Livros e Capítulos de Livros - LIM/25
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A coleção de Livros e Capítulos de Livros reúne capítulos e resumos de obras produzidas por autores do sistema FMUSP-HC que inclui a Faculdade de Medicina da Universidade de São Paulo (FMUSP), o Hospital das Clínicas da FMUSP e demais institutos associados.
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- Acromegaly: Preconception Management(2022) JALLAD, R. S.; BRONSTEIN, M. D.Family planning is an important component of the medical care for women with acromegaly. For women desiring fertility, preconception counseling should be offered to address the potential risks to the mother and fetus. The optimal time to conceive depends on disease control and the need for treatments used to manage acromegaly. Preconception evaluation also entails screening for comorbidities and managing them appropriately. We present a case of a woman with a growth hormone (GH)-secreting tumor who aims to conceive and summarize the pathophysiology and best standards regarding preconception management in this population of patients. © Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are reserved.
- Hyperprolactinemia(2022) GLEZER, A.; BRONSTEIN, M. D.Prolactin (PRL) is a hormone best known by its function for preparing mammary glands for lactation and for inducing hypogonadism in the postpartum period, essential for directing mother care toward the newborn. In clinical practice, hyperprolactinemia is an important cause of hypogonadism and infertility, especially among young women, and the correct diagnosis is essential for the proper therapeutic management. In addition to this well-established role of PRL, there are more than 300 known autocrine and paracrine functions in different species, mainly related to fluid balance, growth, immunoregulation, and protection and, more recently, related to tumorigenesis. In this chapter, we discuss the classical actions of PRL, the pathophysiology of hyperprolactinemia, and its differential diagnosis and treatment. © Springer Nature Switzerland AG 2022.
- Idiopathic Short Stature: Diagnostic and Therapeutic Approach(2022) CANTON, A. P. M.; JORGE, A. A. L.Our clinical case for discussion is about a short statured boy who was 14.6 years old at his first evaluation. He was born after a 39-week gestation as the third child of a non-consanguineous marriage. His birth weight was 3.250 g (-0.3 SDS), and his birth length was not available. His neuropsychomotor development was normal, his school performance was good, and there were no remarkable findings in his medical history. His father’s height was 174 cm (-0.1 SDS), and his mother’s height was 154 cm (-1.3 SDS), resulting in a target height of 170.6 cm (-0.6 SDS). His father and mother apparently had normal pubertal development, and his mother’s age of menarche was 13 years old. His older brother’s height was not available, but he had a previous history of pubertal spurt after 16 years of age. Likewise, his older sister’s height was also not available, but she had a previous history of menarche at 14. © Springer Nature Switzerland AG 2022.
bookPart Crise tireotóxica(2017) DANILOVIC, Debora Lucia Seguro; ALMEIDA, Madson Queiroz de; BRANDãO NETO, Rodrigo Antonio; MARTINS, Herlon SaraivabookPart Estado mixedematoso(2017) DANILOVIC, Debora Lucia Seguro; ALMEIDA, Madson Queiroz de; BRANDãO NETO, Rodrigo Antonio; MARTINS, Herlon SaraivabookPart Bócio e cretinismo endêmico: moléstias associadas à carência crônica de iodo(2017) MEDEIROS-NETO, GeraldobookPart Doenças da hipófise(2023) GLEZER, Andrea; BUENO, Cristina Bellotti Formiga; DUARTE, Felipe Henning Gaia; MACHADO, Marcio Carlos; JALLAD, Raquel; SICKLER, Thais de Paula; BRONSTEIN, Marcello DelanobookPart Doenças osteometabólicas(2023) BRAZ, Manuela Giuliani Marcondes RochabookPart Diabetes mellitus na criança e no adolescente(2023) MANNA, Thais Della; BEZERRA, Milena Gurgel TelesbookPart Tireoide(2023) MARUI, Suemi; BRITO, Luciana Pinto- Pituitary Disorders