIVES: Hypothalamic neurons play a major role in the control of body mass. Obese subjects present radiologic signs of gliosis in the hypothalamus, which may reflect the damage or loss of neurons involved in whole-body energy homeostasis. It is currently unknown if hypothalamic gliosis (1) differs between obese nondiabetic (ND) and obese diabetic subjects (T2D) or (2) is modified by extensive body mass reduction via Roux-n-Y gastric bypass (RYGB). SUBJECTS/METHODS: Fifty-five subjects (all female) including lean controls (CT; n = 13), ND (n = 28), and T2D (n = 14) completed at least one study visit. Subjects underwent anthropometrics and a multi-echo MRI sequence to measure mean bilateral T2 relaxation time in the mediobasal hypothalamus (MBH) and two reference regions (amygdala and putamen). The obese groups underwent RYGB and were re-evaluated 9 months later. Analyses were by linear mixed models. RESULTS: Analyses of T2 relaxation time at baseline showed a group by region interaction only in the MBH (P < 0.0001). T2D had longer T2 relaxation times compared to either CT or ND groups. To examine the effects of RYGB on hypothalamic gliosis a three-way (group by region by time) mixed effects model adjusted for age was executed. Group by region (P < 0.0001) and region by time (P = 0.0005) interactions were significant. There was a reduction in MBH relaxation time by RYGB, and, although the T2D group still had higher T2 relaxation time overall compared to the ND group, the T2D group had significantly lower T2 relaxation time after surgery and the ND group showed a trend. The degree of reduction in MBH T2 relaxation time by RYGB was unrelated to clinical outcomes. CONCLUSION: T2 relaxation times, a marker of hypothalamic gliosis, are higher in obese women with T2D and are reduced by RYGB-induced weight loss.

Objective Diabetes mellitus is associated with significant morbidity and mortality, and education is known to play a key role in managing this disease. This study addresses the effects of a structured education program (SEP) on self-care in subjects with type 1 diabetes mellitus (T1DM). The aim was to evaluate the effect of a SEP on glycemic control, knowledge, and skills associated with diabetes care in subjects with T1DM. Subjects and methods A total of 47 adults with T1DM were followed up for 20 months (32 participated in the SEP and 15 served as a control group). The SEP consisted of workshops, individualized care, 24-hour distant support, and a questionnaire assessing knowledge of diabetes care. Glycosylated hemoglobin (HbA1c) levels were measured before and after the SEP implementation. Results Compared with pre-SEP levels, the mean HbA1c levels decreased by approximately 20% (21 mmol/mol) at 1 year, with a further 11% reduction (10 mmol/mol) observed 8 months later (p < 0.001). Knowledge about diabetes care increased by 37% between the pre-SEP and post-SEP questionnaires (p < 0.005). Conclusion Relevant improvements occurred after SEP activities. The sustained decrease in HbA1c levels and the overall increase in knowledge and confidence regarding diabetes care reinforce the importance, necessity, and positive outcomes of a SEP intervention in T1DM.

A previously healthy 24 yo male presented with a two-month history of epigastric pain, nausea, vomiting, fatigue and malaise. He reported abuse of different substances, including an injectable veterinary vitamin compound, which contains high doses of vitamin A, D and E, and an oily vehicle that induces local edema and enhances muscle volume. Serum creatinine was 3.1 mg/dL, alanine transaminase 160 mg/dL, aspartate transaminase 11 mg/dL, total testosterone 23 ng/dL, 25-OH-vitamin D >150 ng/mL (toxicity >100), 1,25-OH-vitamin D 80 pg/mL, vitamin A 0.7 mg/dL, parathormone

