ABSTRACT Objective The consequences of sleep deprivation in type 1 diabetes (T1D) patients are poorly understood. Our aim was to determine how sleep disorders influence lipid profile and insulin sensitivity in T1D patients. Materials and methods This was a cross-sectional study at a public university hospital. Demographic information and medical histories were obtained during regular scheduled visit of T1D patients to the outpatient clinic. Insulin sensitivity was obtained using the estimated glucose disposal rate (eGDR) formula. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Berlin Questionnaire. Results The adult participants (n = 66, 62% women) had a median age of 28.0 years (interquartile range 21.8-33.0). Six patients (9%) had metabolic syndrome according to the International Diabetes Federation criteria. Thirty patients (46%) were considered poor sleepers according to the Pittsburgh Sleep Quality Index. The LDL-c and total cholesterol levels of poor sleepers were higher than those of good sleepers (103 v. 81; p = 0.003 and 178.0 v. 159.5 mg/dL; p = 0.009, respectively). Three patients (4%) were at high risk of obstructive sleep apnea syndrome (OSAS) according to the Berlin Questionnaire. The eGDR was lower in the group of patients with high probability of having OSAS (6.0 v. 9.1 mg.kg-1.min-1;p = .03). Conclusions Poor subjective quality of sleep and higher risk of OSAS were correlated with a worsened lipid profile and decreased insulin sensitivity, respectively. Therefore, T1D patients with sleep disturbances might have an increased cardiovascular risk in the future.

ABSTRACT Objective This study aimed to evaluate the occurrence and clinical predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM. Subjects and methods The study included 45 women with type 1 diabetes mellitus (DM) (aged 36 ± 9 years) who underwent carotid Doppler ultrasound evaluation to determine the carotid artery intima-media thickness (CIMT) and to assess the occurrence of carotid artery plaques. Insulin sensitivity was assessed by estimated glucose disposal rate (eGDR), and metabolic syndrome (MS) was defined by the World Health Organization criteria. Results The cohort had a mean age of 36 ± 9 years, diabetes duration of 18.1 ± 9.5 years, and body mass index (BMI) of 24.6 ± 2.4 kg/m2. MS was present in 44.4% of the participants. The CIMT was 0.25 ± 0.28 mm, and the prevalence of carotid artery plaques was 13%. CIMT correlated positively with hypertension (p = 0.04) and waist-to-hip ratio (r = 0.37, p = 0.012). The presence of carotid artery plaques correlated positively with age (p = 0.018) and hypertension (p = 0.017). eGDR correlated negatively with CIMT (r = -0.39, p = 0.009) and carotid plaques (p = 0.04). Albuminuria showed a correlation trend with CIMT (p = 0.06). Patients with carotid artery plaques were older, had a higher prevalence of hypertension, and lower eGDR. No correlation was found between CIMT and carotid plaques with diabetes duration, MS, BMI, cholesterol profile, glycated hemoglobin, high-sensitivity C-reactive protein, or fibrinogen. Conclusion Insulin resistance, central obesity, hypertension, and older age were predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM.

Resumo: O presente estudo investigou a correlação da circunferência do pescoço (CP) e outras medidas antropométricas com os fatores de risco cardiovasculares e resistência insulínica (RI) em idosos de Niterói, Rio de Janeiro, Brasil. Foi realizado estudo transversal com 411 pacientes na atenção primária de saúde. Medidas antropométricas como CP, índice de massa corporal (IMC), circunferência da cintura (CC) e razão cintura-quadril (RCQ) foram aferidas. A bioimpedância elétrica (BIA) estimou o percentual da gordura corporal total (%GC). A resistência à insulina foi estimada pelo HOMA-IR (homeostasis model assessment IR index). Os dados foram analisados utilizando o teste de Mann-Whitney e a correlação entre as variáveis numéricas pelo teste de Spearman. A curva ROC (receiver operating characteristic) foi utilizada para avaliar a capacidade preditiva das medidas antropométricas no diagnóstico de RI. A CP foi positivamente correlacionada com a CC, o IMC, RCQ, %TBF e com o HOMA-IR em ambos os sexos. Nas mulheres, a CP apresentou a maior AUC (área sob a curva) para RI. Nos homens, a CC apresentou a maior AUC, seguido pelo IMC e CP. O presente estudo realizado no Sudeste do Brasil sugere que a CP pode predizer a RI, importante marcador de risco cardiovascular, na população idosa atendida na atenção primária de saúde.

