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Akcay G, Danısman B, Basaranlar G, Guzel P, Derin N, Derin AT. The effect of increase in blood glucose level on hearing loss. Braz J Otorhinolaryngol 2022; 88 Suppl 3:S95-S102. [PMID: 35729043 DOI: 10.1016/j.bjorl.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/04/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Previous studies have shown that hearing function is also vulnerable to the effects of diabetes mellitus which can be shown by brainstem auditory evoked potential and distortion product otoacoustic emission recordings. This study aimed to investigate the changes of brainstem auditory evoked potential and distortion product otoacoustic emission in hyperglycemia and whether there is a relationship between reactive oxygen substances production and hearing deterioration in the rat model. METHODS 25 streptozotocin induced diabetic rats were divided into three groups: control, high blood glucose, and diabetes mellitus. Brainstem auditory evoked potential and distortion product otoacoustic emission were recorded, and thiobarbituric acid reactive substances levels were measured in the brainstem tissue. RESULTS At 8 kHz, the latencies of I, II, III, IV, and V brainstem auditory evoked potential waves in high blood glucose and diabetes mellitus groups were elongated, at 16 kHz, only these wave latencies of the diabetes mellitus group were prolonged compared with the control group. A significant decrease was also found in distortion product otoacoustic emission amplitudes at 4, 6, 8, and 10 kHz in the high blood glucose and diabetes mellitus groups compared to the control group. There was a significant increase in thiobarbituric acid reactive substances values due to the increase in blood glucose levels in the high blood glucose and diabetes mellitus groups compared to the control group. CONCLUSION These results suggested that high blood glucose levels may cause hearing impairment not only in the diabetic state but also in the period of hyperglycemia before the onset of manifest diabetes mellitus and reactive oxygen substances may play an important role in the pathophysiology of diabetes mellitus. We suggest that regulating high glucose levels even before the onset of manifest diabetes mellitus may prevent hazardous effects on hearing function. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Guven Akcay
- Hitit University, Faculty of Medicine, Department of Biophysics, Çorum, Turkey
| | - Betul Danısman
- Atatürk University, Faculty of Medicine, Department of Biophysics, Erzurum, Turkey
| | - Goksun Basaranlar
- İzmir Demokrasi University, Vocational School of Health Services, İzmir, Turkey
| | - Pınar Guzel
- Kozan State Hospital, Department of Otolaryngology Head and Neck Surgery, Adana, Turkey
| | - Narin Derin
- Akdeniz University, Faculty of Medicine, Department of Biophysics, Antalya, Turkey.
| | - Alper Tunga Derin
- Akdeniz University, Faculty of Medicine, Department of Otolaryngology Head and Neck Surgery, Antalya, Turkey
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Cho WK, Kang WS, Lee JB, Park HJ, Chung JW, Ahn JH. Interpreting auditory brainstem evoked responses and distortion product otoacoustic emissions in diabetic patients with normal hearing. Auris Nasus Larynx 2020; 48:227-234. [PMID: 32921527 DOI: 10.1016/j.anl.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/26/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Hearing impairment is a reported late complication of diabetes mellitus (DM). Previous studies have suggested that microangiopathic complications may cause cochlear nerve function deterioration. We evaluated the auditory brainstem evoked responses (ABRs) and distortion product otoacoustic emission (DPOAE) results according to the presence of DM in subjects with normal hearing. METHODS A cross-sectional comparative study was conducted from January 2016 to January 2018. Auditory function tests including ABR and DPOAE were performed for outpatients complaining of unilateral tinnitus. All of analyses were conducted in ears without tinnitus on contralateral side of tinnitus ears. We included subjects showing hearing thresholds within 25 dB at 0.5, 1k, 2k, and 4k on pure tone audiometry. 45 ears in patients with type 2 diabetes mellitus and 85 ears in non-diabetic patients were finally enrolled in our study. RESULTS Diabetic subjects showed significantly more prolonged absolute peak latencies (I, III, V) and inter-peak latencies (I-V, III-V) than non-diabetic subjects. However, there was no significant difference in the inter-peak latency (I-III) between these two groups. Diabetic subjects also showed significantly lower amplitudes at f2 frequencies of 1001, 1200, 1587, 4004, 5042, and 6348 Hz than non-diabetic subjects. Additionally, the prevalence of a DPOAE response, defined as 3 dB above the noise floor, was significantly lower in diabetic subjects than that in non-diabetic subjects. CONCLUSION Diabetic patients with normal hearing can still have abnormal ABR and DPOAE results due to diabetic neuroangiopathy. ABR and DPOAE assessments can help in detecting subclinical auditory dysfunction, which precedes the manifestation of hearing impairment in diabetic patients.
