ABSTRACT Objectives To describe the findings of thyroid ultrasonography (T-US), its contribution to diagnose congenital hypothyroidism (CH) and the best time to perform it. Subjects and methods Forty-four patients with CH were invited to undergo T-US and 41 accepted. Age ranged from 2 months to 45 years; 23 patients were females. All were treated with L-thyroxine; 16 had previously undergone scintigraphy and 30 had previous T-US, which were compared to current ones. Results At the current T-US, the thyroid gland was not visualized in its normal topography in 10 patients (24.5%); 31 T-US showed topic thyroid, 17 with normal or increased volume due to probable dyshormonogenesis, 13 cases of hypoplasia and one case of left-lobe hemiagenesis. One patient had decreased volume due to central hypothyroidism. Scintigraphy scans performed 3-4 years earlier showed 100% agreement with current results. Comparisons with previous T-US showed concordant results regarding thyroid location, but a decrease in current volume was observed in eight due to the use of L-thyroxine, calling the diagnosis of hypoplasia into question. Conclusions The role of T-US goes beyond complementing scintigraphy results. It allows inferring the etiology of CH, but it must be performed in the first months of life. An accurate diagnosis of CH will be attained with molecular study and the T-US can guide this early assessment, without therapy withdrawal.

OBJECTIVE: To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro. METHODS: Cross-sectional and retrospective study of thirty cases treated over a period of two decades. RESULTS: 17 men (56.7%) aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%), somatostatin receptor ligands + radiotherapyin 5 patients (17.8%), radiotherapy in 3 patients (10.7%), and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%). Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65%) have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels. CONCLUSION: The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes.

OBJECTIVES: To establish cut-off values for growth hormone concentrations using clonidine as a secretagogue and an immunochemiluminescent assay as the method of measurement and to analyze the response time as well as the influence of gender, nutritional status and pubertal stage. METHODS: A total of 225 tests were performed in 3 patient groups, categorized as group 1 (normal), group 2 (idiopathic short stature) and group 3 (growth hormone deficiency). Among the 199 disease-free individuals, 138 were prepubertal, and 61 were pubertal. Clonidine (0.1 mg/m2) was orally administered, and the growth hormone level was measured by immunochemiluminescent assay. The growth hormone peak and the difference between the growth hormone peak and the baseline level were then analyzed. Statistical analyses were performed using Student’s t-test or the Mann-Whitney test and Kruskal-Wallis test followed by Dunn’s post hoc test. Cut-off values were determined using a receiver operating characteristic curve. RESULTS: Group 1 and group 2 had no difference in growth hormone peak, gender, body mass index standard deviation score, or pubertal stage. Group 3 exhibited a significantly lower growth hormone peak than the other groups did. The receiver operating characteristic curve demonstrated that growth hormone concentrations ≥ 3.0 ng/mL defined responsiveness to clonidine. In total, 3.02% of individuals in group 1 and group 2 were considered false positive, i.e., these children lacked growth hormone deficiency and had a peak below 3.0 ng/mL. CONCLUSION: Clonidine-stimulated growth hormone concentrations ≥3 ng/mL, as measured by immunochemiluminescent assay, suggest responsiveness to the stimulus regardless of gender, body mass index standard deviation score or pubertal stage.

Objective To report our experience of treating central precocious puberty (CPP) with a GnRH analogue with respect to the final heights (FH) attained in patients who completed treatment. Subjects and methods Among 105 records of children diagnosed with precocious puberty, 62 cases (54 girls and 8 boys), who were treated with leuprolide acetate/3.75 mg/monthly, were selected, and divided into 4 groups: group 1 (G1), 25 girls who attained FH; group 2 (G2), 18 girls who completed treatment but did not reach FH; group 3 (G3), 11 girls still under treatment; and group 4 (G4), 8 boys, 5 of which attained FH. Treatment was concluded at a bone age of 12 years, and follow-up continued until FH was achieved. Results In both G1 and G2 groups, height standard deviation score (SDS), weight-SDS and percentile of body mass index (PBMI) did not show intra/intergroup differences at the beginning and at interruption of treatment, but when added, G1+G2, height-SDS and weight-SDS differed significantly (p = 0.002 and 0.0001, respectively). In G1, 19 of 25 cases attained TH, and average height gain was 16.7 cm (7.7- 27.1); there was significant difference between FH and prediction of FH at the start (PFH at start) (p = 0.0001), as well as between PFH at interruption vs TH and vs FH (p = 0.007) with FH higher than TH (p = 0.004). Significant correlation was identified between FH and height gain after treatment. Conclusion As shown by some studies, GnRH analogue treatment was effective in children with CPP reaching FH near the genetic target.

