Aggressive nonfunctioning pituitary neuroendocrine tumors.

Nonfunctioning pituitary neuroendocrine tumors (NF-PitNETs) are tumors that are not associated with clinical evidence of hormonal hypersecretion. According to the World Health Organization (WHO), there are some subtypes of PitNETs that exhibit more aggressive behavior than others. Among the types of potentially aggressive PitNETs, three are nonfunctional: silent sparsely granulated somatotropinomas, silent corticotropinomas, and poorly differentiated PIT-1 lineage tumors.

Lower bone density and microarchitecture alterations in HIV-infected Brazilian men aged 50 years and older are associated with estradiol levels.

Objective: Combination antiretroviral treatment (cART) allows for longer survival for people living with HIV and hence long-term complications of both disease and treatment are common. Our purpose was to evaluate bone alterations in men living with HIV (MLWH) and receiving cART and to identify associated factors that can be corrected or mitigated.

Patients And Design: Thirty MLWH and 36 healthy controls (≥50 years) were studied for areal bone mineral density (aBMD) and body composition (dual-energy X-ray absorptiometry), volumetric bone mineral density (vBMD) and bone microstructure (high-resolution peripheral quantitative computed tomography [HR-pQCT]), serum calcium, phosphate, parathyroid hormone, 25(OH)D, testosterone (T), estradiol (E ), glucose, creatinine, and albumin levels.

Correlates With Epithelial-Mesenchymal Transition Markers and in Adrenocortical Tumors.

Background/aim: Although the knowledge regarding adrenocortical carcinomas (ACC) tumorigenesis has significantly improved during the last decade, it still remains to be completely determined. Epithelial-mesenchymal transition (EMT) is a well described transcription factor induced process, postulated as an essential step toward cancer progression and metastasis development. In this context, Twist1 has been described as the EMT master-regulator.

LIMITATIONS OF BASAL CORTISOL IN THE DIAGNOSIS OF CUSHING SYNDROME.

Objective: Cushing syndrome (CS) is one of the most challenging diseases to diagnose due to the difficulties that may arise during laboratory test interpretations. A random serum cortisol level is often obtained by a general practitioner as a first step in the work-up of suspected CS patients. In this respect, it is rarely useful and has limitations.

Impact of Weight Loss With Intragastric Balloon on Bone Density and Microstructure in Obese Adults.

The historical concept that obesity protects against bone fractures has been questioned. Weight loss appears to reduce bone mineral density (BMD); however, the results in young adults are inconsistent, and data on the effects of weight loss on bone microstructure are limited. This study aimed to evaluate the impact of weight loss using an intragastric balloon (IGB) on bone density and microstructure.

Inhaled glucocorticoids are associated with vertebral fractures in COPD patients.

Chronic obstructive pulmonary disease (COPD) is an independent risk factor for osteoporosis. Oral glucocorticoids are deleterious to bone; however, the impact of inhaled glucocorticoids (ICS) remains unclear. Our objective was to determine whether ICS contribute to osteoporosis and fragility fractures.

Periodontal profile and radiographic characterization of the jaws in a patient with autosomal dominant osteopetrosis.

Unlabelled: Osteopetrosis (OP) comprehends a rare group of conditions, presenting on radiographs increased bone density, deriving from irregularities in osteoclast differentiation or function. In the autosomal dominant osteopetrosis (ADO), some patients stay asymptomatic for some time, or only develop mild symptoms. The dental surgeon is often the first to presuppose the disease during routine imaging examinations, referring the patient to a specialized medical group.

Pituitary Hyperplasia in a Female Patient with a Severe Childhood Abuse History.

A 24-year-old Caucasian female patient was referred to our endocrinology service to investigate a structural magnetic resonance imaging (sMRI) finding of "pituitary mass". The first two sMRI were identified as pituitary adenoma but the following two examinations suggested the possibility of pituitary hyperplasia (PH). The patient was referred to our service for diagnostic clarification and therapy due to the divergence in sMRI reports and the surgical procedure indicated by the neurosurgical team of the other institution.

Vitamin D Deficiency and Its Influence on Bone Metabolism and Density in a Brazilian Population of Healthy Men.

