Aim This study measures changes in tear film lipid layer thickness (LLT) and ocular comfort in normal subjects after 10 min use of a novel device, which delivers meibomian therapy with latent heat. The device is designed to promote the release of meibomian sebum into the tear film by delivering latent heat to the eyelids, thus thickening the lipid layer. Normal lid movements are maintained, facilitating resurfacing of the tear film. Method A prospective, controlled, observer masked, single intervention trial in which 24 normal subjects were randomised into three groups. Group I underwent 10 min treatment with the activated device, Group II used the inactivated device for the same duration of time, and Group III had no intervention. The LLT of each subject was measured with a Keeler Tearscope s prior and subsequent to the 10-min period. Subjective alteration in ocular comfort was also assessed. Results Seven of eight subjects (87.5%) in Group I exhibited an increase in LLT. The mean LLT in this group showed a statistically significant increase (left eyes 1.0 levels, Po0.001, right eyes 0.9 levels, Po0.003) compared to Groups II and III. Six of eight subjects (75%) using the activated device experienced subjective improvement in ocular comfort. Conclusion Meibomian therapy with this device increases LLT in normal individuals. This implies a more stable tear film, reflected in subjective improvement in ocular comfort.

The aortic root diameter was higher, and the prevalence of aortic ectasia was more common in acromegalic patients than in controls. In addition, only acromegalic disease was associated with aortic ectasia, suggesting the direct effects of GH and insulin-like growth factor-I excess on the cardiovascular system.

We evaluated growth hormone (GH) and insulin-like growth factor I (IGF-I) response to moderate submaximal acute short-term physical exercise under basal conditions and after the administration of octreotide, a somatostatin analogue (SA), in a double-blind, counter-balanced experimental protocol. Seven untrained male volunteers performed two identical exercise tests, each on a treadmill (2.5% slope) for 30 minutes (min) at 60% of VO2max. Before starting the exercise test all the subjects received a single administration of placebo or octreotide and vice versa at two different sessions. Plasma GH, IGF-I and lactate assays were evaluated before starting, during, at the end and in the recovery phase. In the placebo-treated group GH rose significantly both during exercise and recovery whereas no significant modifications in IGF-I levels were observed. SA administration inhibited the exercise-dependent GH secretion, which showed a small rise only during exercise and returned to basal levels during recovery. In the same group, IGF-I decreased significantly after exercise compared to basal values. The results suggest that 1) in our experimental conditions acute physical exercise at aerobic threshold does not modify IGF-I concentration 2) SA is able to inhibit the exercise-dependent GH secretion and to decrease post-exercise IGF-I concentration.

Acromegaly is a systemic disease with various etiologies. It can occur as a sporadic or, more rarely, as a familial disease. Numerous complications such as endocrine, cardiovascular, respiratory, metabolic, osteoarticular and neoplastic disturbances occur and must be taken into account when establishing a therapeutic strategy. For this reason, the decision as to a treatment modality of acromegaly must be followed by a thorough evaluation of the patient and once the diagnosis of complications is settled, adequate treatment should be instituted. Follow up of the patients requires periodical re-assessment of complications status.

