Introduction: Prolactinomas are preferentially treated with dopamine agonists. However, a few adenomas are resistant to this treatment.Objective: To evaluate the characteristics of patients with resistance to dopamine agonists in the long-term.Method: A retrospective study of six cases was made. Patients who did not achieve normalized prolactin blood concentrations and a reduction of more than 50% of the tumor volume with the minimum dose of 3.5 mg per week of cabergoline for 3 months or the maximum supported dose of bromocriptine for 6 months were considered resistant to dopamine agonists. Patients were followed up at the Clinic of Neurology and Endocrinology or the University Hospital of Brasilia.Results: Six patients were selected. Three patients were initially treated with bromocriptine prior to treatment with cabergoline. Four patients were men, and two were women. At the time of diagnosis, ages ranged from 9 to 62 years. Initial prolactin concentrations ranged from 430 to 14,992 ng/mL and in the last assessment ranged from 29.6 to 2,169 ng/mL. The tumor volume ranged from 0.77 to 24.0 mm3. Tumor regression occurred in all patients, ranging from 20 to 100%, but total disappearance of the adenoma with an empty sella occurred in one patient. The maximum weekly doses of cabergoline ranged from 3.0 to 4.5 mg. Follow-up time ranged from seven to 17 years. Normalization of prolactin concentrations occurred only in one woman after 17 years of treatment. Three patients also underwent surgery, but only one woman was cured of the disease.Conclusion: This study confirms that tumors resistant to dopamine agonists are more aggressive, since we did not have any microadenoma; treatment with high dose of cabergoline may reduce the size of the tumor without its disappearance, and that normalization of prolactin concentration rarely occurs. To our knowledge, this is the longest follow-up of a series of cases with resistance to dopamine agonists.
A hiperglicemia durante a gestação é condição frequente e está relacionada a múltiplas complicações materno-infantis. Depois do primeiro trimestre, período marcado por relativa sensibilidade à insulina, o crescimento da placenta promove a liberação de hormônios contrarreguladores da insulina permitindo que as hiperglicemias sobrevenham na gestante susceptível. A despeito dos enormes avanços farmacológicos no tratamento do diabetes, a insulinoterapia é a modalidade de escolha para as gestantes, considerando-se o perfil de segurança e escassez de estudos de longo prazo com outras drogas. As recomendações para o tratamento do diabetes gestacional e pré-gestacional são baseadas na opinião de especialistas e na experiência do serviço. O objetivo deste estudo é descrever a experiência do serviço de Endocrinologia e Metabologia do Hospital Universitário de Brasília no manejo de gestantes com diabetes, bem como apresentar uma abordagem prática de insulinização nessas pacientes. ABSTRACTHyperglycaemia during pregnancy is a frequent condition and is related to many maternal-infant complications. After the first trimester, a period marked by relative insulin sensitivity, placental growth promotes the release of insulinregulating hormones, allowing hyperglycaemia to occur in the susceptible pregnant woman. In spite of the enormous pharmacological advances in the treatment of diabetes, insulin therapy is the modality of choice for pregnant women, considering the safety profile and shortage of long-term studies with other drugs. Recommendations for the treatment of gestational and pre-gestational diabetes are based on the opinion of experts and the experience of the service. The objective of this study is to describe the experience of the Endocrinology and Metabolism Service of the University Hospital of Brasília in the management of pregnant women with diabetes as well as to present a practical approach on how to use insulin in these patients.
Dedico este trabalho aos meus filhos, Caroline e João Gabriel e, ao meu esposo, João Ulisses, pelo incentivo e apoio em todas as minhas decisões. v AGRADECIMENTOS A Deus, pelas oportunidades oferecidas ao colocar pessoas tão especiais no meu caminho. "Toda honra e toda a glória sejam dadas a Ti, e que eu seja mero instrumento nas Tuas mãos". Ao meu querido esposo, João Ulisses Gonzaga, presente em todas as etapas deste projeto, agradeço pelo apoio incondicional, pela dedicação e pela participação constante na vida da nossa família. À minha querida filha, Caroline de Magalhães Gonzaga, pelo afeto e pelo sorriso gentil. A sua natureza genuína e o seu amor singelo me transformam a cada dia. Ao meu querido filho, João Gabriel de Magalhães Gonzaga, pela alegria contagiante, pela força que me impulsiona e me faz crescer como pessoa, mãe e profissional. Aos meus queridos pais, João Ribeiro de Magalhães (in memorian) e Anna Maria Alves Ribeiro por todos os sacrifícios, pelo exemplo e pelo constante incentivo. Às minhas queridas irmãs Joana Darc Magalhães Junqueira, Rita de Cássia Alves Magalhães de Paula, e, ao meu querido irmão, José Ângelo de Magalhães que mesmo distantes fisicamente mantém constante a torcida por mim. À minha querida amiga Milene Fernandes que se tornou irmã e companheira de todos os momentos. Ao meu orientador, Prof. Dr. Luiz Augusto Casulari Roxo da Motta, por aceitar o maior desafio: orientar-me. A minha gratidão será eterna. Muito obrigada pelo constante incentivo, pela atenção e pelas oportunidades oferecidas.
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