Prolactinomas, drug induced hyperprolactinemia, and macroprolactinemia were the 3 most common causes of hyperprolactinemia. Although PRL levels could not reliably define the etiology of hyperprolactinemia, PRL values >500 ng/ml were exclusively seen in patients with prolactinomas. CAB was significantly more effective than BCR in terms of prolactin normalization, tumor shrinkage, and tolerability.

Os hormônios esteróides anabólicos androgênicos (EAA) compreendem a testosterona e seus derivados. Eles são produzidos nos testículos e no córtex adrenal, e promovem as características sexuais secundárias associadas à masculinidade. Na medicina, os EAA são utilizados geralmente no tratamento de sarcopenias, do hipogonadismo, do câncer de mama e da osteoporose. Nos esportes, são utilizados para o aumento da força física e da massa muscular; entretanto, os efeitos sobre o desempenho atlético permanecem, ainda, controversos. Os EAA podem causar diversos efeitos colaterais, como psicopatologias, câncer de próstata, doença coronariana e esterilidade. Estudos epidemiológicos apontam a problemática acerca do uso de EAA, nos esportes; todavia, no Brasil não existem publicações substanciais sobre esse tema. Esta revisão analisa esse assunto, procurando despertar a curiosidade e o interesse dos leitores para a produção científica de novos trabalhos relacionados ao tema.

Objective: To investigate the role of dietary calcium and vitamin D in the process of growth and development of children and adolescents, focusing in particular on the prevention and treatment of delayed growth caused by nutritional deficiency. Sources:Information was gathered from articles published in the last 2 decades, from searches on the databases SciELO, PubMed and Medline, technical books and publications of international organizations. Summary of the findings:Growth is influenced by intrinsic (genetic and metabolic) and extrinsic factors (environmental factors such as diet, health, hygiene, housing and access to health services). Among the nutritional factors are vitamin and oligoelement deficiencies which may be associated with malnutrition or caused by insufficient absorption. Since calcium is one of the main mineral components of bone tissue, it is essential for adequate bone formation and, considering that vitamin D plays an important role in calcium metabolism, a diet with insufficient quantities of these nutrients can impact on the formation of the skeleton and on the process of growth and development. Conclusions:In children and adolescents, low intake or low absorption of calcium and vitamin D may limit their statural growth, and it is necessary to supply sufficient quantities of both during the critical growth phases.J Pediatr (Rio J). 2008;84(5):386-394: Growth disorders, rickets, nutrition, diet, nutritional recommendations.

Hypopituitarism is a disorder characterized by insufficient secretion of one or more pituitary hormones. New etiologies of hypopituitarism have been recently described, including head trauma, cerebral hemorrhage, and drug-induced hypophysitis. The investigation of patients with these new disorders, in addition to advances in diagnosis and treatment of hypopituitarism, has increased the prevalence of this condition. Pituitary hormone deficiencies can induce significant clinical changes with consequent increased morbidity and mortality rates, while hormone replacement based on current guidelines protects these patients. In this review, we will first discuss the different etiologies of hypopituitarism and then address one by one the clinical aspects, diagnostic evaluation, and therapeutic options for deficiencies of TSH, ACTH, gonadotropin, and GH. Finally, we will detail the hormonal interactions that occur during replacement of pituitary hormones.

Arq Bras Endocrinol Metab vol 47 nº 4 Agosto 2003 368 RESUMOA síndrome de Cushing representa um desafio diagnóstico, requerendo suspeita clínica apurada, conhecimento adequado da regulação hormonal do eixo hipotálamo-hipófise-adrenal, aplicação precisa de testes funcionais que estimulam ou inibem este eixo e a indicação de exames de imagem resolutivos para as diversas etiologias investigadas. Neste artigo, discutimos a abordagem diagnóstica da síndrome de Cushing, analisando a aplicação dos diversos testes utilizados tanto para o diagnóstico sindrômico como para definição da sua etiologia. Destacamos o diagnóstico diferencial entre a doença de Cushing leve e os estados de pseudo-Cushing e entre doença de Cushing e síndrome do ACTH ectópico. Baseados nestes conceitos e conhecimentos, e em nossa experiência, propomos um modelo de abordagem para pacientes com suspeita de síndrome de Cushing, ressaltando que, em algumas situações, para um correto diagnóstico etiológico, são necessários métodos invasivos e sofisticados. The diagnosis of Cushing's syndrome require an accurate clinical suspicion, information about hypothalamic-pituitary-adrenal axis, adequate use of functional hormonal tests and the indication of resolutive image examination with the objective of determining its etiology. In this paper, we discuss the diagnostic approach of the Cushing's syndrome, the application of the hormonal tests used for the syndromic and etiologic definition, with special focus in the differential diagnosis of Cushing's Disease vs. pseudo-Cushing's states and Cushing's disease vs. ectopic ACTH syndrome. Finally, we propose a standard approach for these patients, including suggestions about the application of sophisticated and invasive methods. Keywords: Cushing's syndrome; Cushing's disease; Hypercortisolism; Differential diagnosis O DIAGNÓSTICO DIFERENCIAL DE PACIENTES com síndrome de Cushing (SC) tem-se constituído em importante desafio à prática endocrinológica, mesmo empregando-se os mais avançados métodos laboratoriais e/ou de imagem. Tratando-se de entidade rara (2-5 novos casos por milhão de habitantes/ano), seu diagnóstico diferencial envolve situações clínicas comuns como obesidade, diabete mélito, hipertensão arterial, hirsutismo, irregularidade menstrual, além da corticoterapia exógena (1,2), o que a torna um diagnóstico a ser considerado no dia a dia do consultório