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RESUMOA acromegalia é uma doença de alta mortalidade, especialmente em razão de complicações cardiovasculares. Com o objetivo de avaliar os fatores determinantes da hipertrofia ventricular esquerda (HVE) e as alterações cardíacas na acromegalia, analisamos 40 acromegálicos submetidos a exames clínico-laboratoriais e ao ecocardiograma. As variáveis analisadas foram idade, sexo, duração de doença, hipertensão arterial (HA), intolerância à glicose/DM, uso ou não de octreotide, GH e %IGF-I. Na análise univariada, pacientes com HVE foram mais idosos (p= 0,031), apresentaram maior prevalência de HA (p= 0,009) e maiores valores da %IGF-I (p= 0,002), comparados aos sem HVE. Na análise multivariada, HA e %IGF-I foram determinantes de HVE (p= 0,035 e p= 0,016). Após a dicotomização da %IGF-I, foi criado um escore e a freqüência de HVE foi 9%, 65%, 92% x 0, 1, 2; p< 0,0001. Encontramos uma prevalên-cia de ectasia de aorta maior e de doença valvar menor do que a da literatura. Concluímos que HA e %IGF-I foram determinantes de HVE. Acromegaly has a high mortality rate due mainly to cardiovascular complications. The aim was to evaluate the determinant factors of left ventricular hypertrophy (LVH) and cardiac alterations in 40 acromegalic patients submitted to clinical-laboratorial studies and echocardiogram. The variables analyzed were age, sex, disease duration, arterial hypertension (AH), impaired glucose tolerance/DM, previous treatment with octreotide, GH and %IGF-I. Univaried analysis showed that patients with LVH were older (p= 0.031), had higher prevalence of AH (p= 0.009) and higher %IGF-I (p= 0.002), than those without LVH. Multivaried analysis showed AH and %IGF-I as determinants of LVH (p= 0.035 and p= 0.016). After dichotomizing of %IGF-I, a score was created and the frequency of LVH was 9%, 65%, 92% x 0, 1, 2; p< 0.0001. Prevalence of aortic ectasia was higher and valvar disease was smaller than reported in the literature. We conclude that AH and %IGF-I were determinants of LVH.

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RESUMOObjetivo: Avaliar o metabolismo da glicose em pacientes acromegálicos antes e após o tratamento com octreotide LAR. Pacientes e métodos: Este foi um estudo longitudinal e prospectivo com 30 pacientes do ambulatório de pesquisa em acromegalia do Serviço de Endocrinologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF/UFRJ). Eles foram submetidos à avaliação clínica e laboratorial com dosagens de hormônio do crescimento (GH), fator de crescimento semelhante à insulina tipo I (IGF-I), insulina, pró-insulina, peptídeo C, hemoglobina glicosilada (HbA1c), proteína de ligação do IGF tipo 1 (IGFBP-1) e a um teste oral de tolerância à glicose (TOTG), antes e após seis meses de tratamento com octreotide LAR. Foi aplicado o teste dos postos sinalizados de Wilcoxon e o critério de determinação de significância adotado foi o nível de 5%. Resultados: Encontraram-se 16 pacientes (54%) com tolerância normal à glicose, sete (23%) com intolerância à glicose e sete (23%) com diabetes melito (DM). Doze pacientes completaram os seis meses de tratamento, sendo que houve piora da tolerância à glicose em três e piora do controle glicêmico dos dois pacientes diabéticos. Houve aumento da circunferência abdominal (p = 0,03) e queda do GH (p = 0,04), % IGF-I acima do limite superior do valor de referência (%LSVR) (p = 0,001), insulina (p = 0,019), peptídeo C (p = 0,002) e do modelo de avaliação homeostática (HOMA-IR) (p = 0,039). Conclusões: Nesta série, o tratamento com octreotide LAR acarretou piora da tolerância à glicose em três pacientes não-diabéticos e piora do controle glicêmico em dois diabéticos, apesar da diminuição da resistência insulínica (RI). This was a prospective and longitudinal study involving 30 patients from the acromegaly research outpatient clinic of the Endocrinology unit of the HUCFF/ UFRJ. They underwent clinical and laboratorial evaluations, with measurements of growth hormone (GH), insulin-like growth factor type I (IGF-I), insulin, proinsulin, C peptide, glycosylated hemoglobin (HbA1c), IGF binding protein type 1 (IGFBP-1) and glucose, during oral glucose tolerance test (OGTT), before and after six months of treatment with octreotide LAR. The Wilcoxon signed-rank test was used and values of 5% were considered statistically significant. Results: We found 16 (54%) patients with normal glucose tolerance, 7 (23%) with impaired glucose tolerance and 7 (23%) diabetics. Twelve patients completed the six-month treatment, out of which three