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Lima JV, Kater CE. The Pheochromocytoma/Paraganglioma syndrome: an overview on mechanisms, diagnosis and management. Int Braz J Urol 2023; 49:307-319. [PMID: 37115176 DOI: 10.1590/s1677-5538.ibju.2023.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/22/2022] [Indexed: 04/29/2023] Open
Abstract
Pheochromocytomas/paragangliomas (PPGL) are rare, metastatic, and potentially fatal neuroendocrine tumors, often neglected because they present symptoms similar to other prevailing clinical conditions such panic syndrome, thyrotoxicosis, anxiety, hypoglycemia, etc., delaying diagnosis and treatment. The rate of diagnosis of PPGL has been increasing with the improvement in the measurement of catecholamine metabolites and the expanding availability of imaging procedures. Its essential genetic nature has been extensively investigated, comprising more than 20 genes currently related to PPGL and more new genes will probably be revealed. This overview will shed some light on the clinical, laboratory, topographical, genetic diagnosis, and management of PPGL.
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Affiliation(s)
- José Viana Lima
- Divisão de Endocrinologia e Metabolismo, Faculdade de Medicina da Santa Casa de São Paulo, São Paulo, SP, Brasil
- Unidade de Adrenal e Hipertensão, Divisão de Endocrinologia e Metabolismo, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brasil
| | - Claudio Elias Kater
- Unidade de Adrenal e Hipertensão, Divisão de Endocrinologia e Metabolismo, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brasil
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Brandão CMÁ, Chiamolera MI, Biscolla RPM, Lima JV, De Francischi Ferrer CM, Prieto WH, de Sá Tavares Russo P, de Sá J, Dos Santos Lazari C, Granato CFH, Vieira JGH. No association between vitamin D status and COVID-19 infection in São Paulo, Brazil. Arch Endocrinol Metab 2021; 65:381-385. [PMID: 33740339 PMCID: PMC10065340 DOI: 10.20945/2359-3997000000343] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In recent years the immunomodulatory actions of vitamin D, a steroid hormone, have been extensively studied. In 2020, due to the COVID-19 pandemic, the question arose as to 25(OH)D status would be related to susceptibility to SARS-CoV-2 infection, since several studies pointed out a higher prevalence and severity of the disease in populations with low levels of 25(OH)D. Thus, we investigated the 25(OH)D levels in adults "Detected" positive for SARS CoV-2 by RT-PCR (reverse transcriptase polymerase chain reaction) test, and in negative controls, "not Detected", using the Fleury Group's examination database, in Sao Paulo, Brazil. Of a total of 14.692 people with recent assessments of 25(OH)D and RT-PCR tests for COVID-19, 2.345 were positive and 11.585 were negative for the infection. The groups did not differ in the percentage of men and women, or in the age distribution. There were no differences in the distribution of 25(OH)D between the two groups (p = 0.08); mean 25(OH)D of 28.8 ± 21.4 ng/mL and 29.6 ± 18.1 ng/mL, respectively. In the specific population studied, clinical, environmental, socioeconomic and cultural factors should have greater relevance than 25(OH)D in determining the susceptibility to COVID-19.
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de Oliveira FM, Fragoso MCBV, Meneses AF, Vilela LAP, Almeida MQ, Palhares RB, de Arruda Mattos TV, Scalissi NM, Viana Lima J. ADRENAL INSUFFICIENCY CAUSED BY PARACOCCIDIOIDOMYCOSIS: THREE CASE REPORTS AND REVIEW. AACE Clin Case Rep 2019; 5:e238-e243. [PMID: 31967043 DOI: 10.4158/accr-2018-0632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 02/03/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Fungal infections can affect the adrenal glands, causing primary adrenal insufficiency (PAI). Although endemic to South America, paracoccidioidomycosis (PCM), which can lead to PAI, has gained global relevance with the increase in international travel and migration. Methods The present report describes 3 patients with PAI caused by PCM. Results Patients in cases 1 and 2 both reported indisposition, asthenia, nausea, hyperpigmentation of the skin, hypotension, and weight loss. Complementary exams confirmed PAI due to PCM. Case 1 was serologically diagnosed. In contrast, the definitive diagnosis of case 2 was only reached by computed tomography (CT)-guided adrenal biopsy after negative serologies for PCM. Case 3, with diabetes mellitus, had a history of asthenia, nausea and weight loss after persistent sinusitis. Initially, serologic results were negative for PCM and the patient's CT-guided biopsy resulted in insufficient tissue to obtain a definitive diagnosis. Contrary to the initial hypothesis of invasive aspergillosis, since the only etiological evidence for the patient's clinical condition were positive serologies for Aspergillus fumigatus, histopathologic examination of the specimen provided by a left adrenalectomy finally confirmed PCM as the etiology for PAI in this case as well. Conclusion The 3 cases illustrate the necessity to investigate PAI whenever there are suspicious clinical findings. They also show that fungal infections should be considered among the diagnostic hypotheses during the etiological investigation of PAI. Finally, they teach us that definitive diagnosis of PCM may require direct visualization of the pathogen.