During Pregnancy and Lactation(2020) JALLAD, R. S.; GLEZER, A.; MACHADO, M. C.; BRONSTEIN, M. D.The presence of a pituitary adenoma may affect the course of pregnancy, as the hormonal changes related to these tumors may lead to early termination of pregnancy due to failure to implant or maintain the conceptus or early embryo. The age-adjusted incidence rate of pituitary adenomas is estimated to be 3.4 cases per 100,000 inhabitants per year. They are usually benign adenomas, with a peak incidence in young women of childbearing age. The management of pituitary adenomas during pregnancy depends on its clinical presentation and should be adapted to the individual case. Most pregnant women with pituitary adenomas can be safely observed with frequent neuro-ophthalmologic assessments and MRI, if needed. Among women with pituitary adenomas, prolactin (PRL)-secreting pituitary adenomas (prolactinomas) are the most common. Dopamine agonists (DAs) are the gold standard treatment for prolactinomas; they normalize serum PRL levels, leading to tumor shrinkage in more than 80% of cases and restoration of eugonadism. In micro- and intrasellar macroprolactinomas, DA is usually withdrawn when pregnancy is confirmed. In pregnant women with acromegaly, hormonal control is often achieved in most patients, allowing the withdrawal of clinical treatment. Due to similar clinical features and changes in the hypothalamic-pituitary-adrenal (HPA) axis during pregnancy, the diagnosis of Cushing disease (CD) during gestation can be difficult. Similar to nonpregnant women, surgery is the first treatment option for CD during pregnancy, if complications develop. Overall, pregnancy in women harboring clinically nonfunctioning tumors is a rare event. Causes of hypopituitarism that are most specific to pregnancy include lymphocytic hypophysitis and postpartum pituitary infarction (Sheehan’s syndrome). During pregnancy, the priority for hormonal replacement should be glucocorticoid, followed by thyroid hormone. Doses should be adjusted throughout pregnancy based on the severity and nature of the condition. For this reason, it is necessary to follow these patients regularly and closely during pregnancy. Central or nephrogenic diabetes insipidus (DI) can also be observed during pregnancy. Therefore, a detailed medical history is essential for the differential diagnoses of DI. Primary polydipsia and head trauma should be excluded. Ingestion of drugs such as lithium, mannitol, diuretics, and anticholinergic drugs should be questioned. Management of pituitary disease during pregnancy in otherwise healthy women poses difficult challenges from various perspectives. However, a multidisciplinary approach, involving the endocrinologist, obstetrician, neurosurgeon, and anesthesiologist, will allow a better outcome for both mother and fetus during pregnancy. © 2020 Elsevier Inc. All rights reserved.
- Management of pituitary tumors in pregnancy(2021) GLEZER, A.; JALLAD, R. S.; MACHADO, M. C.; BRONSTEIN, M. D.In patients harboring pituitary tumors, hormonal hypersecretion (prolactin, growth hormone, and cortisol), pituitary stalk disconnection, and direct pituitary damage may impair gonadal axis, leading to infertility. Fortunately, the advances in medical and surgical treatments, as well as in human reproduction techniques, increased pregnancy rates in women bearing pituitary tumors. As pituitary tumors are usually diagnosed before pregnancy, hormonal hypersecretion and tumor dimensions should be controlled before conception, minimizing maternal-fetal comorbidities. Physiologic changes in pituitary-target gland axis in normal pregnancy may lead to misdiagnosis of pituitary tumors. Additionally, there are peculiarities in follow-up and medical management of pituitary tumors during pregnancy. Lactation can be allowed depending on clinical treatment instituted. Finally, tumor status must be reevaluated after delivery as tumor remission can occur, especially in prolactinomas. © 2021 Elsevier Inc. All rights reserved.