As alterações metabólicas decorrentes do diabetes melito tipo 1 (DM1) podem prejudicar o crescimento e o desenvolvimento. OBJETIVO: Avaliar a estatura final de pacientes com DM1 e a interferência da doença no crescimento. PACIENTES E MÉTODOS: A estatura final de 58 pacientes com DM1 foi avaliada em relação aos dados antropométricos e controle metabólico. RESULTADOS: A idade média foi de 26,4 anos (15,0-51,0) e a duração da doença, de 9,6 anos (1,4-25,0). A estatura final foi 165,1 cm (149,3-183,0) e o z-escore da estatura final foi igual a 0,09 (-1,76-2,85). Num subgrupo (n = 34), foi possível avaliar o controle glicêmico durante a fase de crescimento estatural. A média de hemoglobina glicosilada foi 12,2% (6,8-24,1) e as correlações entre dados antropométricos e controle glicêmico não foram estatisticamente significantes (p > 0,05). CONCLUSÃO: Não houve interferência do DM1 na estatura final, apesar do controle glicêmico inadequado.

Metabolic changes resulting from type 1 diabetes mellitus (DM1) may put growth and development at risk. OBJECTIVE: To evaluate the final stature of DM1 patients and the interference of DM1 in growth. SUBJECTS AND METHODS: The final height reached by 58 DM1 patients was evaluated according to anthropometric data and metabolic control. RESULTS: Mean age was 26.4 years (15.0-51.0) and the duration of disease was of 9.6 years (1.4-25.0). Final stature was 165.1 cm (149.3-183.0) and the z-score for height was 0.09 (-1.76-2.85). In a subgroup (n = 34), it was possible to evaluate the effect of metabolic control on growth. Mean glycosylated hemoglobin was 12.2% (6.8-24.1) and the correlation between anthropometric data and glucose control was not considered statistically significant (p > 0.05). CONCLUSION: We conclude that DM1 had no effect on the final stature, to the detriment of a poor metabolic control.

A doença nodular tiroidiana é problema clínico comum, principalmente em regiões com carência de iodo. Esse estudo avaliou a eficácia da injeção percutânea de etanol (IPE) no tratamento de nódulos tiroidianos únicos, múltiplos, sólidos, císticos, de diferentes tamanhos com ou sem disfunção glandular, em região endêmica de bócio. Quarenta e dois pacientes com diagnóstico de bócio colóide ou hiperplasia nodular colóide, na punção biópsia aspirativa por agulha fina (PBAAF), foram selecionados para análise após terem sido submetidos a pelo menos duas IPEs. Os nódulos tiroidianos eram múltiplos (sólidos e ou císticos) em 52,4% dos pacientes, únicos e sólidos ou mistos em 35,7% e únicos e císticos em 11,9%. A redução média dos nódulos após injeção de etanol foi de 58,2% para os únicos e 60,8% nos císticos. Nos nódulos múltiplos, avaliou-se a redução de todo o lobo tiroidiano, alcançando 52,4% de redução. Os efeitos colaterais registrados foram decorrentes apenas do desconforto na aplicação. Este estudo indica que a injeção percutânea de etanol (IPE), alcançando reduções médias de volume que variam de 49 a 60%, é método seguro, eficaz e simples para o tratamento de nódulos tiroidianos benignos.