Objective: To review current concepts of physiopathology, diagnosis and treatment of diabetic ketoacidosis (DKA) in childhood, as well as preventive measures to avoid cerebral edema. Sources:The authors selected articles from MEDLINE with the keywords diabetes, ketoacidosis, hyperglycemia and cerebral edema, and priority was given to studies including children and that contained complete texts published in English, Portuguese or Spanish. Chapters of books published in Brazil describing the treatment of DKA in pediatric intensive care unit were also reviewed. Based on the reviewed literature and on the author's experience, the most efficient and recommended measures for DKA management are presented. Summary of the findings:Normal saline solution (NaCl 0.9%) has been increasingly used for fast replacement and hydration, as a substitute to diluted (hypotonic) solutions, as well as contraindication of sodium bicarbonate to repair metabolic acidosis in DKA. Regular insulin should be used as continuous infusion (0.1 IU/kg/h) without the need of a loading dose. For fast corrections of glucose oscillations, a practical scheme using two bags of electrolytic solutions is presented. Cerebral edema, its physiopathological mechanism and current treatment are reviewed. Conclusions:Use of continuous infusion of regular insulin associated with adequate water and electrolyte replacement using isotonic solutions, besides being an effective treatment for DKA, preserves plasma osmolarity and prevents cerebral edema.J Pediatr (Rio J). 2007;83(5 Suppl):S119-127: Diabetes, acidosis, dehydration, insulin, cerebral edema.

Mesmo entre os especialistas mais dedicados, a prática clínica da Neuroendocrinologia é conhecida por sua larga complexidade. Os temas e subtemas a partir dos quais se pode dividir a especialidade são inúmeros e precisam ser tratados com o devido cuidado, assegurando aos profissionais médicos referências confiáveis para as abordagens e aplicações mais adequadas em sua rotina. O Guia Prático em Neuroendocrinologia é o resultado da reunião dos principais nomes da área e uma iniciativa do Departamento de Neuroendocrinologia da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM). Em 28 capítulos escritos em uma linguagem acessível, o guia oferece uma literatura que, ao assimilar a complexidade da Neuroendocrinologia, enfoca as lacunas de conhecimento de endocrinologistas de todo o país, visando transformá-las em informações consistentes e atualizadas para o melhor atendimento dos pacientes.

Background: Adrenal hypoplasia congenita (AHC) is a rare disease (1:70.000 men) characterized by reduction in all cortical adrenal hormones and also by hypogonadism. NR0B1 -related AHC includes both X-linked AHC and Xp21 deletion. AHC gene mutation was first described in 1994 and occurs in less than 1% of adrenal insufficiency (AI) cases and it is imperative that clinical endocrinologists increase their knowledge on this condition to recognize it as promptly as they were used to do so in other causes of pediatric AI.Clinical Cases: We describe here two sporadic cases and three familial cases from one family, all of them attending at our Endocrine Unit at HCPA, in the South of Brazil. The median age of AI first symptoms was 1 month old in two patients (acute infantile onset due to a salt wasting crises), and eleven years old in the remaining patients (childhood onset). Their exams confirmed the clinical suspicion of primary AI because of low plasma cortisol (from < 0.5 to 4 mcg/dl - reference range from 7-24 mcg/dl), as well as all adrenal steroids levels, high ACTH levels (from 672 to 2225 pg/ml - reference range from 7-63 pg/ml) and high plasmatic renin (from 92 to 448 mcUI/ml - reference range from 2.8-39.9 mcUI/ml). They were also extensively investigated searching for the AI pathophysiology. After some years of lost follow-up, one of the familial cases that had first been seen in 1993, returned to our hospital and was diagnosed with hypogonadism, leading to NR5OB1 gene evaluation.Regarding the genetic etiology, one of the sporadic cases developed a clinical picture including profound developmental delay, seizures and strabismus suggestive of a contiguous gene syndrome that involves Duchenne muscular dystrophy, glycerol kinase deficiency and AHC. A CGH array was performed and identified a Xp21.3-p21.1 deletion. The affected family had an extensive history suggestive of a genetic disease with X-linked inheritance pattern, as shown by the premature death of 3 uncles and a male cousin. A deleterious variant (c.131_212delinsTGAGACCTGTACCGT) in NR5OB1 gene was identified by Sanger sequencing in hemizygous state in the 46,XY affected patients.Conclusion: Albeit a rare disease, it is crucial that endocrinologist all around the World could be aware about clinical characteristics of this condition in order to properly diagnose it. And it is even possible, as it occurred with one of our patient, to make a late pathophysiologic diagnosis, making possible to treat the associated hypogonadism. Reference: Acherman JC, Vilain EJ. NR0B1- related adrenal hypoplasia congenita. GeneReviews 1993-2019.