ABSTRACT BACKGROUND: Fat, muscle, and bone are endocrine organs capable of affecting the metabolic profile and cardiovascular risk. Relating these components is important to the establishment of early intervention strategies for overweight patients. AIMS: This study aimed to evaluate the influence of body mass components on the metabolic profile and cardiovascular risk in the preoperative period of bariatric surgery. METHODS: A cross-sectional study was conducted with patients admitted for bariatric surgery at a university hospital in the city of Recife, Brazil, between 2018 and 2019. Body composition was determined using dual-energy x-ray absorptiometry. Cardiovascular risk was assessed using the Framingham risk score. Data were collected on anthropometric, clinical, and lifestyle characteristics. The lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides), blood glucose, and vitamin D were determined using the standard methods of the hospital laboratory. RESULTS: A total of 60 patients were analyzed, 86.7% of whom had comorbidities, 33.3% had moderate/high cardiovascular risk, and 71.4% had vitamin D insufficiency/deficiency. Lower lean body mass (adjusted PR 3.24; 95%CI 1.19–5.77) was independently associated with the severity of obesity. The body mass index and waist circumference were negatively correlated with lean body mass (r=-0.52; p<0.01)/r=-0.36; p<0.01). Lean body mass was negatively correlated with fat mass (r=-0.26; p<0.05), trunk fat (r=-0.29; p<0.05), fasting glucose (r=-0.26; p<0.05), and bone mineral density (r=-0.26; p<0.05). A total of 84.2% of individuals with less trunk fat tended to have low cardiovascular risk (p=0.05). However, physical inactivity (adjusted PR 2.14; 95%CI 1.19–5.54) and the risk of alcohol dependence (adjusted PR 2.41; 95%CI 1.76–4.15) were the only variables independently associated with cardiovascular risk. CONCLUSION: Obese patients in the preoperative period of bariatric surgery with less trunk fat tended to have low cardiovascular risk. However, the other components of body mass were also not associated with cardiovascular risk.

RESUMO RACIONAL: O tecido adiposo, músculos e ossos representam órgãos endócrinos, capazes de interferir no perfil metabólico e risco cardiovascular. Relacionar esses componentes será importante para estratégias de intervenção precoce, em obesos. OBJETIVOS: Avaliar a influência dos compartimentos da massa corporal, sobre o perfil metabólico e risco cardiovascular, no pré-operatório de cirurgia bariátrica. MÉTODOS: Estudo transversal, com pacientes admitidos para cirurgia bariátrica, em hospital universitário. A composição corporal foi avaliada pela absortometria radiológica de dupla energia e o risco cardiovascular pelo escore de risco de Framingham. Foram analisadas variáveis antropométricas, clínicas e de estilo de vida. Foi avaliado perfil lipídico (colesterol total, HDL-c, LDL-c, triglicerídeos), glicemia e vitamina D, utilizando a metodologia padrão. RESULTADOS: Foram analisados 60 pacientes, 86,7% apresentavam comorbidades, 33,3% risco cardiovascular moderado/elevado e 71,4% insuficiência/deficiência de vitamina D. Menor massa corporal magra associou-se à gravidade da obesidade. O índice de massa corpórea e a circunferência da cintura correlacionaram-se negativamente com a massa corporal magra (r=-0,52; p<0,01)/r=-0,36; p<0,01). A massa corporal magra correlacionou-se negativamente com a massa gorda (r=-0,26; p<0,05), gordura troncular (r=-0,29; p<0,05), glicemia de jejum (r=-0,26; p<0,05) e densidade mineral óssea (r=-0,26; p<0,05). Ao todo, 84,2% dos indivíduos com menos gordura troncular apresentaram tendência a baixo risco cardiovascular (p=0,05). Contudo, inatividade física (razão de prevalência ajustada 2,14; IC95% 1,19–5,54) e risco de dependência alcoólica foram as únicas variáveis independentemente associadas ao risco cardiovascular. CONCLUSÕES: Os pacientes obesos em pré-operatório de cirurgia bariátrica com menos gordura troncular, apresentaram tendência a baixo risco cadiovascular. Contudo, o risco cardiovascular também não foi associado aos demais componentes da massa corporal.