bookPart 0 Citação(ões) na Scopus Hormonal influence in neurofibromatosis type 1-associated neurofibromas(2012) CUNHA, K. S. G.; BRONSTEIN, M.; MEZITIS, S.; GELLER, M.One of the main clinical manifestations of Neurofibromatosis type 1 (NF1) is the development of multiple neurofibromas. It has been suggested that loss of heterozygosity (LOH) of the NF1 gene in Schwann cells represents the first step in the development of NF1-associated neurofibromas. Beyond mutations of the NF1 gene, numerous additional factors probably influence neurofibroma formation and growth. Periods of hormonal changes (puberty and pregnancy) have been correlated with an increase in number and growth rate of discrete neurofibromas, and also with malignant transformation of plexiform neurofibromas. Research advances have been made in elucidating the hormonal influence in neurofibromas of NF1. Most of the studies developed to date focused on the study of steroid hormones, mainly sex steroid hormones, on the development of neurofibromas. It seems that progesterone and androgen are responsible, at least in part, for the alterations observed in neurofibromas during periods of hormonal changes. The investigations of the influence of growth hormone (GH) in neurofibromas are still in their initial steps, but it is known that the majority of NF1-associated neurofibromas express GH receptor and also insulin-like growth factor 1 (IGF-1) receptor. Current knowledge suggests that selective hormone receptor could be useful for the treatment of NF1-associated neurofibromas. © 2012 by Nova Science Publishers, Inc. All rights reserved.- Disorders of Prolactin Secretion and Prolactinomas(2015) BRONSTEIN, M. D.
- The Pituitary Gland in Pregnancy(2022) GLEZER, A.; BRONSTEIN, M. D.During pregnancy, pituitary morphology and function are modified by placental hormonal secretion. Pituitary volume is increased due to lactotroph hypertrophy and hyperplasia. Placental sex steroids inhibit GnRH and gonadotropin secretion. The placenta secretes a variant isoform of GH, increasing IGF-1 levels. TSH secretion decreases in the first trimester, secondary to thyroid stimulation by human chorionic gonadotropin. Hepatic production of thyroid-binding globulin is stimulated by estrogens, increasing total T4 and T3. Placental CRH stimulates pituitary and placental ACTH, increasing cortisol levels throughout pregnancy. Infertility is common in patients harboring pituitary tumors. Pathophysiology includes hormonal hypersecretion and tumoral mass effect. Hypopituitarism can also result from surgery and/or radiotherapy for pituitary adenoma treatment. Hyperprolactinemia, occurring in prolactinomas, the most common subtype of pituitary adenomas, and other pituitary tumors, inhibits GnRH pulsatility. Different mechanisms seem to play a role in hypogonadism of patients harboring acromegaly: tumoral gonadotroph compression, hyperprolactinemia, and GH/IGF-1 excess disrupting gonadal axis. In Cushing's disease, hypogonadism is mainly due to the negative impact of hypercortisolism and hyperandrogenism in the gonadotrophic axis. Clinically nonfunctioning pituitary tumors seldom are associated with pregnancy. In pituitary adenomas, treatment is often necessary to control hormonal hypersecretion and tumor mass effect related to infertility. Other causes of infertility include lymphocytic hypophysitis and Sheehan's syndrome. This chapter reviews the pathophysiology, diagnosis, and therapeutic approaches for women with pituitary diseases, before and during pregnancy, in order to induce fertility and avoid the deleterious effects of hormonal hyper- or hyposecretion. © 2022 Elsevier Inc. All rights reserved.
- Pituitary Physiology During Pregnancy and Lactation(2020) JALLAD, R. S.; GLEZER, A.; MACHADO, M. C.; BRONSTEIN, M. D.Pregnancy promotes a physiologic increase in the size of the maternal pituitary gland, especially the adenohypophysis, mainly due to estrogenic stimulation of lactotrophs. Prolactin promotes mammary gland differentiation and ensures milk production after delivery. Hyperprolactinemia inhibits gonadotrophin secretion. Placental growth hormone has a key role in the maternal adaptation, being closely related to fetal growth, and is a potential candidate to mediate insulin resistance observed in late pregnancy. Normal gestation is considered a state of hypercortisolism due to physiological activation of the hypothalamic-pituitary-adrenal axis. Although important changes in the physiology of the pituitary-thyroid axis occur, mainly due to the increase in chorionic gonadotrophin and thyroxin-binding globulin levels, the normal pregnant woman usually remains euthyroid. Gonadotrophin secretion is inhibited, preventing the stimulation of new ovarian follicles and, consequently, ovulation throughout the gestation period. The increase in antidiuretic hormone during pregnancy is balanced by placental vasopressinase activity, keeping plasma levels similar to that in nonpregnant subjects. Serum oxytocin concentrations gradually increase during gestation and reach peak values during labor. In conclusion, pregnancy is a state of integration of three complex and physiological neuroendocrine compartments: maternal, placental, and fetal. Each plays a critical role in maintaining the health of the embryo/fetus, placenta, and mother up to delivery. © 2020 Elsevier Inc. All rights reserved.