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Leopoldo CMDS, Leopoldo FMDS, Santos ARLD, Veiga JCE, Lima JV, Scalissi NM, Lazarini PR, Dolci RLL. Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery. Arq Neuropsiquiatr 2017; 75:301-306. [PMID: 28591390 DOI: 10.1590/0004-282x20170035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/24/2017] [Indexed: 11/22/2022]
Abstract
Objective The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. Methods A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. Results The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. Conclusion The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensions may preclude gross total resection of these tumors.
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Affiliation(s)
| | | | - Américo Rubens Leite Dos Santos
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Disciplina de Neurocirurgia, São Paulo SP, Brasil
| | - José Carlos Esteves Veiga
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Disciplina de Neurocirurgia, São Paulo SP, Brasil
| | - José Viana Lima
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Medicina, Disciplina de Endocrinologia, São Paulo SP, Brasil
| | - Nilza Maria Scalissi
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Medicina, Disciplina de Endocrinologia, São Paulo SP, Brasil
| | - Paulo Roberto Lazarini
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Otorrinolaringologia São Paulo SP, Brasil
| | - Ricardo Landini Lutaif Dolci
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Otorrinolaringologia São Paulo SP, Brasil
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Galho AR, Cordeiro MF, Ribeiro SA, Marques MS, Antunes MFD, Luz DC, Hädrich G, Muccillo-Baisch AL, Barros DM, Lima JV, Dora CL, Horn AP. Protective role of free and quercetin-loaded nanoemulsion against damage induced by intracerebral haemorrhage in rats. Nanotechnology 2016; 27:175101. [PMID: 26965041 DOI: 10.1088/0957-4484/27/17/175101] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intracerebral haemorrhage (ICH) is a worldwide public health problem. Experimental studies have shown that oxidative stress plays an important role in the pathogenesis of ICH and could represent a target for its treatment. However, the blood-brain barrier is an obstacle to be overcome, as it hampers the administration of compounds to the central nervous system. In this study, we compared the effects of a quercetin-loaded nanoemulsion (QU-N) with the free form of the drug (QU-SP) in a collagenase-induced ICH rat model. Quercetin (QU) is a polyphenol that has an antioxidant effect in vitro, but due to its high lipophilicity, it has low bioavailability in vivo. In this study, animals submitted or not to ICH were treated with a single intraperitoneal QU dose (free or nanoemulsion) of 30 mg kg(-1). Motor assessment was evaluated by the open field, foot fault and beam walking behavioural tests. 72 h after surgery the haematoma size was evaluated and biochemical measurements were performed. Animals treated with QU-N had a significant improvement in the beam walking and open field tests. Also, QU-N was able to reduce the size of the haematoma, preserving the activity of glutathione S-transferase (GST), increasing GSH content, and the total antioxidant capacity. QU-SP recovered locomotor activity and increased the GSH content and the total antioxidant capacity. Thus, it can be observed that QU presented antioxidant activity in both formulations, but the incorporation into nanoemulsions increased its antioxidant effect, which was reflected in the improvement of the motor skills and in the haematoma size decrement. These results suggest that the nanoemulsion containing QU developed in this study could be promising for future studies on treatments for ICH.