ABSTRACT Hypopituitarism is a disorder characterized by insufficient secretion of one or more pituitary hormones. New etiologies of hypopituitarism have been recently described, including head trauma, cerebral hemorrhage, and drug-induced hypophysitis. The investigation of patients with these new disorders, in addition to advances in diagnosis and treatment of hypopituitarism, has increased the prevalence of this condition. Pituitary hormone deficiencies can induce significant clinical changes with consequent increased morbidity and mortality rates, while hormone replacement based on current guidelines protects these patients. In this review, we will first discuss the different etiologies of hypopituitarism and then address one by one the clinical aspects, diagnostic evaluation, and therapeutic options for deficiencies of TSH, ACTH, gonadotropin, and GH. Finally, we will detail the hormonal interactions that occur during replacement of pituitary hormones.

RESUMO Objetivo Verificar a influência do consumo de alimentos ultraprocessados em índices antropométricos e de aterogenicidade. Métodos Estudo transversal com 327 adolescentes na faixa etária de 14 a 19 anos. Avaliaram-se dados sociodemográficos, antropométricos, bioquímicos e de consumo alimentar. As razões dos índices de aterogenicidade foram calculadas por meio do Índice de Castelli I (Colesterol Total/Lipoproteína de Alta Densidade), Índice de Castelli II (Lipoproteína de Baixa Densidade/Lipoproteína de Alta Densidade) e da estimativa do tamanho da partícula de Lipoproteína de Baixa Densidade (Índice Aterogênico do Plasma=Triglicerídeos/Lipoproteína de Alta Densidade). A regressão logística foi utilizada para a análise bruta e ajustada entre consumo de alimentos ultraprocessados, indicadores antropométricos e índice de aterogenicidade. O nível de significância foi de 5%. Resultados A maioria dos adolescentes que participaram do estudo era do sexo feminino (59,3%). As meninas apresentaram maior consumo de alimentos ultraprocessados (26,6% vs. 20,5%). Do total de participantes, 16,5% estavam com excesso de peso e 65,7% eram de escolas públicas. Adolescentes com valores alterados para o Índice Castelli I e II e para o Índice Aterogênico do Plasma apresentaram valores de peso, Circunferência da Cintura, Circunferência da Cintura/Altura e Índice de Massa Corporal/Idade significantemente superiores. A análise ajustada identificou associação significante (Razão de possibilidades=2,29; Intervalo de confiança 95%:1,23-4,28) entre o elevado consumo de alimentos ultraprocessados e o índice de Castelli II. Conclusão As associações entre os índices aterogênicos com os índices antropométricos e com o consumo de alimentos ultraprocessados ressaltam a influência negativa desses alimentos na saúde cardiovascular de adolescentes.

ABSTRACT Objective To investigate the influence of ultra-processed food consumption on anthropometric and atherogenic indices. Methods A cross-sectional study was conducted with 327 adolescents aged 14 to 19 years. Sociodemographic, anthropometric, biochemical, and food consumption data were evaluated. The ratios of atherogenic indices were calculated using the Castelli I (Total Cholesterol/High Density Lipoprotein Cholesterol), Castelli II (Low Density Lipoprotein Cholesterol/High Density Lipoprotein Cholesterol), and estimated Low Density Lipoprotein Cholesterol particle size (Atherogenic Index of Plasma=Triglycerides/High-Density Lipoprotein Cholesterol) indices. Logistic regression was used for the unadjusted and adjusted analysis between ultra-processed foods consumption, anthropometric, and atherogenic indices. The level of significance was 5%. Results Most participants were female (59.3%). Girls had a higher consumption of ultra-processed foods (26.6% vs. 20.5%). Of the total number of adolescents, 16.5% were overweight and 65.7% were from public schools. Adolescents with altered values for the Castelli I and II Index, and for the Atherogenic Index of Plasma had significantly higher weights, Waist Circumference, Waist Circumference/ Height and Body Mass Index/ Age values. The adjusted analysis identified a significant association (Odds ratio=2.29; 95% Confidence interval: 1.23-4.28) between the high consumption of ultra-processed foods and the Castelli II index. Conclusion The associations between atherogenic indices and anthropometric indices and the consumption of ultra-processed foods highlight the negative influence of these foods on adolescents’ cardiovascular health.

