Regina do Carmo Silva

Increased diagnostic probability of subclinical Cushing's syndrome in a population sample of overweight adult patients with type 2 diabetes mellitus.

Endogenous Cushings Syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00 h and salivary and serum cortisol after a 1 mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253 ng/dL, 47 ng/dL, and 1.8 microg/dL, respectively for the 23:00 h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5-fold higher than in the remaining patients. After a confirmatory 2 mg x 2 day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population.

Prevalência dos marcadores imunológicos Anti-GAD e Anti-IA2 em parentes de primeiro grau de diabéticos do tipo 1 em amostra da população da Grande São Paulo

BACKGROUND: Increasingly accurate prediction of Type1 Diabetes Mellitus (DM1), based on analysis of autoantibody markers, has become possible in first-degree relatives of patients with diabetes (PDM1). These markers indicate autoimmune process against pancreatic islet beta-cells. Anti-GAD and anti-IA2 are considered predictive of DM1, whose prevalences are considerably variable in different populations studied. There are few data about the frequency of these markers on the Brazilian population. The aim of this study is determine the prevalence of positivity for anti-GAD and for anti-IA2 among DM1 patients first-degree relatives (PDM1) in a sample of the Brazilian population of Great Sao Paulo City. METHODS: Forty-eight children and adolescents PDM1 with median of age of 14.5 years (range 6.7 to 17.9 years). Anti-GAD and anti-IA2 was mesured by radioassay (Kronus®, USA). The cut-off limit for both antibodies was set at the 99th percentile from normal subjects serum samples (anti-GAD: n=194; Median of age=13.4 yrs; range 9.7 to 64 yrs; anti-IA2: n=71; Median of age= 12.6; range 11.1 - 15.2 yrs). A subject was considered to be positive for anti-IA2 if specific binding exceeded the 99th among the analysis of 71 subjects. The limit to positivity was 1.72 U/ml to anti-GAD and 0.97 U/ml to anti-IA2. RESULTS: Five PDM1(10.4%) have showed positivity to anti-GAD, with significantly higher prevalence than controls (P<0.01). The anti-IA2 prevalence rate seems to be equivalent between PDM1 and controls. CONCLUSION: The prevalence of anti-GAD has been more prevalent among the PDM1. No differences were observed between prevalences for anti-IA2 showed by PDM1 and controls.BACKGROUND Increasingly accurate prediction of Type I Diabetes Mellitus (DMI), based on analysis of autoantibody markers, has become possible in first-degree relatives of patients with diabetes (PDMI). These markers indicate autoimmune process against pancreatic islet beta-cells. Anti-GAD and anti-IA2 are considered predictive of DMI, whose prevalences are considerably variable in different populations studied. There are few data about the frequency of these markers on the Brazilian population. The aim of this study is determine the prevalence of positivity for anti-GAD and for anti-IA2 among DMI patients first-degree relatives (PDMI) in a sample of the Brazilian population of Great São Paulo City. METHODS Forty-eight children and adolescents PDMI with median of age of 14.5 years (range 6.7 to 17.9 years). Anti-GAD and anti-IA2 was measured by radioassay (Kronus , USA). The cut-off limit for both antibodies was set at the 99th percentile from normal subjects serum samples (anti-GAD: n=194; Median of age=13.4 yrs; range 9.7 to 64 yrs; anti-IA2: n=71; Median of age=12.6; range 11.1-15.2 yrs). A subject was considered to be positive for anti-IA2 if specific binding exceeded the 99th among the analysis of 71 subjects. The limit to positivity was 1.72 U/ml to anti-GAD and 0.97 U/ml to anti-IA2. RESULTS Five PDMI (10.4%) have showed positivity to anti-GAD, with significantly higher prevalence than controls (P<0.01). The anti-IA2 prevalence rate seems to be equivalent between PDMI and controls. CONCLUSION The prevalence of anti-GAD has been more prevalent among the PDMI. No differences were observed between prevalences for anti-IA2 showed by PDMI and controls.

Síndrome dos ovários policísticos, síndrome metabólica, risco cardiovascular e o papel dos agentes sensibilizadores da insulina

The Polycystic Ovary Syndrome (PCOS) affects 6 to 10% of women of childbearing age. Insulin resistance and hyperinsulinemia are present in nearly all PCOS patients and play a central role in the development of both hyperandrogenism and metabolic syndrome (MS). MS occurs in approximately 43% of PCOS patients, raising the cardiovascular risk to up seven fold in these patients. Several serum, functional and structural markers of endothelial dysfunction and subclinical atherosclerosis were described in PCOS patients, even those young and non-obese. However, despite the fact that PCOS adversely affects the cardiovascular profile, long-term studies did not demonstrate a consistent raise in cardiovascular mortality, which seems to be more observed in the post-menopausal period. Recently, oral contraceptives are being substituted for insulin sensitizing agents (metformin and glitazones) in the PCOS treatment, due to their effects on insulin resistance and cardiovascular risk.

Doença de addison de etiologia auto-imune

A doenca de Addison de etiologia auto-imune e uma endocrinopatia rara e potencialmente fatal, que pode ocorrer de forma isolada ou como parte das sindromes poliglandulares auto-imunes (SPA) dos tipo I e II. Auto-anticorpos anti-cortex adrenal sao considerados marcadores imunologicos sensiveis do processo auto-imune destrutivo, podendo identificar individuos na fase pre-clinica da doenca. A enzima 21-hidroxilase (citocromo P450c21) representa o principal antigeno adrenocortical, embora outros citocromos P450 (17a-hidroxilase e colesterol desmolase) possam, tambem, desencadear a resposta auto-imune, principalmente na SPA do tipo I e na doenca de Addison associada a falencia ovariana precoce. O papel dos auto-anticorpos anti-P450c21 na patogense da falencia adrenal ainda nao esta bem estabelecido, assim como aquele dos anticorpos anti-receptor do ACTH.