Vitamin D supplementation is universal for postmenopausal women, but not for elderly men, in whom osteoporosis is also commonly neglected. This study aimed to evaluate vitamin D deficiency and its association with secondary hyperparathyroidism, bone resorption, and bone density in Brazilian men. A total of 120 men, 20-93 years, were evaluated for serum calcium, phosphorus, creatinine, 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, biochemical markers of bone resorption (carboxy-terminal telopeptide, carboxy-terminal peptide of type I collagen), and bone mineral density (dual-energy X-ray absorptiometry).

Recurrence and mortality prognostic factors in childhood adrenocortical tumors: Analysis from the Brazilian National Institute of Cancer experience.

Prognostic markers that can help identifying precocious risk of unfavorable outcomes in patients with childhood adrenocortical tumors (ACTs) are still unclear. This observational and retrospective study aimed to identify clinical and pathology prognostic factors of recurrence and death in a tertiary cancer center population. Clinical, pathology, demographic, staging, and therapy data from patients with childhood ACT (median age: 3.

Assessment of Predictive Response Factors to Intragastric Balloon Therapy for the Treatment of Obesity.

Background: Obesity is a worldwide epidemic that is difficult to control with non-invasive treatments, which usually present poor results. In this context, the intragastric balloon (IGB) is an important tool that presents a mean body weight loss (BWL) estimated at approximately 12%, although individual responses are highly variable.

Objectives: This study assesses whether there are factors that can predict responses to IGB therapy either before or early after placement of the device.

Low Frequency of Cardiomyopathy Using Cardiac Magnetic Resonance Imaging in an Acromegaly Contemporary Cohort.

Context: Left ventricular hypertrophy (LVH) and myocardial fibrosis are considered common findings of the acromegaly cardiomyopathy in echocardiography studies.

Objective: To evaluate the frequency of LVH, systolic dysfunction and myocardial fibrosis was undertaken in patients with acromegaly using cardiac magnetic resonance imaging (CMRi) before and after 12 months of octreotide long-acting repeatable treatment.

Patients And Methods: Consecutive patients with active acromegaly submitted to biochemical analysis and CMRi before and after 12 months of treatment.

Insulin-like growth factor (IGF)-I, IGF binding protein-3, and prostate cancer: correlation with Gleason score.

Introduction: Non-androgenic growth factors are involved in the growth regulation of prostate cancer (PCa).

Objective: This is the first Brazilian study to correlate, in a population of patients operated for PCa, PSA, total testosterone, insulin-like growth factor-I (IGF-I) and insulin-like growth factor-binding protein-3 (IGFBP-3) with Gleason score and to compare with a control group with benign prostate hyperplasia (BPH).

Materials And Methods: This retrospective single-center study included 49 men with previously diagnosed PCa and 45 with previously diagnosed BPH.

Truncated somatostatin receptor variant sst5TMD4 confers aggressive features (proliferation, invasion and reduced octreotide response) to somatotropinomas.

The GH/IGF1 response of somatotropinomas to somatostatin analogues (SSA) is associated with their pattern of somatostatin receptor (sst1-sst5) expression. Recently, we demonstrated that expression of a truncated sst5-variant (sst5TMD4) can influence the secretory response of somatotropinomas to SSA-therapy; however, its potential relationship with aggressive features (e.g.

Ki-67 is a predictor of acromegaly control with octreotide LAR independent of SSTR2 status and relates to cytokeratin pattern.

Introduction: Only one study has evaluated Ki-67 as a predictor of the response to somatostatin analog therapy in acromegaly; however, other predictors like somatostatin receptor type 2 (SSTR2) and cytokeratin pattern expressions were not considered.

Objective: To evaluate whether Ki-67 is a predictor of octreotide LAR (OCT-LAR) response in somatotropinomas independent of SSTR2 and cytokeratin expression patterns.

Methods: Protein expression was analyzed by immunohistochemistry.

Acromegaly has a negative influence on trabecular bone, but not on cortical bone, as assessed by high-resolution peripheral quantitative computed tomography.

Introduction: Acromegaly is one of the causes of secondary osteoporosis, although studies of bone mineral density (BMD) have yielded conflicting results and none of them have evaluated the bone properties.

