Efeitos tardios na função hipotálamo-hipófise após tratamento de tumores parasselares

Abstract

RESUMO -O acompanhamento a longo prazo de pacientes submetidos a tratamento de tumores da região parasselar é importante para detectar complicações tardias da terapêutica. Neste estudo avaliamos 6 pacientes com craniofaringioma, 1 com meningioma, 1 com germi¬ noma e 1 com cisto epidermóíde, localizados na região parasselar. Eles haviam sido tratados, em média, 3,8±3,2 anos antes, por cirurgia e radioterapia (6 casos) ou somente cirurgia (3 casos). Cinco pacientes eram do sexo feminino e a média de idade era de 24,3±18,8 anos. A avaliação consistiu na infusão endovenosa de TRH (200 mg), GnRH (100 mg) e insulina regular (0,1 UI Kg/peso), bem como na dosagem dos hormônios hipofisários antes (0) e após 20, 40, 60 e 80 minutos. Encontramos os seguintes resultados: (a) resposta deficitária do GH e do cortisol era todos pacientes; (b) 7/9 pacientes não tiveram respostas adequadas do FSH e 3/9 do L.H; (c) 4/9 tiveram respostas inadequadas da prolactina e 2/8 do TSH. Concluimos que: (a) o déficit de GH e cortisol são os mais frequentes nestes pacientes; (b) a lesão após radioterapia pode localizar-se tanto no hipotálamo quanto na hipófise ou, ainda, em ambos; (c) a sensibilidade das células hipofisárias e hipotalâmicas à irradiação é diferente de acordo com os hormônios que produzem; (d) é necessário o acompanhamento endocrinológico frequente dos pacientes submetidos a tratamento de tumores parasselares, a fim de detectar déficits hormonais tardios. SUMMARY -Long term follow-up of patients submitted to treatment of paraselar tumours region is important for the detection of late therapeutic complications. In this study the authors conducted an evaluation of six patients with craniopharyngioma, one with germinoma, one with meningioma, and one epidermoid cyst. All above tumours were localized at paraselar region. Six out of nine patients had been treated both by surgery and by radiotherapy and the other three surgically only, on an average 3.8±3.2 years before this observation was carried out. Five patients were female with their ages average 24.3±18.8 years old. Evaluation consisted: in the first place, an intravenous infusion of thyrotropin-releasing hormone (TRH, 200 mg), gonadotropin-releasing hormone (GnRH, 100 mg), and insulin tolerance test (0,1 IU/Kg, regular insulin); and secondly, in measurements of pituitary hormones secretion at different time points -0, 20,40, 60 and 80 minutes. We found both diminished response of growth hormone and Cortisol in all the patients. Seven out of nine patients did not have adequate response to follicle-stimulating hormone.Three out of nine responded unsatisfactory to luteinizing hormone. Four out of nine showed inadequate responses to prolactin as well as, two out of eight to thyrotropin.We concluded that: (a) growth hormone and Cortisol deficiency are the most frequent finding in these patients; (b) post-radiotherapy lesions can be located in the hypothalamus or pituitary, or even in Trabalho realizado na

Incidence of Obesity Does Not Appear to Be Increased after Treatment of Acute Lymphoblastic Leukemia in Brazilian Children: Role of Leptin, Insulin, and IGF-1

“…It has been proposed that high serum leptin levels in patients treated for ALL during childhood may be either a direct consequence of radiation-induced hypothalamic damage or an indirect effect produced by a centrally induced GH deficiency [10] since the hypothalamus is more sensitive to irradiation than pituitary [41, 42], as shown by the lower GH peak response after insulin tolerance test than after the GHRH + arginine [12]. Indeed, GH treatment might reduce serum leptin level in children with GH deficiency or Prader-Willi syndrome [43], but not in survivors of childhood ALL with GH deficiency [12].…”

Evaluation of pituitary and thyroid hormones in patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm

“…Even if it is not possible to completely exclude the possibility of an associated thyroid disease in our patients, the absence of antibodies against thyroid might be considered as indicative of the absence of primary hypothyroidism 30 . Increased levels of TSH have been described in patients with serious sistemic diseases 31,32 , with hypothalamic and pituitary tumors 8,9,30,33 , following surgery or cerebral radiotherapy 8 often producing diagnostic confusion with primary hypothyroidism 8 .…”

“…Os níveis de FSH e LH foram normais de acordo com a idade e sexo: homens -FSH = 4,0±2,9 mUI/ml (VN =1 a 10,5 mUI/ml); LH = 6,1±6,3 mUI/ml (VN =2 a 12 mUI/ml); mulheres -pré-menopausa: FSH = 2,5±1,5 mUI/ml (VN =2,4 a 9,3 mUI/ml); LH 3,9±5,1 mUI/ml (VN =2 a 15 µUI/ml); pós-menopausa: FSH = 48,3±18,5 mUI/ml (valor normal =31 a 134 mUI/ml); LH = 29±13,8 mUI/ml (VN =16 a 64 mUI/ml). Os níveis de TSH foram 3,9±5,2 µUI/ml (VN =0,5 a 4,7 µUI/ml) e cinco pacientes ( Neoplasic, inflammatory or vascular diseases involving the hypothalamus and/or the pituitary gland, as well as surgical and radiotherapic treatments of these structures have been reported to increase TSH serum levels 8 and to produce a plurihormonal deficit of the pituitary hormones 9 . Due to the important interactions between the central nervous system (CNS) and the endocrine system, particularly in stressfull situations as a spontaneous subarachnoid hemorrhage by ruptured cerebral aneurysm, we have analyzed the hormonal secretion profile of the major endocrine axes in the first 24 hours following an acute subarachnoid hemorrhage.…”