MARCELLO DELANO BRONSTEIN
Projetos de Pesquisa
Unidades Organizacionais
LIM/25 - Laboratório de Endocrinologia Celular e Molecular, Hospital das Clínicas, Faculdade de Medicina
25 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 25
conferenceObject Phase III, Multicenter, Randomized Study (PAOLA) Demonstrating That Pasireotide LAR Has Superior Efficacy over Octreotide LAR and Lanreotide ATG in Patients with Inadequately Controlled Acromegaly(2014) COLAO, Annamaria; BRONSTEIN, Marcello D.; BRUE, Thierry; COCULESCU, Mihail Gr; FLESERIU, Maria; GUITELMAN, Mirtha; PRONIN, Vyacheslav; RAVEROT, Gerald; SHIMON, Ilan; LIEVRE, Kayo Kodama; FLECK, Juergen; AOUT, Mounir; PEDRONCELLI, Alberto M.; GADELHA, MA'nica- Women with prolactinomas presented at the postmenopausal period(2014) SHIMON, Ilan; BRONSTEIN, Marcello D.; SHAPIRO, Jonathan; TSVETOV, Gloria; BENBASSAT, Carlos; BARKAN, ArielIn women, prolactinomas (mainly microprolactinomas) are commonly diagnosed between 20-40-year old. In postmenopausal women, prolactinomas are rarely encountered and usually do not present with hyperprolactinemia-related symptoms as these are dependent on intact ovarian function. Therefore, the true incidence of prolactin (PRL)-secreting adenomas in postmenopausal woman is unknown. Our study objective was to characterize these rare and unique pituitary tumors. A retrospective study including a consecutive group of postmenopausal women followed and treated at 3 Endocrine academic clinics. Baseline clinical characteristics (PRL and gonadotropins levels, other pituitary hormones, adenoma size and invasiveness, visual fields) and response to treatment are reported. The cohort included 14 postmenopausal women with prolactinomas (mean age at diagnosis, 63.6 +/- A 7.1 years; range, 54-75 years). Mean adenoma size at presentation was 25.6 +/- A 12.4 mm (range, 8-50 mm). Six out of the 14 women had significant visual fields damage. Mean baseline PRL level was 1,783 ng/ml, and median PRL was 827 ng/ml (range, 85-6,732 ng/ml). Medical treatment with cabergoline was given to twelve of the patients. Cabergoline normalized/near-normalized PRL in eleven women; one woman was dopamine agonist-resistant. Five of the six subjects with visual disturbances normalized or improved their vision, and a pre-treatment diplopia in another patient disappeared. Two large pituitary tumors disappeared on MRI following long-term dopamine agonist therapy. All other treated prolactinomas, except the resistant adenoma, shrank following medical treatment. Prolactinomas are rarely diagnosed in postmenopausal women. These women usually harbor large and invasive macroadenomas, secreting high PRL levels, and usually respond to dopamine agonist treatment.
- Penetrance of Functioning and Nonfunctioning Pancreatic Neuroendocrine Tumors in Multiple Endocrine Neoplasia Type 1 in the Second Decade of Life(2014) GONCALVES, Tatiana D.; TOLEDO, Rodrigo A.; SEKIYA, Tomoko; MATUGUMA, Sergio E.; MALUF FILHO, Fauze; ROCHA, Manoel S.; SIQUEIRA, Sheila A. C.; GLEZER, Andrea; BRONSTEIN, Marcelo D.; PEREIRA, Maria A. A.; JUREIDINI, Ricardo; BACCHELLA, Telesforo; MACHADO, Marcel C. C.; TOLEDO, Sergio P. A.; LOURENCO JR., Delmar M.Context: Data are scarce on the penetrance of multiple endocrine neoplasia type 1 (MEN1)-related nonfunctioning pancreatic neuroendocrine tumors (NF-PETs) and insulinomas in young MEN1 patients. Apotential positive correlation between tumor size and malignancy (2-3 cm, 18%; >3 cm, 43%) has greatly influenced the management of MEN1 adults with NF-PETs. Objective: The aim of the study was to estimate the penetrance of NF-PETs, insulinomas, and gastrinomas in young MEN1 carriers. Design: The data were obtained from a screening program (1996-2012) involving 113 MEN1 patients in a tertiary academic reference center. Patients: Nineteen MEN1 patients (aged 12-20 y; 16 patients aged 15-20 y and 3 patients aged 12-14 y) were screened for NF-PETs, insulinomas, and gastrinomas. Methods: Magnetic resonance imaging/computed tomography and endoscopic ultrasound (EUS) were performed on 10 MEN1 carriers, magnetic resonance imaging/computed tomography was performed on five patients, and four other patients underwent an EUS. Results: The overall penetrance of PETs during the second decade of life was42%(8 of 19). All eight PET patients had NF-PETs, and half of those tumors were multicentric. One-fifth of the screened patients (21%; 4 of 19) harbored at least one large tumor (>2.0 cm). Insulinoma was detected in two NF-PET patients (11%) at the initial screening; gastrinoma was not present in any cases. Six of the 11 (54%) screened patients aged 15-20 years who underwent an EUS had NF-PETs. Potential false-positive EUS results were excluded based on EUS-guided biopsy results, the reproducibility of the NF-PET findings, or the observation of increased tumor size during follow-up. Distal pancreatectomy and the nodule enucleation of pancreatic head tumors were conducted on three patients with large tumors (>2.0 cm; T2N0M0) that were classified as grade 1 neuroendocrine tumors (Ki-67 < 2%). Conclusions: Our data demonstrated high penetrance of NF-PETs in 15- to 20-year-old MEN1 patients. The high percentage of the patients presenting consensus criteria for surgery for NF-PET alone or NF-PET/insulinoma suggests a potential benefit for the periodic surveillance of these tumors in this age group.