A obesidade, definida como o acúmulo excessivo ou anormal de gordura que pode causar dano à saúde do indivíduo, é considerada atualmente um dos principais problemas de saúde pública. Resulta de um desequilíbrio entre a ingestão alimentar e o gasto corporal de energia. O controle do balanço energético de animais e seres humanos é realizado pelo sistema nervoso central (SNC) por meio de conexões neuroendócrinas, em que hormônios periféricos circulantes, como a leptina e a insulina, sinalizam neurônios especializados do hipotálamo sobre os estoques de gordura do organismo e induzem respostas apropriadas para a manutenção da estabilidade desses estoques. A maioria dos casos de obesidade se associa a um quadro de resistência central à ação da leptina e da insulina. Em animais de experimentação, a dieta hiperlipídica é capaz de induzir um processo inflamatório no hipotálamo, que interfere com as vias intracelulares de sinalização por esses hormônios, resultando em hiperfagia, diminuição do gasto de energia e, por fim, obesidade. Evidências recentes obtidas por intermédio de estudos de neuroimagem e avaliação de marcadores inflamatórios no líquido cefalorraquidiano de indivíduos obesos sugerem que alterações semelhantes podem estar presentes também em seres humanos. Nesta revisão, apresentamos sumariamente os mecanismos envolvidos com a perda do controle homeostático do balanço energético em modelos animais de obesidade e as evidências atuais de disfunção hipotalâmica em humanos obesos. Obesity, defined as abnormal or excessive fat accumulation that may impair life quality, is one of the major public health problems worldwide. It results from an imbalance between food intake and energy expenditure. The control of energy balance in animals and humans is performed by the central nervous system (CNS) by means of neuroendocrine connections, in which circulating peripheral hormones, such as leptin and insulin, provide signals to specialized neurons of the hypothalamus reflecting body fat stores, and induce appropriate responses to maintain the stability of these stores. The majority of obesity cases are associated with central resistance to both leptin and insulin actions. In experimental animals, high-fat diets can induce an inflammatory process in the hypothalamus, which impairs leptin and insulin intracellular signaling pathways, and results in hyperphagia, decreased energy expenditure and, ultimately, obesity. Recent evidence obtained from neuroimaging studies and assessment of inflammatory markers in the cerebrospinal fluid of obese subjects suggests that similar alterations may be also present in humans. In this review, we briefly present the mechanisms involved with the loss of homeostatic control of energy balance in animal models of obesity, and the current evidence of hypothalamic dysfunction in obese humans.

Introducao : A obesidade e uma das doencas mais prevalentes da atualidade, carregando consigo comorbidades e complicacoes importantes. O bypass gastrico em Y de Roux (GYR) e o tratamento cirurgico para obesidade mais realizado em nivel mundial. O presente estudo visa avaliar o peso e o perfil metabolico pre e pos-operatorio de pacientes que realizaram GYR no Hospital Universitario da Universidade Federal de Santa Catarina (HU-UFSC). Metodos: Trata-se de um estudo de coorte retrospectiva, com pacientes submetidos a GYR no ano de 2012 no HU-UFSC. Foram avaliados os dados antropometricos e o perfil metabolico no pre-operatorio e em tres momentos distintos no primeiro ano de pos-operatorio. Resultados: Foram incluidos 58 pacientes, a maioria mulheres (87%), com media de peso de 122,15 ± 17,26 kg e IMC de 47,14 ± 5,90 kg/m 2 . Quinze pacientes (25,8%) apresentavam diabetes. O peso e IMC ao final do acompanhamento foram de 78,05 ± 13,53 kg e 30,39 ± 4,58 kg/m 2 , respectivamente, sendo o percentual de perda de peso de 35,96 ± 7,20%. Houve diminuicao significativa da glicemia de jejum (111,29 ± 32,92 vs. 88,12 ± 11,92 mg/dL) e melhora do perfil lipidico. Entre os pacientes diabeticos, observou-se queda na HbA1c (7,60 ± 1,42 vs. 5,81 ± 0,67%), e o percentual de pacientes que apresentavam HbA1c menor que 6,5% passou de 57,1 para 91,3%. Conclusao: Os resultados do estudo demonstram que o GYR em nosso meio resultou em significativa perda de peso e melhora do perfil metabolico, tanto em pacientes diabeticos quanto em nao diabeticos.

