Daniela Fedrizzi

Cardiovascular disturbances in acromegaly

Acromegaly causes a number of disorders in the cardiovascular system, resulting from chronic exposure to high levels of GH and IGF-1. Such disorders are the main responsible for increased mortality rates among acromegalic patients. Among several forms of cardiovascular impairment is acromegalic cardiomyopathy, an entity that is initially characterized by a hyperdynamic state, followed by concentric left ventricular hypertrophy and diastolic dysfunction due to relaxation deficit, culminating in systolic dysfunction and sometimes heart failure. In addition, arrhythmias and heart valve diseases are also relevant, especially mitral and aortic, ischemic heart disease, hypertension, and glucose and lipid metabolism disorders. This review approaches the main clinical and prognostic aspects of these entities, the effects of acromegaly treatment on them, and the respective consequences on patient survival.

Hypertension-related factors in patients with active and inactive acromegaly

INTRODUCTION There are several complications of the cardiovascular system caused by acromegaly, especially hypertension. OBJECTIVES To evaluate hypertension characteristics in patients with cured/controlled acromegaly and with the active disease. PATIENTS AND METHODS Cross-sectional study of the follow-up of forty-four patients with acromegaly submitted to clinical evaluation, laboratory tests and cardiac ultrasound. Patients with cured and controlled disease were evaluated as one group, and individuals with active disease as second one. RESULTS Forty-seven percent of the patients had active acromegaly, and these patients were younger and had lower blood pressure levels than subjects with controlled/cured disease. Hypertension was detected in 50% of patients. Subjects with active disease showed a positive correlation between IGF-1 and systolic and diastolic blood pressure levels (r = 0.48, p = 0.03; and r = 0.42, p = 0.07, respectively), and a positive correlation between IGF-1 and urinary albumin excretion (UAE) rates. In patients with active disease, IGF-1 was a predictor of systolic blood pressure, although it was not independent of UAE rate. For individuals with cured/controlled disease, waist circumference and triglycerides were the predictors associated with systolic and diastolic blood pressure. CONCLUSIONS Blood pressure (BP) levels in patients with active acromegaly dependent of the GH excess. However, once thedisease becomes controlled and IGF-1 levels decrease, their blood pressure levels are depend on the other cardiovascular riskfactors [corrected].

Diabetes mellitus in a cohort of patients with acromegaly

OBJECTIVES To evaluate the presence of diabetes mellitus (DM) in a cohort of patients with acromegaly. METHODS This was a cross sectional study. RESULTS Fifty-eight acromegalic patients were assessed. Only 29% met the criteria for cure, and 27% had the disease controlled. Twenty-two had DM; HbA1c was equal to 7.34 ± 2.2%. Most of the diabetic patients (18 out of 22, 82%) did not meet criteria for cure. They were more often hypertensive [16/22 (73%) vs. 17/36 (46%), p = 0.04], and used statins more frequently [14/22 (64%) vs. 8/36 (21%), p = 0.004]. After regression analysis, hypertension was associated with diabetes [odds ratio (OR): 9.28 (95% CI: 1.59 - 54.00), p = 0.01], and cured/ controlled acromegaly was associated with protection against the presence of diabetes [OR: 0.17 (95% CI: 0.03 - 0.78), p = 0.02]. CONCLUSIONS The presence of DM was associated with active acromegaly and presence of hypertension. However, absolute levels of GH and IGF-1 did not differ between patients with and without diabetes.

Severe HDL-c reduction during rosiglitazone therapy in an obese woman with type 2 diabetes

Treatment with rosiglitazone has been associated with severe paradoxical HDL-c reductions. To our knowledge, there are very few reports of this reaction occurring when patients are treated without the combination of a fibrate. A case of severe HDL-c lowering in a patient treated with rosiglitazone without a fibrate is presented. The patient has been treated at a private practice clinic in southern Brazil. A 64-year-old woman with a 2-year history of type 2 diabetes mellitus was referred to her endocrinologist in June 2008. Rosiglitazone 4 mg q.d. was prescribed. Nine months later, the patient experienced a 90.90% decrease of her HDL-c levels. Rosiglitazone was withdrawn and the HDL-c returned to baseline. This paradoxical HDL-c reduction is a potentially severe adverse event. Patients prescribed rosiglitazone should have their HDL-c levels measured before and during therapy.

Reação granulomatosa do tipo corpo estranho simulando tumor de parede torácica em cicatriz de toracotomia prévia

A male patient presented with a painless, slowly-growing chest wall mass in the site corresponding to the surgical wound of a previous thoracotomy for correction of aortic coarctation done fifteen years before. Chest CT scan showed tumor-like lesions with well-defined edges and osteolysis of the adjacent ribs. The patient was submitted to a chest wall resection and reconstruction, whose histological examination showed granular histiocytes and granulomatous reaction to necrohemorragic material. This is a rare event on medical practice. A review of the subject has been done in the literature.