NINA ROSA DE CASTRO MUSOLINO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Challenges in the diagnosis and management of acromegaly: a focus on comorbidities(2016) ABREU, Alin; TOVAR, Alejandro Pinzon; CASTELLANOS, Rafael; VALENZUELA, Alex; GIRALDO, Claudia Milena Gomez; PINEDO, Alejandro Castellanos; GUERRERO, Doly Pantoja; BARRERA, Carlos Alfonso Builes; FRANCO, Humberto Ignacio; RIBEIRO-OLIVEIRA JR., Antonio; VILAR, Lucio; JALLAD, Raquel S.; DUARTE, Felipe Gaia; GADELHA, Monica; BOGUSZEWSKI, Cesar Luiz; ABUCHAM, Julio; NAVES, Luciana A.; MUSOLINO, Nina Rosa C.; FARIA, Maria Estela Justamante de; ROSSATO, Ciliana; BRONSTEIN, Marcello D.Acromegaly is a rare, insidious disease resulting from the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), and is associated with a range of comorbidities. The extent of associated complications and mortality risk is related to length of exposure to the excess GH and IGF-1, thus early diagnosis and treatment is imperative. Unfortunately, acromegaly is often diagnosed late, when patients already have a wide range of comorbidities. The presence of comorbid conditions contributes significantly to patient morbidity/mortality and impaired quality of life. We conducted a retrospective literature review for information relating to the diagnosis of acromegaly, and its associated comorbidities using PubMed. The main aim of this review is to highlight the issues of comorbidities in acromegaly, and to reinforce the importance of early diagnosis and treatment. Successful management of acromegaly goes beyond treating the disease itself, since many patients are diagnosed late in disease evolution, they present with a range of comorbid conditions, such as cardiovascular disease, diabetes, hypertension, and sleep apnea. It is important that patients are screened carefully at diagnosis (and thereafter), for common associated complications, and that biochemical control does not become the only treatment goal. Mortality and morbidities in acromegaly can be reduced successfully if patients are treated using a multimodal approach with comprehensive comorbidity management.
- Machine Learning-based Prediction Model for Treatment of Acromegaly With First-generation Somatostatin Receptor Ligands(2021) WILDEMBERG, Luiz Eduardo; CAMACHO, Aline Helen da Silva; MIRANDA, Renan Lyra; ELIAS, Paula C. L.; MUSOLINO, Nina R. de Castro; NAZATO, Debora; JALLAD, Raquel; HUAYLLAS, Martha K. P.; MOTA, Jose Italo S.; ALMEIDA, Tobias; PORTES, Evandro; JR, Antonio Ribeiro-Oliveira; VILAR, Lucio; BOGUSZEWSKI, Cesar Luiz; TAVARES, Ana Beatriz Winter; NUNES-NOGUEIRA, Vania S.; MAZZUCO, Tania Longo; RECH, Carolina Garcia Soares Leaes; MARQUES, Nelma Veronica; CHIMELLI, Leila; CZEPIELEWSKI, Mauro; BRONSTEIN, Marcello D.; ABUCHAM, Julio; CASTRO, Margaret de; KASUKI, Leandro; GADELHA, MonicaContext: Artificial intelligence (AI), in particular machine learning (ML), may be used to deeply analyze biomarkers of response to first-generation somatostatin receptor ligands (fg-SRLs) in the treatment of acromegaly. Objective: To develop a prediction model of therapeutic response of acromegaly to fg-SRL. Methods: Patients with acromegaly not cured by primary surgical treatment and who had adjuvant therapy with fg-SRL for at least 6 months after surgery were included. Patients were considered controlled if they presented growth hormone (GH) <1.0 ng/mL and normal age-adjusted insulin-like growth factor (IGF)-I levels. Six AI models were evaluated: logistic regression, k-nearest neighbor classifier, support vector machine, gradient-boosted classifier, random forest, and multilayer perceptron. The features included in the analysis were age at diagnosis, sex, GH, and IGF-I levels at diagnosis and at pretreatment, somatostatin receptor subtype 2 and 5 (SST2 and SST5) protein expression and cytokeratin granulation pattern (GP). Results: A total of 153 patients were analyzed. Controlled patients were older (P = .002), had lower GH at diagnosis (P = .01), had lower pretreatment GH and IGF-I (P < .001), and more frequently harbored tumors that were densely granulated (P=.014) or highly expressed SST2 (P < .001). The model that performed best was the support vector machine with the features SST2, SST5, GP, sex, age, and pretreatment GH and IGF-I levels. It had an accuracy of 86.3%, positive predictive value of 83.3% and negative predictive value of 87.5%. Conclusion: We developed a ML-based prediction model with high accuracy that has the potential to improve medical management of acromegaly, optimize biochemical control, decrease long-term morbidities and mortality, and reduce health services costs.
- Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism(2018) VILAR, Lucio; ABUCHAM, Julio; ALBUQUERQUE, Jose Luciano; ARAUJO, Luiz Antonio; AZEVEDO, Monalisa F.; BOGUSZEWSKI, Cesar Luiz; CASULARI, Luiz Augusto; CUNHA NETO, Malebranche B. C.; CZEPIELEWSKI, Mauro A.; DUARTE, Felipe H. G.; FARIA, Manuel dos S.; GADELHA, Monica R.; GARMES, Heraldo M.; GLEZER, Andrea; GURGEL, Maria Helane; JALLAD, Raquel S.; MARTINS, Manoel; MIRANDA, Paulo A. C.; MONTENEGRO, Renan M.; MUSOLINO, Nina R. C.; NAVES, Luciana A.; RIBEIRO-OLIVEIRA JUNIOR, Antonio; SILVA, Cintia M. S.; VIECCELI, Camila; BRONSTEIN, Marcello D.Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called ""hook effect"". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.
article 21 Citação(ões) na Scopus Recommendations of Neuroendocrinology Department from Brazilian Society of Endocrinology and Metabolism for Diagnosis and Treatment of Acromegaly in Brazil(2011) VIEIRA NETO, Leonardo; ABUCHAM, Julio; ARAUJO, Luiz Antonio de; BOGUSZEWSKI, Cesar L.; BRONSTEIN, Marcello D.; CZEPIELEWSKI, Mauro; JALLAD, Raquel S.; MUSOLINO, Nina R. de C.; NAVES, Luciana A.; RIBEIRO-OLIVEIRA JUNIOR, Antonio; VILAR, Lucio; FARIA, Manuel dos S.; GADELHA, Monica R.article 13 Citação(ões) na Scopus Recommendations of Neuroendocrinology Department from Brazilian Society of Endocrinology and Metabolism for diagnosis and treatment of acromegaly in Brazil(2011) VIEIRA NETO, Leonardo; ABUCHAM, Julio; ARAUJO, Luiz Antonio de; BOGUSZEWSKI, Cesar L.; BRONSTEIN, Marcella D.; CZEPIELEWSKI, Mauro; JALLAD, Raquel S.; MUSOLINO, Nina R. de C.; NAVES, Luciana A.; RIBEIRO-OLIVEIRA JUNIOR, Antonio; VILAR, Lucio; FARIA, Manuel dos S.; GADELHA, Monica R.Acromegaly is a disease associated with increased morbidity and reduced life expectancy. Because of its insidious character and its non-recognition, the diagnosis is often made with delay, which, along with the complications related to GH/IGF-I excess, determines high morbidity and mortality. However, an early diagnosis and an effective treatment reduce the morbidity and normalize the mortality rate. In this publication, the goal of Neuroendocrinology Department from Brazilian Society of Endocrinology and Metabolism is to disclose which clinical set should arouse the suspicious of acromegaly and how to diagnose it. Furthermore, we discuss the most effective and safe approach to perform the treatment of acromegaly, emphasizing that it must be carried out in reference centers. Therefore, based on data published in journals with recognized scientific level and authors' experience, recommendations are presented for diagnosis and treatment of the disease. Arq Bias Endocrinol Metab. 2011;55(2):91-105- Brazilian multicenter study on pegvisomant treatment in acromegaly(2019) BOGUSZEWSKI, Cesar L.; HUAYLLAS, Martha Katherine P.; VILAR, Lucio; NAVES, Luciana Ansaneli; RIBEIRO-OLIVEIRA JUNIOR, Antonio; SOARES, Beatriz Santana; CZEPIELEWSKI, Mauro Antonio; ABUCHAM, Julio; CORREA-SILVA, Silvia Regina; BRONSTEIN, Marcello Delano; JALLAD, Raquel Soares; DUARTE, Felipe Gaia; MUSOLINO, Nina Rosa; KASUKI, Leandro; GADELHA, Monica RobertoObjective: Investigate the therapeutic response of acromegaly patients to pegvisomant (PEGV) in a real-life, Brazilian multicenter study. Subjects and methods: Characteristics of acromegaly patients treated with PEGV were reviewed at diagnosis, just before and during treatment. All patients with at least two IGF-I measurements on PEGV were included. Efficacy was defined as any normal IGF-I measurement during treatment. Safety data were reviewed. Predictors of response were determined by comparing controlled versus uncontrolled patients. Results: 109 patients [61 women; median age at diagnosis 34 years; 95.3% macroadenomas] from 10 Brazilian centers were studied. Previous treatment included surgery (89%), radiotherapy (34%), somatostatin receptor ligands (99%), and cabergoline (67%). Before PEGV, median levels of GH, IGF-I and IGF-I % of upper limit of normal were 4.3 mu g/L, 613 ng/mL, and 209%, respectively. Pre-diabetes/diabetes was present in 48.6% and tumor remnant in 71% of patients. Initial dose was 10 mg/day in all except 4 cases, maximum dose was 30 mg/day, and median exposure time was 30.5 months. PEGV was used as monotherapy in 11% of cases. Normal IGF-I levels was obtained in 74.1% of patients. Glycemic control improved in 56.6% of patients with pre-diabetes/diabetes. Exposure time, pre-treatment GH and IGF-I levels were predictors of response. Tumor enlargement occurred in 6.5% and elevation of liver enzymes in 9.2%. PEGV was discontinued in 6 patients and 3 deaths unrelated to the drug were reported. Conclusions: In a real-life scenario, PEGV is a highly effective and safe treatment for acromegaly patients not controlled with other therapies.