Obesity, defined as abnormal or excessive fat accumulation that may impair life quality, is one of the major public health problems worldwide. It results from an imbalance between food intake and energy expenditure. The control of energy balance in animals and humans is performed by the central nervous system (CNS) by means of neuroendocrine connections, in which circulating peripheral hormones, such as leptin and insulin, provide signals to specialized neurons of the hypothalamus reflecting body fat stores, and induce appropriate responses to maintain the stability of these stores. The majority of obesity cases are associated with central resistance to both leptin and insulin actions. In experimental animals, high-fat diets can induce an inflammatory process in the hypothalamus, which impairs leptin and insulin intracellular signaling pathways, and results in hyperphagia, decreased energy expenditure and, ultimately, obesity. Recent evidence obtained from neuroimaging studies and assessment of inflammatory markers in the cerebrospinal fluid of obese subjects suggests that similar alterations may be also present in humans. In this review, we briefly present the mechanisms involved with the loss of homeostatic control of energy balance in animal models of obesity, and the current evidence of hypothalamic dysfunction in obese humans.

Background According to the IDF the number of cases worldwide reached 387 million in 2014, while Brazil occupies the 4th place in the overall ranking with over 13 million cases. These data refer to both Type 2 Diabetes (T2D) and T1D. Although T1D affects the minority of patients, it is responsible for many of the serious complications. T1D, usually diagnosed in youth, requires continuous treatment and control that demand care such as diet, medication and lifestyle changes. This project addresses the importance of a Structured Education Program (SEP) for self-care of individuals with Type 1 Diabetes Mellitus (T1D).

Results We evaluated 69 subjects, mean age 39±10 yrs. and 87% caucasian. Type 2 Diabetes Mellitus (T2D) was found in 47.8%, hypertension in 72.5%, dyslipidemia in 23.2% and metabolic syndrome according to the IDF in 87%. Mean weight, waist circumference and BMI were respectively: 157.4±31.0 kg, 148.2±14.9 cm and 51.2±8.3 kg/m2. The average fasting glycemia was 111.1±34.7 mg/dL (NR 300), LH 3.1±1.3 mUmL (NR 0.8 to 7.6) and calculated free testosterone (CFT) 5.9±2.7 ng/dL (NR> 6.5). 79.7% of subjects had TT ≤ 300 ng/dL and 56.5% CFT ≤ 6.5 ng/dL. Categorizing patients according to the levels of TT [G1 (≤ 200 ng/dL): 53.8±8.5 kg/m2 x G2 (201-299 ng/dL): 49.3±7.2 kg/m2 x G3 (≥ 300 ng/dL): 48.7±8.7 kg/m2], there was a statistically significant difference only in relation to BMI (p=0.04). There were no statistically significant differences in mean TT and CFT between individuals with and without T2D [TT: 218.8±89.4 x 245.5±102.8 ng/dL (p=0.25); CFT: 5.65±2.7 x 2.6±6.21 ng/dL (p=0.39)].

BACKGROUND: Airway inflammation, acknowledged as an important feature of asthma, can be assessed by the examination of induced sputum. OBJECTIVE: To determine the pattern of inflammatory cells in induced sputum from stable steroid-naïve asthmatics, in Florianópolis, Santa Catarina. METHOD: The induced sputum from 34 asthmatics using exclusively inhaled bronchodilators on demand was examined. The patients’ clinical characteristics were obtained at visit 1, and sputum was induced at visit 2. Differential cell count was performed on Giemsa-stained cytospins. Sputum was considered to be eosinophilic if there were ³ 3% eosinophils, and neutrophilic if there were ³ 65% neutrophils. RESULTS: Results are expressed by median and interquartile range. The total cell count was 3.4 (3.7) x 10(6) cells/ml, and cell viability was 80.0 (16.4) %. The proportion of neutrophils was 14.4 (22.1) %, of eosinophils 6.4 (17.2) %, of macrophages 60.3 (37.5) %, and of lymphocytes 1.1 (1.2) %. Eosinophilic sputum was observed in 24 subjects (70.6%); none of them had neutrophilic sputum. There were no significant differences between the eosinophilic and non-eosinophilic groups concerning the measured clinical outcomes, total cell count and proportions of cells in the sputum, except for the proportion of eosinophils (14.4 [19.3] vs 0.4 [1.1], p < 0.001). CONCLUSIONS: In our environment, steroid-naïve asthmatics present a higher proportion of sputum eosinophils, as compared to the established reference values. The clinical and physiological parameters analyzed were unable to predict the presence of eosinophilic inflammation of the airways.