MARCIO CARLOS MACHADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/25 - Laboratório de Endocrinologia Celular e Molecular, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/25 - Laboratório de Endocrinologia Celular e Molecular, Hospital das Clínicas, Faculdade de Medicina - Líder
10 resultados
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bookPart Corticotropinomas(2022) MACHADO, Márcio Carlos; FRAGOSO, Maria Candida Barisson VillaresbookPart Síndrome de Cushing(2017) CASTRO, Margaret de; MARTINS, Clarissa; ELIAS, Paula Condé Lamparelli; MACHADO, Marcio Carlos; FRAGOSO, Maria Candida Barrison Villares; MOREIRA, Ayrton Custódio- 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.
- 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.
bookPart Doença de Cushing(2016) MACHADO, Márcio Carlos; FRAGOSO, Maria Candida B. VillaresbookPart Síndrome da secreção hormonal ectópica(2017) FRAGOSO, Maria Cândida Barisson Villares; MACHADO, Márcio Carlos; MENDONçA, Berenice Bilharinho debookPart 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 da hipófise(2015) GLEZER, Andrea; BUENO, Cristina Bellotti Formiga; DUARTE, Felipe Henning Gaia; MACHADO, Marcio Carlos; JALLAD, Raquel; SICKLER, Thais de Paula; BRONSTEIN, Marcello Delano- 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 Doenças da hipófise(2017) GLEZER, Andrea; BUENO, Cristina Bellotti Formiga; DUARTE, Felipe Henning Gaia; MACHADO, Marcio Carlos; JALLAD, Raquel; SICKLER, Thais de Paula; BRONSTEIN, Marcello Delano