MADSON QUEIROZ DE ALMEIDA
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Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/42 - Laboratório de Hormônios e Genética Molecular, Hospital das Clínicas, Faculdade de Medicina
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/42 - Laboratório de Hormônios e Genética Molecular, Hospital das Clínicas, Faculdade de Medicina
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bookPart Aplicações clínicas dos testes genéticos em endocrinologia(2017) SOUZA, Bruno Ferraz de; SILVA, Magnus Régios Dias da; ALMEIDA, Madson Queiroz de; JORGE, Alexander Augusto de LimaconferenceObject A NEW INSIGHT FOR THE TREATMENT OF PRIMARY MACRONODULAR ADRENAL HYPERPLASIA: ADRENAL SPARING SURGERY EARLY OUTCOMES(2017) TANNO, Fabio; SROUGI, Victor; BRONDANI, Vania; ALMEIDA, Madson; MENDONCA, Berenice; SROUGI, Miguel; CHAMBO, Jose; FRAGOSO, Maria- Diagnosis and management of primary aldosteronism(2017) VILELA, Leticia A. P.; ALMEIDA, Madson Q.ABSTRACT Primary aldosteronism (PA) is the most common form of secondary hypertension (HTN), with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential HTN and the same degree of blood pressure elevation. PA is characterized by an autonomous aldosterone production causing sodium retention, plasma renin supression, HTN, cardiovascular damage, and increased potassium excretion, leading to variable degrees of hypokalemia. Aldosterone-producing adenomas (APAs) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The aldosterone-to-renin ratio is the most sensitive screening test for PA. There are several confirmatory tests and the current literature does not identify a “gold standard” confirmatory test for PA. In our institution, we recommend starting case confirmation with the furosemide test. After case confirmation, all patients with PA should undergo adrenal CT as the initial study in subtype testing to exclude adrenocortical carcinoma. Bilateral adrenal vein sampling (AVS) is the gold standard method to define the PA subtype, but it is not indicated in all cases. An experienced radiologist must perform AVS. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist (spironolactone or eplerenone). Cardiovascular morbidity caused by aldosterone excess can be decreased by either unilateral adrenalectomy or mineralocorticoid antagonist. In this review, we address the most relevant issues regarding PA screening, case confirmation, subtype classification, and treatment.
bookPart Diabete insípido(2017) ALMEIDA, Madson QueirozbookPart Tumores corticais da suprarrenal(2017) ALMEIDA, Madson Queiroz; ANTONINI, Sonir Roberto Rauber; FRAGOSO, Maria Candida Barrison Villares- Adjuvant radiotherapy for the primary treatment of adrenocortical carcinoma: are we offering the best?(2017) SROUGI, Victor; BESSA JUNIOR, Jose; TANNO, Fabio Y.; FERREIRA, Amanda M.; HOFF, Ana O.; BEZERRA, Joao E.; ALMEIDA, Cristiane M.; ALMEIDA, Madson Q.; MENDONCA, Berenice B.; NAHAS, William C.; CHAMBO, Jose L.; SROUGI, Miguel; FRAGOSO, Maria C. B. V.Purpose: To evaluate the role of ARDT after surgical resection of ACC. Materials and Methods: Records of patients from our institutional ACC database were retrospectively assessed. A paired comparison analysis was used to evaluate the oncological outcomes between patients treated with surgery followed by ARDT or surgery only (control). The endpoints were LRFS, RFS, and OS. A systematic review of the literature and metaanalysis was also performed to evaluate local recurrence of ACC when ARDT was used. Results: Ten patients were included in each Group. The median follow-up times were 32 months and 35 months for the ARDT and control Groups, respectively. The results for LRFS (p= 0.11), RFS (p= 0.92), and OS (p= 0.47) were similar among subsets. The mean time to present with local recurrence was significantly longer in the ARDT group compared with the control Group (419 +/- 206 days vs. 181 +/- 86 days, respectively; p= 0.03). ARDT was well tolerated by the patients; there were no reports of late toxicity. The meta-analysis, which included four retrospective series, revealed that ARDT had a protective effect on LRFS (HR= 0.4; CI= 0.17-0.94). Conclusions: ARDT may reduce the chance and prolong the time to ACC local recurrence. However, there were no benefits for disease recurrence control or overall survival for patients who underwent this complementary therapy.