Abstract: This study focused on the correlation between neck circumference and other anthropometric measurements and cardiovascular risk factors and insulin resistance in the elderly in Niterói, Rio de Janeiro State, Brazil. This was a cross-sectional study in 411 patients seen in primary care. Anthropometric measurements including neck circumference, body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) were recorded. Bioelectrical impedance analysis (BIA) estimated the percentage of total body fat (%TBF). Insulin resistance was estimated by HOMA-IR (homeostasis model assessment IR index). The data were analyzed by the Mann-Whitney test and the correlation between numerical variables by Spearman’s test. Receiver operating characteristic (ROC) was used to assess the anthropometric measurements’ predictive capacity to diagnosis insulin resistance. Neck circumference was positively correlated with WC, BMI, WHR, %TBF, and HOMA-IR in both sexes. In women, neck circumference showed higher AUC (area under the curve) for insulin resistance. In men, WC showed higher AUC, followed by BMI and neck circumference. The current study in Southeast Brazil suggests that neck circumference can predict insulin resistance, an important marker of cardiovascular risk in the elderly population treated in primary care.

Resumen: El presente estudio investigó la correlación de la circunferencia del cuello (CP) y otras medidas antropométricas con los factores de riesgo cardiovasculares y resistencia a la insulina (RI) en ancianos de Niterói, Río de Janeiro, Brasil. Fue realizado estudio transversal con 411 pacientes en la atención primaria de salud. Medidas antropométricas como CP, índice de masa corporal (IMC), circunferencia de la cintura (CC) y razón cintura-cadera (RCC) fueron tomadas con precisión. La bioimpedancia eléctrica (BIA) estimó el porcentaje de la grasa corporal total (%GC). La resistencia a la insulina se estimó por el HOMA-IR (homeostasis model assessment IR index). Los datos se analizaron utilizando el test de Mann-Whitney y la correlación entre las variables numéricas por el test de Spearman. La curva ROC (receiver operating characteristic) fue utilizada para evaluar la capacidad predictiva de las medidas antropométricas en el diagnóstico de RI. La CP fue positivamente correlacionada con la CC, el IMC, RCC, %TBF y con el HOMA-IR en ambos sexos. En las mujeres, la CP presentó la mayor AUC (área bajo la curva) para RI. En los hombres, la CC presentó la mayor AUC, seguido por el IMC y CP. El presente estudio realizado en el sudeste de Brasil sugiere que la CP puede predecir la RI, importante marcador de riesgo cardiovascular, en la población anciana atendida en la atención primaria de salud.

Resumo: O presente estudo investigou a correlação da circunferência do pescoço (CP) e outras medidas antropométricas com os fatores de risco cardiovasculares e resistência insulínica (RI) em idosos de Niterói, Rio de Janeiro, Brasil. Foi realizado estudo transversal com 411 pacientes na atenção primária de saúde. Medidas antropométricas como CP, índice de massa corporal (IMC), circunferência da cintura (CC) e razão cintura-quadril (RCQ) foram aferidas. A bioimpedância elétrica (BIA) estimou o percentual da gordura corporal total (%GC). A resistência à insulina foi estimada pelo HOMA-IR (homeostasis model assessment IR index). Os dados foram analisados utilizando o teste de Mann-Whitney e a correlação entre as variáveis numéricas pelo teste de Spearman. A curva ROC (receiver operating characteristic) foi utilizada para avaliar a capacidade preditiva das medidas antropométricas no diagnóstico de RI. A CP foi positivamente correlacionada com a CC, o IMC, RCQ, %TBF e com o HOMA-IR em ambos os sexos. Nas mulheres, a CP apresentou a maior AUC (área sob a curva) para RI. Nos homens, a CC apresentou a maior AUC, seguido pelo IMC e CP. O presente estudo realizado no Sudeste do Brasil sugere que a CP pode predizer a RI, importante marcador de risco cardiovascular, na população idosa atendida na atenção primária de saúde.