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Affiliation(s)
- Won Ki Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jung Bok Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Joong Ho Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
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Pterostilbene protects cochlea from ototoxicity in streptozotocin-induced diabetic rats by inhibiting apoptosis. PLoS One 2020; 15:e0228429. [PMID: 32722679 PMCID: PMC7386625 DOI: 10.1371/journal.pone.0228429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/19/2020] [Indexed: 12/05/2022] Open
Abstract
Diabetes mellitus (DM) causes ototoxicity by inducing oxidative stress, microangiopathy, and apoptosis in the cochlear sensory hair cells. The natural anti-oxidant pterostilbene (PTS) (trans-3,5-dimethoxy-4-hydroxystylbene) has been reported to relieve oxidative stress and apoptosis in DM, but its role in diabetic-induced ototoxicity is unclear. This study aimed to investigate the effects of dose-dependent PTS on the cochlear cells of streptozotocin (STZ)-induced diabetic rats. The study included 30 albino male Wistar rats that were randomized into five groups: non-diabetic control (Control), diabetic control (DM), and diabetic rats treated with intraperitoneal PTS at 10, 20, or 40 mg/kg/day during the four-week experimental period (DM + PTS10, DM + PTS20, and DM + PTS40). Distortion product otoacoustic emission (DPOAE) tests were performed at the beginning and end of the study. At the end of the experimental period, apoptosis in the rat cochlea was investigated using caspase-8, cytochrome-c, and terminal deoxyribonucleotidyl transferase-mediated dUTP-biotin end labeling (TUNEL). Quantitative real-time polymerase chain reaction was used to assess the mRNA expression levels of the following genes: CASP-3, BCL-associated X protein (BAX), and BCL-2. Body weight, blood glucose, serum insulin, and malondialdehyde (MDA) levels in the rat groups were evaluated. The mean DPOAE amplitude in the DM group was significantly lower than the means of the other groups (0.9–8 kHz; P < 0.001 for all). A dose-dependent increase of the mean DPOAE amplitudes was observed with PTS treatment (P < 0.05 for all). The Caspase-8 and Cytochrome-c protein expressions and the number of TUNEL-positive cells in the hair cells of the Corti organs of the DM rat group were significantly higher than those of the PTS treatment and control groups (DM > DM + PTS10 > DM + PTS20 > DM + PTS40 > Control; P < 0.05 for all). PTS treatment also reduced cell apoptosis in a dose-dependent manner by increasing the mRNA expression of the anti-apoptosis BCL2 gene and by decreasing the mRNA expressions of both the pro-apoptosis BAX gene and its effector CASP-3 and the ratio of BAX/BCL-2 in a dose-dependent manner (P < 0.05 compared to DM for all). PTS treatment significantly improved the metabolic parameters of the diabetic rats, such as body weight, blood glucose, serum insulin, and MDA levels, consistent with our other findings (P < 0.05 compared to DM for all). PTS decreased the cochlear damage caused by diabetes, as confirmed by DPOAE, biochemical, histopathological, immunohistochemical, and molecular findings. This study reports the first in vivo findings to suggest that PTS may be a protective therapeutic agent against diabetes-induced ototoxicity.
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Li Y, Liu B, Li J, Xin L, Zhou Q. Early detection of hearing impairment in type 2 diabetic patients. Acta Otolaryngol 2020; 140:133-139. [PMID: 31961256 DOI: 10.1080/00016489.2019.1680863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Hearing impairment is an under-recognized complication of type 2 diabetic patients. Exploring an appropriate technique and method to detect early hearing impairment in diabetic patients is the key to good hearing care.Objectives: The objectives of this study are to evaluate the application effects of extended high-frequency audiometry and distortion product otoacoustic emissions in early detection of hearing impairment in diabetic patients.Materials and methods: The study recruited 65 type 2 diabetic patients with normal hearing thresholds detected by conventional PTA, and 60 control subjects. All subjects completed detailed medical history questionnaires and underwent ENT (Ear, Nose and Throat) physical examinations and laboratory tests. Then they underwent the conventional pure tone audiometry (PTA) tests, extended high frequency audiometry (HFA) and distortion product of otoacoustic emissions (DPOAEs). Audiologic data and the related risk factors of audiology were analyzed.Results: Of 65 diabetic patients, 41 patients (63.1%) suffered from high frequency hearing loss detected by HFA and 58 patients (89.2%) suffered from cochlear dysfunction detected by DPOAEs. The incidence of high frequency hearing loss was 38%, 83.3% and 42.3% at the age of 30-39, 40-49 and 50-59 years, respectively. The factors of age (p = .00) and disease duration (p = .00) were related with the high frequency hearing threshold, while the factor of glycosylated hemoglobin (HbA1c) (p = .716) had no relationship with it.Conclusions and significance: There can be cochlear dysfunction and high frequency hearing loss in diabetic patients with normal hearing thresholds of conventional frequencies. The examinations of HFA and DPOAEs are of great importance for early diagnosis of hearing loss in type 2 diabetic patients.
