Pedro Souteiro

Pregnancy after bariatric surgery: Maternal and fetal outcomes of 39 pregnancies and a literature review

We aimed to evaluate the impact of bariatric surgery (BS) on maternal and fetal outcomes.

Catechol‐O‐methyltransferase activity in psoriasis patients treated with psoralen plus ultraviolet A therapy

Catechol‐O‐methyltransferase (COMT) activity is increased in patients with mild/moderate psoriasis. Narrowband ultraviolet B (nbUVB) phototherapy decreases COMT activity. However, the effect of psoralen plus ultraviolet A (PUVA) on this enzyme activity is unknown, and it remains to be clarified if the nbUVB‐induced effect in COMT activity is related to clinical response. The aim of this study is to evaluate COMT activity in moderate/severe psoriasis and assess whether PUVA therapy modifies this activity.

Prolactinoma management: predictors of remission and recurrence after dopamine agonists withdrawal

ObjectiveProlactinomas are the most common functional pituitary tumour. Dopamine agonists (DA) are its principal treatment. The criteria that should guide therapy withdrawal and the factors that influence disease remission or relapse are not yet fully established. Our purpose is to evaluate the proportion of patients who attempted DA withdrawal, and to identify the factors that influence clinicians to try it. In addition, we aim to study the factors that are involved in prolactinoma remission/relapse after therapy withdrawal.MethodsWe retrospectively evaluated 142 patients with prolactinoma diagnosis who had been treated exclusively with DA. Firstly, the patients were divided in two groups, according to whether DA withdrawal had been attempted, or not, and the factors that might predict clinicians’ decision to discontinue the therapy were then analysed. Secondly, patients who attempted withdrawal were further divided into two subgroups, based on their remission or relapse status and predictors of remission were evaluated.ResultsDA withdrawal was attempted in 35.2% of our patients. Females, subjects with lower initial serum prolactin (PRL) levels, those with microadenomas and those with longer treatment duration all had a higher probability of seeing their therapy discontinued. In the withdrawal group, the remission rate was 72%. Macroprolactinomas relapse more often than microprolactinomas (p < 0.05). The recurrence group had higher median initial serum PRL levels and a lower mean duration of therapy, however these variables did not reach statistical significance.ConclusionWe found a low percentage of attempt of withdrawal of DA therapy in the subjects with prolactinoma. Our data confirms that DA therapy can be discontinued with a high remission rate. Tumour size was the main variable that affected the withdrawal outcome in our patients.

Preoperative thyroid function and weight loss after bariatric surgery

Thyroid function has an important role on body weight regulation. However, the impact of thyroid function on weight loss after bariatric surgery is still largely unknown. We evaluated the association between preoperative thyroid function and the excess weight loss 1 year after surgery, in 641 patients with morbid obesity who underwent bariatric surgery. Patients with a history of thyroid disease, treatment with thyroid hormone or antithyroid drugs and those with preoperative evaluation consistent with overt hypothyroidism or hyperthyroidism were excluded. The preoperative levels of TSH and FT4 were not associated with weight loss after bariatric surgery. The variation of FT3 within the reference range was also not associated with weight loss. In contrast, the subgroup with FT3 above the reference range (12.3% of patients) had a significantly higher excess weight loss than patients with normal FT3. This difference remained significant after adjustment for age, sex, BMI, type of surgery, TSH and FT4. In conclusion, we observed an association between high FT3 and a greater weight loss after bariatric surgery, highlighting a group of patients with an increased benefit from this intervention. Our results also suggest a novel hypothesis: the pharmacological modulation of thyroid function may be a potential therapeutic target in patients undergoing bariatric surgery.

Insulin resistance and sex hormone-binding globulin are independently correlated with low free testosterone levels in obese males

Male obesity is associated with decreased testosterone levels but the pathophysiological mechanisms behind this association are not completely understood. This study aimed to investigate the impact of hyperglycaemia/insulin resistance and sex hormone‐binding globulin (SHBG) levels on testosterone levels in a population of obese men. We investigated the impact of several clinical, anthropometric and analytic measures on testosterone levels in 150 obese males. Testosterone deficiency was present in 52.0% of the enrolled patients. This percentage dropped to 17.6% when only calculated free testosterone (FT) was accounted, as SHBG levels were correlated negatively with body mass index (r = −.20; p < .05). Older age (p < .05) and higher homoeostasis model assessment of insulin resistance (HOMA‐IR) (p < .01) and lower SHBG levels (p < .05) were independently correlated with lower FT. Weight and fasting plasma glucose lost their statistical significance after multivariate adjustment. Patients with type 2 diabetes mellitus and pre‐diabetes had lower FT than those with normal glucose tolerance (p < .05 and p < .01 respectively). Insulin resistance, and not hyperglycaemia and weight per se, seems to be the main determinant of low testosterone levels in obese males. Low SHBG levels are correlated with low FT even after HOMA‐IR adjustment. This suggests that SHBG can be associated with testosterone deficiency beyond the influence of insulin resistance unlike previously reported.

A rare case of spontaneous Cushing disease remission induced by pituitary apoplexy

One week after the diagnosis, the patient presented to the Emergency Department (ER) with severe headaches, nausea, vomits and psychomotor impairment. On physical examination, the patient was hemodynamically stable without any focal neurologic deficits. Blood tests showed severe hyponatremia of 114 mEq/L (135–145). Despite the ER head CT scan that revealed no significant alterations, blood was collected for cortisol and the remaining pituitary hormonal profile and the patient was given 100 mg of hydrocortisone. She was then admitted because of a pituitary apoplexy and ensuing secondary adrenal insufficiency was suspected. The results of the laboratorial study were available on the next day and revealed panhypopituitarism: serum cortisol 1.2 μg/dL; ACTH 41.3 ng/L; TSH 0.04 μUI/L (0.35–4.94); free T4 0,96 ng/dL (0.70–1.48); free T3 1.56 pg/mL (1.71–3.71); FSH 2.14mU/mL (25.8–134.8); LH 0.23mUI/mL (7.7–58.5); oestrogen <5.0 pg/mL (<5–54.7); IGF-1 19 ng/mL (72–167); hGH 0.07 ng/ mL (<8). Glucocorticoid therapy led to symptomatic improvement and to normalization of the sodium levels to 139 mEq/L. Pituitary MRI demonstrated a pituitary macroadenoma with features of tumoral haemorrhage in its interior (Fig. 1), confirming the apoplexy hypothesis. Beyond hypertension, no other precipitating factor such as surgery or trauma was identified. She was evaluated by a neurosurgeon that considered that urgent surgery was not needed as the patient presented good clinical evolution and no neurological deficits. The patient was discharged and medicated with 20 mg of hydrocortisone and 50 μg of levothyroxine. Six months after the apoplectic event, the blood analysis revealed hypocortisolism persistency (morning cortisol 7.4 μg/dL; ACTH 3.8 ng/L) that was corroborated 1 year later. The MRI showed signs of past pituitary apoplexy without residual tumour. Facing the resolution of the Dear Editor-in-Chief,