Abstract: This study focused on the correlation between neck circumference and other anthropometric measurements and cardiovascular risk factors and insulin resistance in the elderly in Niterói, Rio de Janeiro State, Brazil. This was a cross-sectional study in 411 patients seen in primary care. Anthropometric measurements including neck circumference, body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) were recorded. Bioelectrical impedance analysis (BIA) estimated the percentage of total body fat (%TBF). Insulin resistance was estimated by HOMA-IR (homeostasis model assessment IR index). The data were analyzed by the Mann-Whitney test and the correlation between numerical variables by Spearman’s test. Receiver operating characteristic (ROC) was used to assess the anthropometric measurements’ predictive capacity to diagnosis insulin resistance. Neck circumference was positively correlated with WC, BMI, WHR, %TBF, and HOMA-IR in both sexes. In women, neck circumference showed higher AUC (area under the curve) for insulin resistance. In men, WC showed higher AUC, followed by BMI and neck circumference. The current study in Southeast Brazil suggests that neck circumference can predict insulin resistance, an important marker of cardiovascular risk in the elderly population treated in primary care.

Resumen: El presente estudio investigó la correlación de la circunferencia del cuello (CP) y otras medidas antropométricas con los factores de riesgo cardiovasculares y resistencia a la insulina (RI) en ancianos de Niterói, Río de Janeiro, Brasil. Fue realizado estudio transversal con 411 pacientes en la atención primaria de salud. Medidas antropométricas como CP, índice de masa corporal (IMC), circunferencia de la cintura (CC) y razón cintura-cadera (RCC) fueron tomadas con precisión. La bioimpedancia eléctrica (BIA) estimó el porcentaje de la grasa corporal total (%GC). La resistencia a la insulina se estimó por el HOMA-IR (homeostasis model assessment IR index). Los datos se analizaron utilizando el test de Mann-Whitney y la correlación entre las variables numéricas por el test de Spearman. La curva ROC (receiver operating characteristic) fue utilizada para evaluar la capacidad predictiva de las medidas antropométricas en el diagnóstico de RI. La CP fue positivamente correlacionada con la CC, el IMC, RCC, %TBF y con el HOMA-IR en ambos sexos. En las mujeres, la CP presentó la mayor AUC (área bajo la curva) para RI. En los hombres, la CC presentó la mayor AUC, seguido por el IMC y CP. El presente estudio realizado en el sudeste de Brasil sugiere que la CP puede predecir la RI, importante marcador de riesgo cardiovascular, en la población anciana atendida en la atención primaria de salud.

RESUMO: CONTEXTO E OBJETIVO: A prevalência de deficiência de vitamina B12 varia de 5,8% a 30% nos pacientes em tratamento a longo prazo com metformina. Devido à escassez de dados em pacientes brasileiros, este estudo determinou a frequência de deficiência de B12 e fatores relacionados em pacientes brasileiros com diabetes mellitus tipo 2 (DM2) usando metformina. TIPO DE ESTUDO E LOCAL: Estudo transversal em hospital público universitário. MÉTODOS: Pacientes com DM2 e um grupo controle de não diabéticos foram incluídos. Os níveis séricos de vitamina B12 foram dosados e deficiência bioquímica de B12 foi definida como níveis séricos < 180 pg/ml. Foi investigada a associação entre deficiência de B12 e idade, duração do DM2, duração do uso e dose de metformina, uso de inibidores de bomba de prótons (IBP) ou antagonistas dos receptores histamínicos H2 (antagonistas-H2). RESULTADOS: 231 pacientes DM2 usando metformina (DM2-met) e 231 controles foram incluídos. Não houve diferença na frequência de uso de IBP/antagonistas-H2 entre os grupos. Deficiência de B12 foi mais frequente no grupo DM2-met (22,5% versus 7,4%) e essa diferença persistiu após exclusão dos usuários de IBP/antagonistas-H2 (17,9% versus 5,6%). Fatores que interferiram nos níveis séricos de B12 foram: uso de IBP/antagonistas-H2 e duração do uso de metformina ≥ 10 anos. O uso de IBP/antagonistas-H2 associou-se com deficiência de B12, com um risco relativo de 2,60 (95% intervalo de confiança, 1,34-5,04). CONCLUSÕES: Considerando pacientes com DM2, o tratamento com metformina e uso concomitante de IBP/antagonistas-H2 estão associados com maior chance de desenvolver deficiência de B12 quando comparado aos não diabéticos.