- Triple A Syndrome: Preliminary Response to the Antioxidant N-Acetylcysteine Treatment in a Child(2017) FRAGOSO, Maria Candida Barisson Villares; ALBUQUERQUE, Edoarda Vasco de Albuquerque; CARDOSO, Ana Luiza de Almeida; ROSA, Paula Waki Lopes da; PAULO, Rodrigo Bomeny de; SCHIMIZU, Maria Heloisa Massola; SEGURO, Antonio Carlos; PASSARELLI, Marisa; KOEHLER, Katrin; HUEBNER, Angela; ALMEIDA, Madson Q.; LATRONICO, Ana Claudia; ARNHOLD, Ivo Jorge Prado; MENDONCA, Berenice BilharinhoIntroduction: Triple A syndrome (AAAS) is a rare autosomal recessive disorder characterized by alacrima, achalasia, ACTH-resistant adrenal insufficiency, autonomic dysfunction, and progressive neurodegeneration. Increased oxidative stress, demonstrated in patients' fibroblasts in vitro, may be a central disease mechanism. N-acetylcysteine protects renal function in patients with kidney injuries associated with increased oxidative stress and improves viability of AAAS-knockdown adrenal cells in vitro. Patient and Results: A boy diagnosed with AAAS presented with short stature and increased oxidative stress in vivo assessed by increased thiobarbituric acid reactive substances (TBARS), which are markers of lipid peroxidation, and by the susceptibility of LDL to oxidation and the capacity of HDL to prevent it. A homozygous missense germline mutation (c.523G>T, p.Val175Phe) in AAAS was identified. N-acetylcysteine (600 mg orally, twice daily) decreased oxidative stress but did not change the patient's growth pattern. Conclusions: An increase in oxidative stress is reported for the first time in vivo in an AAAS patient. N-acetylcysteine was capable of decreasing TBARS levels, reducing the susceptibility of LDL to oxidation and improving the antioxidant role of HDL. The long-term effect of antioxidant treatment should be evaluated to determine the real benefit for the prevention of the degenerative process in AAAS. (C) 2017 S. Karger AG, Basel
bookPart Crise tireotóxica(2017) DANILOVIC, Debora Lucia Seguro; ALMEIDA, Madson Queiroz de; BRANDãO NETO, Rodrigo Antonio; MARTINS, Herlon SaraivabookPart Hiperplasia adrenal macronodular primária(2017) ALENCAR, Guilherme Asmar; LERARIO, Antonio Marcondes; ALMEIDA, Madson; FRAGOSO, Maria Candida Barisson Villares- Functional pancreatic neuroendocrine tumour causing Cushing's syndrome: the effect of chemotherapy on clinical symptoms(2017) DIVINO, Paulo Henrique do Amor; MARCHETTI, Katia Regina; ALMEIDA, Madson Q.; RIECHELMANN, Rachel P.Background: Neuroendocrine tumours (NETs) are a heterogeneous group of diseases that can originate from any part of the gastrointestinal tract, bronchi, thyroid and pancreas. These tumours may be functioning or not depending on their ability to produce active substances, such as adrenocorticotrophic hormone (ACTH). ACTH-producing pancreatic neuroendocrine tumours are rare, with limited data about effective antitumor therapies. Case Report: A 58-year-old man with a history of type-2 diabetes mellitus and arterial hypertension was diagnosed with Cushing's syndrome (CS) secondary to an ACTH ectopic production from a well-differentiated neuroendocrine tumour of the pancreas metastatic to the liver. The patient underwent initial body-caudal pancreatectomy, splenectomy and hepatic nodulectomy with subsequent recurrence. Hepatic embolisation and somatostatin analogues were used to control CS but without success. Bilateral adrenalectomy led to CS control, while capecitabine and oxaliplatin (CAPOX) was effective in controlling tumour growth and ACTH production. Discussion: ACTH-producing pancreatic neuroendocrine tumours are rare, aggressive and difficult to treat with available therapies. In settings of limited resources, such as in developing countries where targeted therapies are not available, cytotoxic chemotherapy with CAPOX represents a good and inexpensive option to control ACTH-producing pancreatic neuroendocrine tumours. Because of its complexity, the management of this tumour should be performed by multidisciplinary teams.