Miriam da Costa Oliveira

Precocious puberty due to human chorionic gonadotropin secreting germinoma

This study aims to report a rare case of precocious puberty (PP) due to a human chorionic gonadotropin (hCG)-producing germinoma located in the suprasellar region. A 10-year-old male patient presented with sexual precocity, headache, drowsiness, loss of appetite, and papilledema. Significant acceleration of bone age in relation to chronological age, high serum total testosterone levels, and hypopituitarism (unresponsiveness to stimulation test) were observed. Magnetic resonance imaging (MRI) of the brain showed a large suprasellar tumor and triventricular dilatation. High hCG levels were found in both blood and cerebrospinal fluid. Hormone replacement therapy and transcranial surgery associated with radiotherapy were performed, with complete regression of sexual characteristics and normal laboratory tests post-operatively. Clinical and laboratory findings, in addition to MRI scans, led to the diagnosis of an hCG-producing tumor and PP, which represents a rare report in the literature.

NUTRITIONAL AND METABOLIC ASSESSMENT IN OVERWEIGHT PATIENTS WITH AND WITHOUT HYPERPROLACTINEMIA CAUSED BY PROLACTINOMA.

INTRODUCTION prolactinomas are pituitary adenomas that express and secrete prolactin. These patients are overweight and the mechanisms are being studied. GOALS assess nutritional and metabolic status of overweight patients with and without hyperprolactinemia caused by prolactinoma and compare them. MATERIALS AND METHODS cross-sectional study, patients with body mass index (BMI) ≥ 25 kg/m2 with and without prolactinoma: 1) 20 normoprolactinemic (NPrl) with prolactinoma; 2) 23 hyperprolactinemic (HPrl) with prolactinoma; 3) 28 controls without prolactinoma or alterations in prolactin levels. Evaluated through anthropometric, dietetics, and biochemical assessment. RESULTS of the 71 patients evaluated, most were obese women with macroprolactinomas. All three groups had diets with low caloric and monounsaturated fatty acid (MUFA) intake, the NPrl group had low carbohydrate (CHO) intake and high lipid (LIP) and saturated fatty acid (SFA) intake, and the NPrl and HPrl groups had appropriate intake of polyunsaturated fatty acids (PUFA). The HPrl group had elevated total cholesterol. HDL cholesterol was below the recommended threshold for most patients. No statistically significant differences were found in anthropometric and biochemical variables among the groups. CONCLUSIONS most patients with prolactinomas and controls are obese and metabolically similar regardless of prolactin levels. All groups presented low caloric and MUFA intake. Protein, LIP, SFA, and cholesterol were significantly different among the groups, the NPrl group ingested less amount of protein and greater of fat. Snacking between meals and changes of food consumption on weekends was reported by most patients. This is the first study comparing patients with prolactinomas and controls, both with overweight, regarding food consumption and feeding behavior.

Pituitary Adenomas: MCM2 Protein as a Cell Proliferation Marker

Pituitary adenomas occasionally show aggressive behavior with rapid growth and invasion of the surrounding tissues. The identification of biological markers able to recognize aggressive pituitary adenomas in early stages remains a challenge. We aimed to determine the expression of a new cell proliferation marker with clinical significance in several human neoplasms, Mcm2, in pituitary adenomas and to establish the relationship of the Mcm2 index with tumor extension and invasion. The proliferative index was determined in tumor specimens of 64 patients with acromegaly or clinically nonfunctioning pituitary adenoma using immunohistochemical methods for two antigens, Mcm2 and Ki-67. Fifty-four (86%) adenomas showed immunoreactivity to Mcm2. The median Mcm2 index was 0.91% (range 0–13.24%). Immunoreactivity to Ki-67 was observed in 61 adenomas (95%). The median Ki-67 index was 0.88% (range 0–7.39%). A significant positive correlation was found between log Mcm2 index and log Ki-67 index (p < 0.001). Mcm2 and Ki-67 detected a similar number of proliferating cells. Mcm2 index showed a significant association with tumor extension (p = 0.02), but not with tumor invasion and hormone phenotype. In conclusion, we demonstrated that Mcm2 was similar to Ki-67 in the identification of the proliferating cells in this sample.

Frequency of anticardiolipin Ac in patients with hyperprolactinemia.

Sir, Association between hyperprolactinemia and autoimmune diseases has been demonstrated.[1,2] We assessed the frequency of anticardiolipin (ACL IgG and IgM by ELISA) and thyroperoxidase (ATPO by chemiluminescence) antibodies, in 23 patients with hyperprolactinemia, subdivided into two groups: Group 1, untreated hyperprolactinemic patients (n = 14; 42.5 ± 14.7 years) and Group 2, treated hyperprolactinemic patients (n = 9, 39.4 ± 12.1 years). Group 3, control, consisted of 20 individuals without thyroid and autoimmune diseases (n = 20; 47.1 ± 13.6 years). Positivity of ACL was observed in none of the control, in two patients with treated hyperprolactinemia (one IgM and one IgG) and in one with treatment-free hyperprolactinemia (IgM) [Table 1]. ACL IgG levels were significantly higher in the group with hyperprolactinemia (2.1 ± 2.5 GPL) compared to the control group (0.7 ± 0.2 GPL), P = 0.018. ATPO was detected in 11/23 (47%) patients with hyperprolactinemia and in 1/20 (5%) of controls and the mean was significantly higher in the hyperprolactinemic group compared to control (P = 0.004). Table 1 Positivity and variation of the levels of anticardiolipin and thyroperoxidase in hyperprolactinemic and control groups The anticardiolipin antibody is organ-nonspecific, occurring in many autoimmune diseases such as rheumatoid arthritis and SLE, and in general population low levels of ACL (IgG < 4.3 μ/ml, IgM < 3.55 μ/ml and polivalent ACA < 4.55 μ/m) are described as well as positivity for IgM and IgG ACL around 4.6%.[3] In agreement we found no positivity of ACL in control group. Moreover, we detected positivity and mean level of ACL significantly higher in patients with hyperprolactinemia, treated or not, corroborating a previous study that reported positive results of ACL in 27% of women with hyperprolactinemia, with no symptoms of autoimmune diseases.[4] The result of the ACL presented here, as well as the knowledge that hyperprolactinemic individuals have significantly higher percentage of total lymphocytes and CD2-positive cells[2] and that levels of PRL in SLE patients are higher than in the general population[1,2] reinforce the immunomodulating role of prolactin, interacting with environmental and genetic factors for the development of autoimmune diseases. Increased levels of ATPO were detected in approximately half of patients with treated or untreated hyperprolactinemia. The presence of ATPO has already been linked to both hyperprolactinemia[4] and to the low reserve of PRL[5] and hyperprolactinemic women show higher prevalence of thyroid autoimmune disease than the general population.[4] Although some studies suggest that the presence of the ACL in thyroid autoimmune disease may be a non-specific marker for the activation of the immune system, this association is controversial and the influence of these antibodies in the course of thyroidopathy has not been totally explained yet. Data are conflicting regarding this issue, with reports of increased prevalence and no correlation between ACL and autoimmune thyroid disease.[6] The present findings of highest prevalence of ACL and ATPO in patients with hyperprolactinemia reinforce the concern over possible development of autoimmune diseases in prolonged hyperprolactinemia. However, the correlation between these factors remains unclear, suggesting the need for further studies.