ABSTRACT: CONTEXT AND OBJECTIVE: The prevalence of vitamin B12 deficiency varies from 5.8% to 30% among patients undergoing long-term treatment with metformin. Because of the paucity of data on Brazilian patients, this study aimed to determine the frequency of B12 deficiency and related factors among Brazilian patients with type 2 diabetes mellitus (T2DM) using metformin. DESIGN AND SETTING: Cross-sectional study at a public university hospital. METHODS: Patients with T2DM and a control group of non-diabetics were included. Serum B12 levels were measured and biochemical B12 deficiency was defined as serum levels < 180 pg/ml. Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) or histamine H2 antagonists were determined. RESULTS: 231 T2DM patients using metformin (T2DM-met) and 231 controls were included. No difference in the frequency of PPI or H2-antagonist use was seen between the groups. B12 deficiency was more frequent in the T2DM-met group (22.5% versus 7.4%) and this difference persisted after excluding PPI/H2-antagonist users (17.9% versus 5.6%). The factors that interfered with serum B12 levels were PPI/H2-antagonist use and duration of metformin use ≥ 10 years. Use of PPI/H2-antagonists was associated with B12 deficiency, with an odds ratio of 2.60 (95% confidence interval, 1.34-5.04). CONCLUSIONS: Among T2DM patients, treatment with metformin and concomitant use of PPI/H2-antagonists are associated with a higher chance of developing B12 deficiency than among non-diabetics.

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. PSA, testosterone, IGF-I, IGFBP-3 were determined in both groups. Results PSA and IGFBP-3 levels were significantly higher in the PCa group as compared to the BPH group (p<0.001 and p=0.004, respectively). There was a significant difference when we compared the PSA before surgery (p<0.001) and at the inclusion in the study (p<0.001) and IGFBP3 (0.016) among patients with Gleason <7, ≥7 and BPH. In the PCa group, PSA, testosterone, IGF-I and IGFBP-3 levels were comparable between Gleason <7 and ≥7. Conclusions Our data suggest that in localized PCa, the quantification of PSA and, not of IGF-1, may provide independent significant information in the aggressiveness. IGFBP-3 could be a biochemical marker of disease control in PCa patients.

OBJETIVOS: Acromegalia está frequentemente associada a doenças tireoidianas. Neste estudo, avaliamos a presença de tireoidopatias em uma série de pacientes acromegálicos. SUJEITOS E MÉTODOS: Foram avaliados 106 pacientes por ultrassonografia (US) e dosagens de GH, IGF-1, T4 livre, TSH e anticorpo antitireoperoxidase. O IGF-I foi expresso em unidades de massa e desvio-padrão (DP-IGF-I). Punção aspirativa por agulha fina (PAAF) foi realizada quando os nódulos eram maiores que um centímetro ou tinham características suspeitas. RESULTADOS: Alterações tireoidianas foram encontradas em 75 pacientes. Onze apresentavam bócio difuso, 42, bócio nodular e 22, alterações morfológicas inespecíficas. Houve quatro casos (3,8%) de câncer diferenciado de tireoide. Considerando os pacientes com bócio difuso ou nodular, o volume tireoidiano foi maior naqueles com acromegalia em atividade e correlacionou-se positivamente com os níveis de GH, IGF-1 e DP-IGF-1. CONCLUSÕES: Nosso estudo confirmou que as doenças tireoidianas benignas são frequentes nos pacientes acromegálicos. A prevalência de câncer diferenciado de tireoide foi maior que na população geral. Sugerimos que US de tireoide seja realizado rotineiramente nos pacientes com acromegalia.

