Introduction: There are several complications of the cardiovascular system caused by acromegaly, especially hypertension. Objectives: To evaluate hypertension characteristics in patients with cured/controlled acromegaly and with the active disease. Patients and methods: Cross-sectional study of the follow-up of forty-four patients with acromegaly submitted to clinical evaluation, laboratory tests and cardiac ultrasound. Patients with cured and controlled disease were evaluated as one group, and individuals with active disease as second one. Results: Forty-seven percent of the patients had active acromegaly, and these patients were younger and had lower blood pressure levels than subjects with controlled/cured disease. Hypertension was detected in 50% of patients. Subjects with active disease showed a positive correlation between IGF-1 and systolic and diastolic blood pressure levels (r = 0.48, p = 0.03; and r = 0.42, p = 0.07, respectively), and a positive correlation between IGF-1 and urinary albumin excretion (UAE) rates. In patients with active disease, IGF-1 was a predictor of systolic blood pressure, although it was not independent of UAE rate. For individuals with cured/controlled disease, waist circumference and triglycerides were the predictors associated with systolic and diastolic blood pressure. Conclusions: Our findings suggest that blood pressure levels in patients with active acromegaly are very similar, and depend on excess GH. However, once the disease becomes controlled and IGF-1 levels decrease, their blood pressure levels will depend on the other cardiovascular risk factors. Arq Bras Endocrinol Metab. 2011;55(7):468-74
Objectives: To evaluate the presence of diabetes mellitus (DM) in a cohort of patients with acromegaly. Methods: This was a cross sectional study. Results: Fifty-eight acromegalic patients were assessed. Only 29% met the criteria for cure, and 27% had the disease controlled. Twenty-two had DM; HbA1c was equal to 7.34 ± 2.2%. Most of the diabetic patients (18 out of 22, 82%) did not meet criteria for cure. They were more often hypertensive [16/22 (73%)
A acromegalia acarreta uma série de distúrbios ao sistema cardiovascular, decorrentes da exposição crônica a níveis elevados de GH e IGF-1. Estes distúr-bios são os principais responsáveis pelo aumento da mortalidade de acromegáli-cos. Entre as várias formas de acometimento cardiovascular, destaca-se a miocardiopatia acromegálica, entidade caracterizada, inicialmente, pelo estado hiperdinâmico, seguido de hipertrofi a ventricular esquerda concêntrica e disfunção diastólica por défi cit de relaxamento, culminando com disfunção sistólica e, por vezes, insufi ciência cardíaca franca. Além disso, são também relevantes as arritmias, as valvulopatias, sobretudo mitral e aórtica, a cardiopatia isquêmica, a hipertensão e os distúrbios dos metabolismos glicêmico e lipídico. Nesta revisão são abordados os principais aspectos clínicos e prognósticos destas entidades, os efeitos do tratamento da acromegalia sobre elas e as repercussões correspondentes sobre a sobrevida dos pacientes. ABSTRACT Cardiovascular Disturbances in Acromegaly.Acromegaly causes a number of disorders in the cardiovascular system, resulting from chronic exposure to high levels of GH and IGF-1. Such disorders are the main responsible for increased mortality rates among acromegalic patients. Among several forms of cardiovascular impairment is acromegalic cardiomyopathy, an entity that is initially characterized by a hyperdynamic state, followed by concentric left ventricular hypertrophy and diastolic dysfunction due to relaxation defi cit, culminating in systolic dysfunction and sometimes heart failure. In addition, arrhythmias and heart valve diseases are also relevant, especially mitral and aortic, ischemic heart disease, hypertension, and glucose and lipid metabolism disorders. This review approaches the main clinical and prognostic aspects of these entities, the effects of acromegaly treatment on them, and the respective consequences on patient survival. (Arq Bras Endocrinol Metab 2008; 52/9:1416-1429)
Acromegaly has several complications on the cardiovascular system, especially hypertension. Objectives: To evaluate clinical characteristics and laboratorial cardiovascular risk markers of a group of patients with acromegaly and to determine whether they are correlated with presence of hypertension and disease activity. Study design: Uncontrolled cross-sectional study. Patients and Methods: Forty-four patients with active or inactive acromegaly being followed at the Neuroendocrinology Clinic of the HCPA were submitted to clinical assessment, laboratory tests (biochemical parameters for acromegaly control, lipid profile, renin, aldosterone, 24-hour microalbuminuria, ultrasensitive C-reactive protein), and echocardiography. Results: The prevalence rates found in the sample were as follows: active acromegaly, 40.9%; hypertension, 56.8%; diabetes mellitus, 18.2%; obesity, 29.5%. Patients with active disease did not have the highest number of cardiovascular risk factors when compared with healed individuals. There were no correlations between disease activity and presence of hypertension, renin and aldosterone levels, or us-CRP. Patients with left ventricular hypertrophy had lower levels of GH and IGF-1 (nonsignificant p). There was correlation between acromegaly activity and microalbuminuria levels and HOMA index. Conclusions: There is no greater aggregation of cardiovascular risk factors in active acromegaly; there is correlation between disease activity and nontraditional cardiovascular risk parameters -microalbuminuria and insulin resistance.
SUMMARYTreatment with rosiglitazone has been associated with severe paradoxical HDL-c reductions. To our knowledge, there are very few reports of this reaction occurring when patients are treated without the combination of a fibrate. A case of severe HDL-c lowering in a patient treated with rosiglitazone without a fibrate is presented. The patient has been treated at a private practice clinic in southern Brazil. A 64-year-old woman with a 2-year history of type 2 diabetes mellitus was referred to her endocrinologist in June 2008. Rosiglitazone 4 mg q.d. was prescribed. Nine months later, the patient experienced a 90.90% decrease of her HDL-c levels. Rosiglitazone was withdrawn and the HDL-c returned to baseline. This paradoxical HDL-c reduction is a potentially severe adverse event. Patients prescribed rosiglitazone should have their HDL-c levels measured before and during therapy. Arq Bras Endocrinol Metab. 2010;54(7):663-7 SUMÁRIOO tratamento com rosiglitazona tem sido associado a reduções paradoxais e severas no HDL-c. Há muito poucos relatos dessa reação ocorrendo em pacientes tratados com rosiglitazona sem a combinação com um fibrato. Apresentou-se um caso de diminuição severa no HDL-c em uma paciente tratada com rosiglitazona sem fibrato associado. A paciente foi tratada em uma clínica privada no Sul do Brasil. Uma mulher de 64 anos com história de diabetes melito tipo 2 há 2 anos foi encaminhada ao seu endocrinologista em junho de 2008. Prescreveu-se rosiglitazona 4 mg uma vez ao dia. Nove meses depois, a paciente teve redução de 90,90% em seus níveis de HDL-c. A rosiglitazona foi retirada e o HDL-c retornou aos níveis prévios. Essa redução paradoxal do HDL-c é um evento adverso potencialmente severo. Pacientes aos quais se prescreve rosiglitazona devem ter seus níveis de HDL-c medidos antes e durante o tratamento.
Paciente apresentando tumoração indolor, de crescimento lento, em local correspondente à cicatriz de toracotomia para correção de coarctação de aorta realizada 15 anos antes. Tomografia computadorizada de tórax mostrou lesões tumorais de contornos relativamente bem definidos e osteólise dos arcos costais adjacentes. Realizada ressecção e reconstrução de parede torácica. O anatomopatológico demonstrou reação de histiócitos granulares e reação granulomatosa de corpo estranho a material necro-hemorrágico. Este é um evento raro na prática médica, tendo-se realizado revisão da literatura pertinente.
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