- Growth failure and experience with growth hormone therapy in noonan syndrome(2019) MALAQUIAS, A. C.; JORGE, A. A. L.Noonan syndrome (NS, OMIM 163950) is a frequent autosomal dominant disorder characterized by facial dysmorphisms, short stature, and congenital heart defects. Mutations related to RAS/MAPK (mitogen-activated protein kinase) signaling pathway have shown to be involved in the pathogenesis of NS as well as Noonan-like syndromes (NLS). These mutations are predicted to be gain-of-function defects increasing signaling down the RAS/MAPK pathway. Several hormones act through receptors that stimulate the RAS/MAPK pathway, and therefore, NS and related disorders present implications in different endocrine systems, including the GH/IGF-1 system. Additionally, adult height of NS patients has shown improvement after recombinant human growth hormone (rhGH) treatment. In this chapter, we review the diagnostic, clinical, and molecular aspects of NS and rhGH treatment of short stature in these patients. © 2019 Elsevier Inc. All rights reserved.
- Growth defects in noonan syndrome(2012) MALAQUIAS, A. C.; JORGE, A. A. L.Noonan syndrome is one of the most common syndromes transmitted by a Mendelian mode and is mainly characterized by dysmorphic facial features, congenital heart disease, and proportionate postnatal short stature. In recent years, germline mutations that affect components of the RAS/MAPK (mitogen-activated protein kinase) pathway as PTPN11, KRAS, SOS1, and RAF1 genes were shown to be involved in the pathogenesis of Noonan syndrome as well as of four rare syndromes with phenotype overlapping with Noonan syndrome: LEOPARD syndrome, cardiofaciocutaneous syndrome, Costello syndrome, and neurofibromatosis type 1. These mutations are predicted to be gain-of-function defects increasing signaling down the RAS/MAPK pathway. Some genotype-phenotype correlation has been reported in Noonan syndrome patients, allowing screening for mutations in Noonan syndrome-related genes based on clinical signs. Several hormones act through receptors that stimulate the RAS/MAPK pathway, and therefore, Noonan syndrome and related disorders represent a remarkable opportunity to study the implication of the RAS/MAPK pathway in different endocrine systems, including the GH/IGF-1 system. Additionally, similarly to Turner syndrome, growth velocity and final height of Noonan syndrome patients can be improved by recombinant human growth hormone treatment. In this chapter, we review the diagnostic, clinical, and molecular aspects of Noonan syndrome and rhGH treatment of short stature in these patients. © Springer Science+Business Media, LLC 2012. All rights reserved.
- Body weight, metabolism, and clock genes(2014) ZANQUETTA, M. M.; CORRêA-GIANNELLA, M. L.; MONTEIRO, M. B.; VILLARES, S. M. F.3.1 INTRODUCTION The prevalence of obesity is growing rapidly, affecting all ages and social classes, despite all scientific efforts to clarify its causes. Excess body weight has become one of the biggest health issues today, and is principally due to increased food availability, high caloric diets and sedentary lifestyles. Recent studies have shown the importance of new discoveries regarding the intracellular mechanisms which can trigger obesity and other metabolic disturbances. © 2015 by Apple Academic Press, Inc.
- Iodine-Deficiency Disorders(2015) MEDEIROS-NETO, G.; RUBIO, I. G. S.