conferenceObject Long-Term Follow-up of Cabergoline Treatment in Occult Ectopic Acth Syndrome(2014) CACCELLI, Milena; FRAGOSO, Maria Candida B. V.; MALVEIRA, Ludmila; BRONSTEIN, Marcello D.; MACHADO, Marcia CarlosconferenceObject Sagit (c): A Novel Comprehensive Clinical Practice Tool for Managing Acromegaly(2014) GIUSTINA, Andrea; BEVAN, John S.; BRONSTEIN, Marcello D.; CASANUEVA, Felipe F.; CHANSON, Philippe; PETERSENN, Stephan; Xuan-Mai Truong Thanh; MASSIEN, Christine; DIAS-BARBOSA, Carla; GUILLEMIN, Isabelle; ARNOULD, Benoit; MELMED, ShlomoconferenceObject Impact of Clomiphene Citrate on IGF-1 and Testosterone Levels in Acromegalic Patients Non Controlled By Conventional Therapy(2014) DUARTE, Felipe H. G.; JALLAD, Raquel S.; BRONSTEIN, Marcello D.conferenceObject Dramatic Size Reduction with Primary Pharmacological Therapy of a Giant Pituitary Macroadenoma in an Acromegalic Patient(2014) MIRANDA, Mirela Costa de; NAKAGUMA, Marilena; DUARTE, Felipe H. G.; JALLAD, Raquel S.; BRONSTEIN, Marcello D.- Pasireotide Versus Octreotide in Acromegaly: A Head-to-Head Superiority Study(2014) COLAO, A.; BRONSTEIN, M. D.; FREDA, P.; GU, F.; SHEN, C. -C.; GADELHA, M.; FLESERIU, M.; LELY, A. J. van der; FARRALL, A. J.; RESENDIZ, K. Hermosillo; RUFFIN, M.; CHEN, Y.; SHEPPARD, M.Context: Biochemical control reduces morbidity and increases life expectancy in patients with acromegaly. With current medical therapies, including the gold standard octreotide long-acting-release (LAR), many patients do not achieve biochemical control. Objective: Our objective was to demonstrate the superiority of pasireotide LAR over octreotide LAR in medically naive patients with acromegaly. Design and Setting: We conducted a prospective, randomized, double-blind study at 84 sites in 27 countries. Patients: A total of 358 patients with medically naive acromegaly (GH > 5 mu g/L or GH nadir >= 1 mu g/L after an oral glucose tolerance test (OGTT) and IGF-1 above the upper limit of normal) were enrolled. Patients either had previous pituitary surgery but no medical treatment or were de novo with a visible pituitary adenoma on magnetic resonance imaging. Interventions: Patients received pasireotide LAR 40 mg/28 days (n = 176) or octreotide LAR 20 mg/28 days (n = 182) for 12 months. At months 3 and 7, titration to pasireotide LAR 60 mg or octreotide LAR 30 mg was permitted, but not mandatory, if GH >= 2.5 mu g/L and/or IGF-1 was above the upper limit of normal. Main Outcome Measure: The main outcome measure was the proportion of patients in each treatment arm with biochemical control (GH <2.5 mu g/L and normal IGF-1) at month 12. Results: Biochemical control was achieved by significantly more pasireotide LAR patients than octreotide LAR patients (31.3% vs 19.2%; P = .007; 35.8% vs 20.9% when including patients with IGF-1 below the lower normal limit). In pasireotide LAR and octreotide LAR patients, respectively, 38.6% and 23.6% (P = .002) achieved normal IGF-1, and 48.3% and 51.6% achieved GH <2.5 mu g/L. 31.0% of pasireotide LAR and 22.2% of octreotide LAR patients who did not achieve biochemical control did not receive the recommended dose increase. Hyperglycemia-related adverse events were more common with pasireotide LAR (57.3% vs 21.7%). Conclusions: Pasireotide LAR demonstrated superior efficacy over octreotide LAR and is a viable new treatment option for acromegaly.
conferenceObject Phase III, Multicenter, Randomized Study (PAOLA) Demonstrating That Pasireotide LAR Has Superior Efficacy over Octreotide LAR and Lanreotide ATG in Patients with Inadequately Controlled Acromegaly(2014) COLAO, Annamaria; BRONSTEIN, Marcello D.; BRUE, Thierry; COCULESCU, Mihail Gr; FLESERIU, Maria; GUITELMAN, Mirtha; PRONIN, Vyacheslav; RAVEROE, Gerald; SHIMON, Ilan; LIEVRE, Kayo Kodama; FLECK, Juergen; AOUT, Mounir; PEDRONCELLI, Alberto M.; GADELHA, MA'nica- Challenges and pitfalls in the diagnosis of hyperprolactinemia(2014) VILAR, Lucio; FLESERIU, Maria; BRONSTEIN, Marcello D.The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population.
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