OBJECTIVES: Acromegaly is frequently associated with thyroid diseases. In this study, we evaluated the frequency of thyroid disorders in a series of acromegalic patients. SUBJECTS AND METHODS: We evaluated 106 acromegalic patients using thyroid ultrasonography (US) and measurements of GH, IGF-I, free T4, TSH and anti-thyroperoxidase antibody levels. IGF-I was expressed in mass units and age-related standard deviation scores (SD-scores). Fine-needle aspiration biopsy (FNAB) was performed on thyroid nodules with a diameter greater than one centimeter or with suspicious characteristics. RESULTS: Thyroid disorders were found in 75 patients. Eleven patients had diffuse goiter, 42 patients had nodular goiter, and 22 patients had unspecific morphological abnormalities. Four patients (3.8%) had thyroid carcinoma. Considering the patients with diffuse or nodular goiter, thyroid volume was greater in patients with active acromegaly, and was positively correlated with GH, IGF-I, and IGF-I SD-score. CONCLUSIONS: Our study confirmed that benign thyroid diseases are frequent in acromegalic patients. The prevalence of thyroid cancer was higher than in the overall population. We suggest that thyroid US should be routinely performed in patients with acromegaly.

Introduction Published data suggest that patients with acromegaly have an increased prevalence of prostate disorders. Objective To evaluate prostatic disorders in acromegalic patients comparing these results after one year of treatment of acromegaly and with a group of healthy men. Materials and Methods This study was composed of two parts: sectional study comparing patients with healthy controls (baseline) and prospective, longitudinal study (at baseline and after one year of treatment). Forty acromegalic patients were enrolled and evaluated at baseline and after one year with the application of international prostatic symptoms score (IPSS), digital rectal examination, measurements of growth hormone (GH), insulin-like growth factor-I (IGF-I), insulin-like growth factor-binding protein-3 (IGFBP-3), sex hormone-binding globulin (SHBG), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, total and free prostate-specific antigen (PSA) levels and prostate ultrasonography (US). Thirty healthy men were selected as control group. Results We stratified patients and controls according to age, considering 40 years-old as cut off. Healthy controls under 40 had IPSS values lower than acromegalic patients. When considering only older patients and controls prostate hyperplasia and structural abnormalities were more frequent in acromegalics. After one year of treatment there was significant decrease in GH, IGF-I and prostate volume in acromegalics over 40 years-old. Conclusions Acromegalics under 40 have more urinary symptoms according to IPSS and above 40 years-old higher frequency of structural changes and increased prostate volume than healthy men. Significant reduction of GH and IGF-I levels during treatment of acromegaly leads to decrease in the prostate volume.

OBJETIVO: Avaliar a relação entre composição corporal, síndrome metabólica (SM) e resistência insulínica (RI) no diabetes tipo 1 (DM1). SUJEITOS E MÉTODOS: Quarenta e cinco mulheres com DM1 (36 ± 9 anos; índice de massa corporal 24,6 ± 4,4 kg/m²) foram submetidas à análise de composição corporal e RI por meio de densitometria por dupla emissão de raios-X e taxa de disponibilização de glicose estimada (eGDR), respectivamente. Vinte mulheres (45%) apresentavam SM, conforme critérios da Organização Mundial da Saúde (OMS). RESULTADOS: Mulheres com SM apresentaram maior gordura central e menor eGDR do que as sem SM (41,9 ± 2,0 vs. 33,7±1,8%; p = 0,004 e 4,99 ± 0,40 vs. 8,37 ± 0,39; p < 0,0001). A gordura corporal total e a gordura periférica não diferiram entre os grupos. A gordura central foi inversamente correlacionada com eGDR (r = -0,33; p = 0,03). CONCLUSÃO: Deposição de gordura central em mulheres jovens não obesas com DM1 esteve associada com SM e RI. Avaliação da composição corporal pode ser importante na identificação de pacientes com risco metabólico elevado.