Objectives And Patients: Our objective was to correlate, in a cohort of 82 acromegalic patients, BMD and bone microarchitecture, using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography, with the presence of type 2 diabetes mellitus (T2DM), disease activity, and gonadal status and to compare these bone parameters between 45 eugonadal acromegalic patients and 45 healthy controls.

Results: Acromegalic patients with T2DM had lower trabecular density and trabecular bone volume to tissue volume ratio in the distal tibia.

Vertebral fracture assessment in acromegaly.

Most vertebral fractures (VFs) are asymptomatic and incidentally found on X-rays. The effects of acromegaly on bone mineral density (BMD) are still controversial, and the prevalence of VFs in this specific population remains uncertain. The objective of this study was to assess VFs in acromegaly through vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA).

Association of dengue hemorrhagic fever with multiple risk factors for pituitary apoplexy.

Objective: To describe pituitary apoplexy that developed during the course of dengue hemorrhagic fever.

Methods: We describe the clinical findings, laboratory test results, imaging findings, and clinical course of the study patients.

Results: Patient 1 was a 40-year-old man who developed clinical signs and symptoms of dengue, which was confirmed by serologic testing.

Growth of an aggressive tumor during pregnancy in an acromegalic patient.

Pregnancy in acromegalic patients is a rare event, but is usually uneventful, with stable GH and IGF-I levels and no tumor enlargement. Medical treatment can usually be withdrawn without problems and although no major adverse event has been reported, the suspension of drug treatments is generally recommended. No case report exists in the literature regarding evolution of a somatotropinoma with invasiveness markers throughout pregnancy.

Aortic root ectasia in patients with acromegaly: experience at a single center.

Background: Acromegaly is associated with increased cardiovascular mortality, and increased aortic root diameter has been recently described in the literature as a possible feature of acromegalic cardiomyopathy.

Objective: To assess the aortic root diameter and the prevalence of aortic ectasia in acromegalic patients.

Patients And Methods: This paper presents a transversal analysis of 42 acromegalic patients by Doppler echocardiogram and comparison with 42 age, sex, body surface area and hypertension matched controls.

Impact of gsp oncogene on the mRNA content for somatostatin and dopamine receptors in human somatotropinomas.

Introduction: It has been reported in some series that gsp+ somatotropinomas are more sensitive to somatostatin analogues (SA) and dopamine's actions which may be related to their somatostatin receptor (SSTR) and dopamine receptor (DR) profile. No previous studies have been undertaken to evaluate the SSTR and DR profile related with the gsp status in somatotropinomas.

Objectives: To determine if (1) gsp status is correlated with response to octreotide LAR (LAR) and tumor expression patterns of SSTR1-5 and DR1-5 and (2) cAMP level can directly modulate SSTR and DR mRNA levels.

Germ cell tumor presenting as sellar mass with suprasellar extension and long history of hypopituitarism.

Objective: Primary central nervous system germ cell tumors are rare neoplasms usually located in the pineal and/or suprasellar region. Pure germinomas do not usually secrete beta-human chorionic gonadotropin hormone (beta-HCG) or alpha-fetoprotein (AFP) and diagnosis is made a few weeks or months after beginning of symptoms.

Case: Here we report a case of a pure germinoma in a 20 year-old woman presenting as a sellar mass with suprasellar extension, abnormal serum beta-HCG and a long history of polyuria and polydipsia (4 years), that was initially diagnosed as a pituitary macroadenoma.

Expression analysis of dopamine receptor subtypes in normal human pituitaries, nonfunctioning pituitary adenomas and somatotropinomas, and the association between dopamine and somatostatin receptors with clinical response to octreotide-LAR in acromegaly.

Context: Dopamine receptor (DR) and somatostatin receptor subtype expression in pituitary adenomas may predict the response to postsurgical therapies.

Objectives: Our objectives were to assess and compare the mRNA levels of DR1-5 and somatostatin receptors 1-5 in normal pituitaries (NPs), nonfunctioning pituitary adenomas (NFPAs), and somatotropinomas. In addition, we determined whether the level of DR expression correlates with the in vivo response to octreotide-LAR in acromegalic patients.