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Affiliation(s)
- A R Galho
- Programa de Pós-graduação em Ciências Fisiológicas - Fisiologia Animal Comparada, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, 96210-900, Brazil
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de Castroneves LA, Negrão MV, de Freitas RMC, Papadia C, Lima JV, Fukushima JT, Simão EF, Kulcsar MAV, Tavares MR, Jorge AADL, de Castro G, Hoff PM, Hoff AO. Sorafenib for the Treatment of Progressive Metastatic Medullary Thyroid Cancer: Efficacy and Safety Analysis. Thyroid 2016; 26:414-9. [PMID: 26701095 DOI: 10.1089/thy.2015.0334] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Treatment of advanced medullary thyroid carcinoma (MTC) was recently improved with the approval of vandetanib and cabozantinib. However, there is still a need to explore sequential therapy with more than one tyrosine kinase inhibitor (TKI) and to explore alternative therapies when vandetanib and cabozantinib are not available. This study reports the authors' experience with sorafenib as a treatment for advanced MTC. METHODS This is a retrospective longitudinal study of 13 patients with progressive metastatic MTC treated with sorafenib 400 mg twice daily between December 2011 and January 2015. The primary endpoints were to evaluate response and progression-free survival (PFS) in patients treated with sorafenib outside a clinical trial. The secondary endpoint was an assessment of the toxicity profile. One patient was excluded because of a serious allergic skin rash one week after starting sorafenib. RESULTS The analysis included 12 patients with metastatic MTC (median age 48 years), 10 with sporadic and 2 with hereditary disease. The median duration of treatment was 11 months, and the median follow-up was 15.5 months. At data cutoff, 2/12 (16%) patients were still on treatment for 16 and 34 months. According to Response Evaluation Criteria in Solid Tumors analysis, 10 (83.3%) patients showed stable disease, and two (16.6%) had progression of disease; no partial response was observed. The median PFS was nine months. However, three patients with extensive and rapidly progressive disease died within three months of sorafenib treatment. The median PFS excluding these three patients was 12 months. Adverse events (AE) occurred in nine (75%) patients. The main AEs were skin toxicity, weight loss, and fatigue. Five (41.6%) patients needed dose reduction, and one patient discontinued treatment because of toxicity. CONCLUSIONS Treatment with sorafenib in progressive metastatic MTC is well tolerated and resulted in disease control and durable clinical benefit in 75% of patients. Sorafenib treatment could be considered when vandetanib and cabozantinib are not available or after failing these drugs.
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Affiliation(s)
- Luciana Audi de Castroneves
- 1 Endocrinology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Vailati Negrão
- 2 Medical Oncology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Miguel Costa de Freitas
- 3 Radiology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carla Papadia
- 1 Endocrinology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Viana Lima
- 4 Endocrinology Department, Irmandade da Santa Casa da Misericórdia de São Paulo , São Paulo, Brazil
| | - Julia T Fukushima
- 5 Intensive Care Unit; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Marco Aurélio Vamondes Kulcsar
- 7 Head and Neck Surgery Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcos Roberto Tavares
- 8 Head and Neck Surgery Department; Hospital das Clínicas , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexander Augusto de Lima Jorge
- 9 Genetics Endocrinology LIM 25; Hospital das Clínicas , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gilberto de Castro
- 2 Medical Oncology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Marcelo Hoff
- 2 Medical Oncology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Oliveira Hoff
- 1 Endocrinology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Peixoto S, Vogeley J, Nery R, Barros C, Lima JV, Soares R. Selection and identification of probiotic bacteria for use in the marine shrimp culture. Commun Agric Appl Biol Sci 2013; 78:354-357. [PMID: 25141710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Fernandes A, Santos JM, Lima JV, Mourão L, Santos AL, Luís AS. [Unstable angina. An evaluation of a diagnostic and therapeutic methodology]. Rev Port Cardiol 1993; 12:1023-7, 1000. [PMID: 8117455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The authors describe the diagnostic and therapeutic management of 55 patients with the diagnosis of unstable angina admitted at a medical intensive care unit. According to Braunwald classification, 52 patients had primary angina and the remaining three had post-infarction angina. Risk stratification was based on non invasive procedures such as 2D echocardiogram and exercise test after clinical stabilization. Coronary angiography was performed in all patients. Most of the patients needed revascularization: 62% by percutaneous transluminal coronary angioplasty (PTCA) and 13% were submitted to coronary artery by-pass graft (CABG). None of the patients died during hospitalization.
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