OBJECTIVE: Our aim was to determine the relationship between body fat composition, metabolic syndrome (MS), and insulin resistance in type 1 diabetes (DM1). SUBJECTS AND METHODS: Forty-five DM1 women (36 ± 9 years; body mass index 24.6 ± 4.4 kg/m²) had body composition and insulin resistance determined by dual-energy X-ray absorptiometry and estimated glucose disposal ratio (eGDR), respectively. Twenty patients (45%) had MS according to World Health Organization (WHO) criteria. RESULTS: Women with DM1 and MS had increased central fat and lower eGDR than women without MS (41.9 ± 2.0 vs. 33.7 ± 1.8%; p = 0.004 and 4.99 ± 0.40 vs. 8.37 ± 0.39; p < 0.0001, respectively). Total body fat and peripheric fat were similar between the groups. Central fat negatively correlated with eGDR (r = -0.33; p = 0.03). CONCLUSION: Central fat deposition in young non-obese DM1 women was related to MS and insulin resistance. Thus, body fat composition analysis might be important to identify DM1 patients with increased metabolic risk.

Pacientes com acromegalia têm uma prevalência aumentada de desordens prostáticas em comparação a controles saudáveis da mesma idade. Aumento do tamanho de toda a próstata ou da zona de transição, juntamente com uma incidência elevada de outras alterações estruturais, como nódulos, cistos e calcificações, foi descrito. O aumento da próstata em acromegálicos jovens e com níveis baixos de testosterona devido ao hipogonadismo central sugere que o excesso crônico do GH e do IGF-I cause hiperplasia prostática. A relação entre câncer de próstata e acromegalia é, até o momento, apenas circunstancial. Entretanto, um seguimento prolongado desses pacientes é necessário uma vez que estudos epidemiológicos reportaram uma associação entre níveis séricos de IGF-I no limite superior da normalidade e câncer de próstata na população geral. Esta revisão aborda as patologias prostáticas em pacientes com acromegalia.

Acromegalic patients have an increased prevalence of prostatic disorders compared to age-matched healthy subjects. Increased size of the whole prostate or the transitional zone, together with an elevated incidence of other structural changes, such as nodules, cysts, and calcifications, have been reported. Prostate enlargement in young acromegalic patients with low testosterone levels due to central hypogonadism supports the hypothesis that chronic GH and IGF-I excess cause prostate hyperplasia. The relationship between prostatic carcinoma and acromegaly is, until now, only circumstantial. Long-term follow-up of these patients is necessary since epidemiologic studies showed association between serum IGF-I levels in the upper normal limit and prostate cancer in the general population. This review approaches prostate diseases in patients with acromegaly.

O câncer de próstata é a segunda neoplasia mais frequentemente diagnosticada em homens adultos. Os androgênios são considerados fatores de crescimento primários para células prostáticas normais e malignas. Entretanto, outros fatores de crescimento não androgênicos estão envolvidos na regulação do crescimento das células prostáticas malignas. Associação entre IGF-I e risco de câncer de próstata é bem estabelecida. No entanto, não há evidência de que a dosagem do IGF-I melhore a especificidade na detecção do câncer de próstata, além daquela alcançada pelos níveis de antígeno prostático específico (PSA). Até hoje, não há consenso sobre a possível associação entre IGFBP-3 e risco de câncer de próstata. Apesar de não estar estabelecido, altos níveis de insulina parecem particularmente associados ao risco de tumores prostáticos agressivos. Esta revisão descreveu base fisiopatológica, evidências epidemiológicas e modelos animais que apoiam a associação da família das IGFs e insulina com câncer de próstata. Também foram descritas terapias potenciais que têm como alvo esses fatores de crescimento, os quais, no futuro, poderão ser usados para tratar pacientes com câncer de próstata.