Thyroid nodular disease is a common clinical disorder mainly in iodine lacking regions. This study has evaluated the effectiveness of percutaneous ethanol injection (PEI) in the treatment of single, multiple, solid, and cystic thyroid nodules of different sizes with or without glandular dysfunction, in goiter endemic region. Forty-two patients with diagnosis of colloid goiter or colloid nodular hyperplasia in fine-needle aspiration (FNA) were selected for analysis, after having been submitted to at least two PEI. Thyroid nodules were multiple (solid and or cystic) in 52.4% of the patients, single and solid or mixed in 35.7%, and single and cystic in 11.9%. The mean reduction of nodules after ethanol injection was of 58.2% in the single and of 60.8% in the cystic ones. The reduction of the whole thyroid lobe was evaluated in the multiple nodules and it reached 52.4%. The side-effects were registered only as a consequence of the application discomfort. This study points out that the percutaneous ethanol injection reaching volume mean reductions, varying from 49% to 60%, is a safe, effective, and simple method for the treatment of benign thyroid nodules.

Descrevemos um caso de tumor ovariano das células da granulosa cuja manifestação inicial foi puberdade precoce isossexual, em criança de 7 anos e 4 meses, de evolução progressiva e rápida, associada a massa hipogástrica palpável. A avaliação hormonal demonstrou estradiol: 296pg/ml; 17alfaOH-progesterona: 20ng/ml; S-DHEA: 27µg/dl; betahCG: 0,66mUI/ml; testosterona: 120ng/dl; progesterona: 3,4ng/ml; LH: 0,5mUI/ml; e FSH: 0,01mUI/ml e não responsivos ao estímulo com o GnRH, (Relisorm®: 100µg iv). Exames de imagem confirmaram massa tumoral em ovário esquerdo. A paciente foi submetida à salpingo-ooforectomia esquerda com retirada completa do tumor que pesou 656g e mediu 14,5 x 10,0 x 7,0cm, restrito ao ovário e cujo exame histopatológico demonstrou tumor de células da granulosa juvenil. Durante a cirurgia amostras sangüíneas foram obtidas da veia ovariana ipsilateral ao tumor e as concentrações de esteróides foram estudadas. Níveis elevados de estradiol (969pg/ml), progesterona (15,8ng/ml), 17alfaOH-progesterona (34ng/ml) e testosterona (158ng/dl) foram encontrados. No pós-operatório observou-se rápida regressão das mamas, dos pêlos pubianos, com normalização das concentrações hormonais. Durante o seguimento, a paciente apresentou desenvolvimento puberal normal, e não há sinais de reincidência do tumor.

We report a case of juvenile granulosa cell tumor of the ovary in a 7.4 years old girl, who presented isosexual pseudo-precocious puberty of progressive outcome and palpable hypogastric mass. Hormonal measurements showed: oestradiol: 296pg/ml; 17-alpha-OH-progesterone: 20ng/ml; DHEAS: 27µg/dl; betahCG: 0.66mIU/ml; testosterone: 120ng/dl; progesterone: 3.4ng/ml; LH: 0.5mIU/ml; and FSH: 0.01mIU/ml not responsive to GnRH test (Relisorm®: 100µg iv). Abdominal images confirmed left ovarian mass. Unilateral salpingo-oophorectomy was performed with complete resection of a 656g and 14.5 x 10 x 7cm tumor restricted to the left ovary. The histologic analysis revealed a juvenile granulosa cell tumor. During the surgery blood from left ovary vein was obtained and steroids concentration were analyzed. Elevated levels of oestradiol (969pg/ml), progesterone (15.8ng/ml), 17-alpha-OH-progesterone (34ng/ml) and testosterone (158ng/dl) were found. Few days after the surgery, rapid regression of breast and pubic hair was observed, with return of steroid concentrations to the normal pre-pubertal levels. During 9 years of follow-up, normal pubertal development happened at an expected age, and no signs of tumor relapse were found.