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Affiliation(s)
- Yanhong Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Bo Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Jin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Lingyu Xin
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Qian Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
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Erkan SO, Tuhanioğlu B, Gürgen SG, Özdaş T, Taştekin B, Pelit A, Görgülü O. The effect of resveratrol on the histologic characteristics of the cochlea in diabetic rats. Laryngoscope 2018; 129:E1-E6. [PMID: 30284252 DOI: 10.1002/lary.27253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/20/2018] [Accepted: 04/04/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to investigate changes in the cochlea and the potential dose-dependent effects of resveratrol (RSV) against diabetes mellitus (DM) ototoxicity. STUDY DESIGN Animal model. METHODS Twenty-four male Wistar albino rats were divided into four groups. Baseline distortion product otoacoustic emission (DPOAE) measurements were evaluated. Group I was the control group, group II was made diabetic with single-dose streptozotocin, and groups III and IV were rendered diabetic as group II and administered 10 and 20 mg RSV, respectively, intraperitoneally for 4 weeks. All animals were sacrificed after repeated DPOAE measurement. Apoptosis was investigated using caspase-3, Bax (Bcl-associated X protein), and TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) staining. RESULTS The DPOAE values in the diabetic group were found to be significantly lower compared with the other groups at 5,714 Hz and 8,000 Hz (P < .05). No significant difference in otoacoustic emission was detected in the comparison of the RSV doses (P > .05). The histopathologic investigation using caspase-3, Bax, and TUNEL staining showed that the mean rank of the diabetic group was significantly higher compared with the RSV10, RSV20, and control groups (DM > RSV10 > RSV20 > control) (P < .05). CONCLUSIONS These results imply that RSV administration offered statistically significant protection for the cochleas of rats against diabetes. This protective effect improved histologically with higher doses. LEVEL OF EVIDENCE NA Laryngoscope, 129:E1-E6, 2019.
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Affiliation(s)
- Sanem O Erkan
- Department of Otorhinolaryngology-Head and Neck Surgery, Health Science University, Adana City Hospital, Yüreğir, Adana, Turkey
| | - Birgül Tuhanioğlu
- Department of Otorhinolaryngology-Head and Neck Surgery, Health Science University, Adana City Hospital, Yüreğir, Adana, Turkey
| | - Seren G Gürgen
- Department of Histology and Embriology, Celal Bayar University, Manisa, Turkey
| | - Talih Özdaş
- Department of Otorhinolaryngology-Head and Neck Surgery, Health Science University, Adana City Hospital, Yüreğir, Adana, Turkey
| | - Bora Taştekin
- Department of Biophysics, Çukurova University, Yüreğir, Adana, Turkey
| | - Aykut Pelit
- Department of Biophysics, Çukurova University, Yüreğir, Adana, Turkey
| | - Orhan Görgülü
- Department of Otorhinolaryngology-Head and Neck Surgery, Health Science University, Adana City Hospital, Yüreğir, Adana, Turkey
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Hearing loss in type 1 diabetes: Are we facing another microvascular disease? A meta-analysis. Int J Pediatr Otorhinolaryngol 2018; 113:38-45. [PMID: 30174007 DOI: 10.1016/j.ijporl.2018.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/04/2018] [Accepted: 07/04/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Evidence shows type 1 diabetes(T1D) leads to vascular damage and neuropathy. The purpose of this study was to perform a systematic review and a meta-analysis to assess the evidence of the effects of T1D on hearing function. METHODS Three electronic databases were used. The articles were independently reviewed by two authors using predefined inclusion criteria to identify eligible studies. They were then classified as high or low methodological quality. Meta-analysis was performed on pooled data of hearing loss(HL) prevalence, pure tone audiometry(PTA), otoacoustic emissions(OAE) and auditory brainstem response(ABR). RESULTS Twenty-one articles fulfilled the inclusion criteria. In all studies, HL was defined as pure tone greater than 20 dB in at least one frequency. The prevalence of HL ranged between 5.17% and 48% for diabetics, which was higher than in controls which ranged between 0% à 40% (OR = 7.7, 95% CI 3.32-17.98, p < 0.05 and I2 = 40%). The tendency of mean thresholds of PTA was higher in diabetics than in controls, with results being statistically significant at 250, 500 and 1000 Hz. OAE were significantly lower in diabetic patients. ABR latencies were longer in T1D group compared to controls and were statistical significant. CONCLUSIONS Patients with T1D have a significantly greater prevalence of HL compared to the control group. These damages could be compared to other microvascular diseases. Further studies are needed to assess whether hearing testing should be considered as a part of the screening process in T1D patients and therefore, secondary preventive treatment may be warranted as well.