Prostate cancer is the second most frequent malignancy diagnosed in adult men. Androgens are considered the primary growth factors for prostate normal and cancer cells. However, other non-androgenic growth factors are involved in the growth regulation of prostate cancer cells. The association between IGF-I and prostate cancer risk is well established. However, there is no evidence that the measurement of IGF-I enhances the specificity of prostate cancer detection beyond that achievable by serum prostate-specific antigen (PSA) levels. Until now, there is no consensus on the possible association between IGFBP-3 and prostate cancer risk. Although not well established, it seems that high insulin levels are particularly associated with risk of aggressive prostatic tumours. This review describes the physiopathological basis, epidemiological evidence, and animal models that support the association of the IGFs family and insulin with prostate cancer. It also describes the potential therapies targeting these growth factors that, in the future, can be used to treat patients with prostate cancer.

Um aumento na incidência de anormalidades no metabolismo ósseo-mineral (osteopenia/osteoporose) tem sido observado em pacientes com síndrome de imunodeficiência humana adquirida (SIDA). Relatamos dois casos de osteonecrose em pacientes com SIDA. Ambos os pacientes estavam recebendo terapia anti-retroviral de alta potência (HAART) e apresentavam um ou mais fatores de risco conhecidos para osteonecrose. Nós revisamos a literatura e discutimos a patogênese, diagnóstico, prevenção e tratamento desta patologia em pacientes com SIDA.

An increase in the incidence of abnormalities on bone and mineral metabolism (osteopenia/osteoporosis) and the development of osteonecrosis has been observed in patients with acquired immunodeficiency syndrome (AIDS). Two cases of osteonecrosis in patients with AIDS are reported. Both patients were receiving highly active antiretroviral therapy (HAART) and presented with one or more known risk factors for osteonecrosis. We review the literature and discuss the pathogenesis, diagnosis, prevention and treatment of this entity in patients with AIDS.

CONTEXTO: A síndrome da hiperinsulinemia autoimune (SHA, doença de Hirata) é uma causa rara de hipoglicemia nos países ocidentais. Ela é caracterizada por episódios de hipoglicemia, níveis elevados de insulina e presença de anticorpos anti-insulina. Nosso objetivo é relatar um caso da SIA identificado na América do Sul. RELATO DO CASO: Um homem caucasiano de 56 anos de idade começou a apresentar sintomas neuroglicopênicos durante hospitalização devida a trauma grave. A avaliação laboratorial confirmou hipoglicemia e níveis extremamente elevados de insulina. Os exames radiológicos convencionais realizados foram negativos para tumor pancreático. A remissão clínica da doença não ocorreu durante o uso de verapamil e corticóides. Desta forma, pancreatectomia subtotal foi realizada devido à ausência de resposta ao tratamento conservador e à impossibilidade de serem utilizados imunosupressores em razão da bacteremia persistente. O exame histopatológico revelou hiperplasia difusa de células beta. O paciente persiste apresentando níveis elevados de insulina porém praticamente não apresenta mais episódios de hipoglicemia.

CONTEXT: Insulin autoimmune syndrome (IAS, Hirata disease) is a rare cause of hypoglycemia in Western countries. It is characterized by hypoglycemic episodes, elevated insulin levels, and positive insulin antibodies. Our objective is to report a case of IAS identified in South America. CASE REPORT: A 56-year-old Caucasian male patient started presenting neuroglycopenic symptoms during hospitalization due to severe trauma. Biochemical evaluation confirmed hypoglycemia and abnormally high levels of insulin. Conventional imaging examinations were negative for pancreatic tumor. Insulin antibodies were above the normal range. Clinical remission of the episodes was not achieved with verapamil and steroids. Thus, a subtotal pancreatectomy was performed due to the lack of response to conservative treatment and because immunosuppressants were contraindicated due to bacteremia. Histopathological examination revealed diffuse hypertrophy of beta cells. The patient continues to have high insulin levels but is almost free of hypoglycemic episodes.