Browsing by Author "Carvalheiro, M"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
- Um Caso Clínico de Diabetes - Discutido no "Workshop": Diabetes e OsteoporosePublication . Santos, J; Teixeira, AS; Aurélio, M; Carvalho, P; Paiva, I; Pereira da Silva, JA; Carvalheiro, MIntrodução: A diabetes mellitus tipo 2 constitui actualmente um grave problema de saúde pública, pela sua elevada incidência e prevalência. A evolução do conhecimento científico conduziu à introdução recente de novos fármacos, assim como à revisão das recomendações internacionais para o tratamento da hiperglicémia e dos objectivos terapêuticos a atingir. No dia 13 de Dezembro de 2008, realizou-se no Palace Hotel do Buçaco um Workshop Multidisciplinar subordinado ao tema “Diabetes e Osteoporose”, dirigido a internos de Endocrinologia, Medicina Interna e Reumatologia. Foram discutidos de forma interactiva dois casos clínicos, um na área da Diabetologia e outro de Reumatologia. Apresentamos os pontos fundamentais da discussão do caso clínico de Diabetes. Caso Clínico: Doente do sexo feminino, 52 anos, obesa, observada em Consulta de Diabetes por apresentar A1c de 8%, apesar da dieta e da medicação (metformina).Apresentava uma tensão arterial (TA) de 150/95 mmHg, colesterol total (CL–T) 250 mg/dL, triglicerídeos (TG) 220 mg/dL, HDL 35 mg/dL e LDL 160 mg/dL. Questão: Quais as medidas terapêuticas a adoptar? Passados 6 meses, apresentava HbA1c 7,8%, CL-T 200 mg/dL,TG 190 mg/dL, HDL 40 mg/dL, LDL 130 mg/dL e microalbuminúria 30 mg/24h. Questão: Quais as modificações terapêuticas a instituir? Um ano depois, regressa à consulta, medicada com prednisolona por patologia reumatismal, com glicémias de 300 mg/dL em jejum e A1c 10,2%. Questão: Qual a estratégia terapêutica a adoptar? Dois anos mais tarde, a doente apresenta A1c 12%, CL-T 280 mg/dL, HDL 30 mg/dL, LDL 180 mg/dL e TG 200 mg/dL,TA 160/95 mmHg. Antecedentes de Acidente Vascular Cerebral, encontrando-se novamente medicada com antidiabéticos orais. Questão: Perante este quadro, o que prescrever? Conclusões: A diabetes mellitus implica uma abordagem multifactorial, dirigida à hiperglicemia e aos restantes factores de risco associados: dislipidemia, hipertensão arterial, hipercoagulabilidade, insulinorresistência e obesidade. De acordo com a Sociedade Europeia para o Estudo da Diabetes e com Sociedade Portuguesa de Diabetologia, o objectivo é alcançar uma A1c inferior a 6,5%, no sentido de prevenir e evitar a progressão das complicações. Os novos antidiabéticos orais conduziram a um aumento das opções terapêuticas disponíveis e implicaram uma revisão das recomendações internacionais.
- Estudo Comparativo, Aleatorizado, em Dupla Ocultação, de Orlistat Versus Placebo, de Eficácia e Segurança, em Doentes Obesos com Hipercolesterolemia Ligeira a ModeradaPublication . Castro, JJ; Dias, T; Chambel, P; Carvalheiro, M; Correia, LG; Guerreiro, L; Marques, O; Medina, JL; Nobre, E; Silva Nunes, J; Pereira, MC; Polónia, J; Portugal, J; Raimundo, A; Ruas, A; Marques da Silva, P; Vasconcelos, C; Lima Reis, J; Galvão Teles, AINTRODUCTION: Obesity is a chronic disease and a serious health problem that leads to increased prevalence of diabetes, hypertension, dyslipidemia and gallbladder disease. OBJECTIVE: To evaluate the efficacy of orlistat for weight loss and improved lipid profile compared to placebo in obese patients with hypercholesterolemia, treated over a period of 6 months. METHODOLOGY: In a 6-month, multicenter (10 centers in Portugal), double-blind, parallel, placebo-controlled study, 166 patients, aged 18-65 years, body mass index (BMI) > or = 27 kg/m2, LDL cholesterol > 155 mg/dl, were randomized to a reduced calorie diet (600 kcal/day deficit) plus orlistat three times a day or placebo. Exclusion criteria included triglycerides > 400 mg/dl, severe cardiovascular disease, uncontrolled hypertension, type 1 or 2 diabetes under pharmacological treatment, and gastrointestinal or pancreatic disease. RESULTS: The mean difference in weight from baseline was 5.9% (5.6 kg) in the orlistat group vs. 2.3% (2.2 kg) in the placebo group. In the orlistat group 49% of patients achieved 5-10% weight loss and 8.8% achieved > 10%. The orlistat group showed a significant reduction in total and LDL cholesterol, with similar changes for HDL in both treatment groups. The frequency of gastrointestinal adverse events was slightly higher in the orlistat group than in the placebo group, leading to discontinuation in 7 patients. CONCLUSION: Treatment with orlistat plus a reduced calorie diet for 6 months achieved significant reductions in weight, BMI and lipid parameters.
- PROP1 Gene Analysis in Portuguese Patients with Combined Pituitary Hormone DeficiencyPublication . Lemos, MC; Gomes, L; Bastos, M; Leite, V; Limbert, E; Carvalho, D; Bacelar, C; Monteiro, M; Fonseca, F; Agapito, A; Castro, JJ; Regateiro, F; Carvalheiro, MOBJECTIVE: Mutations of the PROP1 gene lead to combined pituitary hormone deficiency (CPHD), which is characterized by a deficiency of GH, TSH, LH/FSH, PRL and, less frequently, ACTH. This study was undertaken to investigate the molecular defect in a cohort of patients with CPHD. DESIGN, PATIENTS AND MEASUREMENTS: A multicentric study involving 46 cases of CPHD (17 familial cases belonging to seven kindreds and 29 sporadic cases) selected on the basis of clinical and hormonal evidence of GH deficiency, central hypothyroidism and hypogonadotrophic hypogonadism, in the absence of an identified cause of hypopituitarism. Mutations of PROP1 were investigated by DNA sequencing. Clinical, hormonal and neuroradiological data were collected at each centre. RESULTS: PROP1 mutations were identified in all familial cases: five kindreds presented a c. 301-302delAG mutation, one kindred presented a c. 358C --> T (R120C) mutation and one presented a previously unreported initiation codon mutation, c. 2T --> C. Of the 29 sporadic cases, only two (6.9%) presented PROP1 germline mutations (c. 301-302delAG, in both). Phenotypic variability was observed among patients with the same mutations, particularly the presence and age of onset of hypocortisolism, the levels of PRL and the results of pituitary imaging. One patient presented a sellar mass that persisted into adulthood. CONCLUSIONS: This is the first report of a mutation in the initiation codon of the PROP1 gene and this further expands the spectrum of known mutations responsible for CPHD. The low mutation frequency observed in sporadic cases may be due to the involvement of other unidentified acquired or genetic causes.