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Genome-wide DNA methylation analysis of human peripheral blood reveals susceptibility loci of diabetes-related hearing loss. J Hum Genet 2018; 63:1241-1250. [PMID: 30209346 DOI: 10.1038/s10038-018-0507-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/08/2018] [Accepted: 08/17/2018] [Indexed: 11/08/2022]
Abstract
Diabetes-related hearing loss (DRHL) is a complication of diabetes mellitus that is drawing more attention currently. DNA methylation has a critical role in the pathogenesis of type 2 diabetes mellitus (T2DM) and its complications. Therefore, we investigated the genome-wide DNA methylation of peripheral blood of T2DM patients with/without hearing loss in order to explore the susceptibility loci of DRHL. Between DRHL group and control group, 113 gene sites were identified to be differentially methylated regions (DMRs). Among 38 DMRs with whole samples, the classification accuracy is up to 90%. With alignment to T2DM susceptibility genes and deafness genes published, KCNJ11 was found to be the only overlapped gene. The DNA methylation level of KCNJ11 was associated with stroke (t = 2.595, p < 0.05), but not with diabetic nephropathy and diabetic retinopathy. The detective rate of distortion product otoacoustic emissions (DPOAE) from low to high frequencies (0.7-6 kHz) on the right ear was significantly correlated with the methylation level of KCNJ11. The auditory brainstem response (ABR) threshold on the right ear was also correlated (r = 0.678, p < 0.05). This DNA methylation profile indicates the susceptibility loci of DRHL. The potassium metabolism may have a critical role in the hearing loss caused by hyperglycemia.
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Felício JS, de Souza d’Albuquerque Silva L, Martins CLELP, Neto JFA, de Lemos MN, de Souza Resende F, da Silva WM, de Alcântara AL, de Oliveira MCNI, de Souza Neto NJK, de Franco IIF, Zahalan NA, Janaú LC, de Souza ACCB, Santos FM, de Queiroz NNM, Mourão NAL, dos Santos MC, Felício KM, de Melo FTC. Cochlear dysfunction and microvascular complications in patients with type 1 diabetes mellitus. Diabetol Metab Syndr 2018; 10:81. [PMID: 30455746 PMCID: PMC6230237 DOI: 10.1186/s13098-018-0380-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/19/2018] [Indexed: 11/30/2022] Open
Abstract
Sensorineural hearing impairment has been associated with DM, and it is probably linked to the same pathophysiological mechanisms as well-established in microvascular diabetes complications. The study of otoacoustic emissions (OAEs) is useful to identify subclinical cochlear dysfunction. Therefore, the aim of this study was to evaluate the association between abnormal OAEs responses, diabetic kidney disease (DKD) and diabetic cardiac autonomic neuropathy (CAN). We performed a cross-sectional study with 37 type 1 DM patients without auditory symptoms, submitted to the study of Distortion Product Otoacoustic Emissions (DPOAEs) and screened for DKD and CAN. The otoacoustic emissions responses were considered abnormal in 27/37 (73%) patients. A correlation was found between abnormal OAEs responses and presence of DKD (r = 0.36, p < 0.05), and 14/16 (88%) patients with a lower amplitude of OAEs in 8 kHz frequency band presented DKD. Abnormal OAEs responses in the 6 kHz frequency band were correlated with the presence (r = 0.41, p = 0.01) and severity of CAN (r = 0.44, p < 0.001). Additionally, 7/9 (78%) patients with abnormal OAE responses in this frequency also presented abnormal CAN scores. Our results suggest that abnormal otoacoustic emissions responses in high frequency bands are associated with diabetes microvascular complications and could be a risk marker for DKD and CAN, presenting low sensitivity and high specificity. Therefore, assuming that hearing impairment is a pre-clinical stage of hearing loss, performing distortion product otoacoustic emissions in T1DM patients with microvascular complications could be useful to identify those who would be benefit with regular audiologic follow up and tighter diabetes control.
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Affiliation(s)
- João Soares Felício
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Lilian de Souza d’Albuquerque Silva
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Carlliane Lima e Lins Pinto Martins
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - João Felício Abrahão Neto
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Manuela Nascimento de Lemos
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Fabrício de Souza Resende
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Wanderson Maia da Silva
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Angélica Leite de Alcântara
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Maria Clara Neres Iunes de Oliveira
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Norberto Jorge Kzan de Souza Neto
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Isabela Imbelloni Farias de Franco
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Nathalie Abdallah Zahalan
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Luísa Correa Janaú
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Ana Carolina Contente Braga de Souza
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Flavia Marques Santos
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Natércia Neves Marques de Queiroz
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Neyla Arroyo Lara Mourão
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Márcia Costa dos Santos
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Karem Miléo Felício
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
| | - Franciane Trindade Cunha de Melo
- Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil
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