ABSTRACT Objective Investigate the therapeutic response of acromegaly patients to pegvisomant (PEGV) in a real-life, Brazilian multicenter study. Subjects and methods Characteristics of acromegaly patients treated with PEGV were reviewed at diagnosis, just before and during treatment. All patients with at least two IGF-I measurements on PEGV were included. Efficacy was defined as any normal IGF-I measurement during treatment. Safety data were reviewed. Predictors of response were determined by comparing controlled versus uncontrolled patients. Results 109 patients [61 women; median age at diagnosis 34 years; 95.3% macroadenomas] from 10 Brazilian centers were studied. Previous treatment included surgery (89%), radiotherapy (34%), somatostatin receptor ligands (99%), and cabergoline (67%). Before PEGV, median levels of GH, IGF-I and IGF-I % of upper limit of normal were 4.3 µg/L, 613 ng/mL, and 209%, respectively. Pre-diabetes/diabetes was present in 48.6% and tumor remnant in 71% of patients. Initial dose was 10 mg/day in all except 4 cases, maximum dose was 30 mg/day, and median exposure time was 30.5 months. PEGV was used as monotherapy in 11% of cases. Normal IGF-I levels was obtained in 74.1% of patients. Glycemic control improved in 56.6% of patients with pre-diabetes/diabetes. Exposure time, pre-treatment GH and IGF-I levels were predictors of response. Tumor enlargement occurred in 6.5% and elevation of liver enzymes in 9.2%. PEGV was discontinued in 6 patients and 3 deaths unrelated to the drug were reported. Conclusions In a real-life scenario, PEGV is a highly effective and safe treatment for acromegaly patients not controlled with other therapies.

RESUMO Objetivo: avaliar a associação do consumo alimentar com estado nutricional, atividade física e fatores sociodemográficos no pré-operatório de cirurgia bariátrica. Métodos: estudo transversal, realizado no período de 2018 a 2019, com pacientes internados para a cirurgia bariátrica no Hospital Universitário Oswaldo Cruz da Universidade Federal de Pernambuco. Foram obtidos dados sociodemográficos, estado nutricional pelo índice de massa corporal (IMC), circunferência da cintura, maior peso e peso pré-cirúrgico, consumo alimentar obtido pelo questionário de frequência alimentar baseado na pirâmide alimentar adaptada para o paciente bariátrico e atividade física. Resultados: participaram do estudo 60 pacientes, sendo 78,3% do sexo feminino, com idades de 38,8±9,6 anos, 53,3% casados e 70% dos indivíduos com mais de 12 anos de estudo. Na prática de atividade física, 31,7% eram sedentários. Sobre o estado nutricional, a média de IMC observada foi de 47,3±6,96kg/m2. O peso pré-operatório, maior peso atingido antes da cirurgia e circunferência da cintura foi maior no sexo masculino (p<0,05). Houve associação entre atividade física e consumo alimentar, sendo que indivíduos sedentários consumiam mais carboidratos (p=0,041). Por outro lado, dados sociodemográficos e estado nutricional não apresentaram associações com o consumo. Conclusão: o nível de atividade física evidenciou associação significativa apenas com o consumo de carboidratos.

ABSTRACT Objective: to evaluate the association of food consumption with nutritional status, physical activity and sociodemographic factors in the bariatric surgery period preoperative. Methods: we conducted a cross-sectional study from 2018 to 2019, with patients admitted for bariatric surgery at the Oswaldo Cruz University Hospital, Federal University of Pernambuco. We collected data sociodemographic and nutritional data such as body mass index (BMI), waist circumference, highest weight and pre-surgical weight. We evaluated food consumption with the food frequency questionnaire based on the food pyramid adapted for bariatric patients and physical activity. Results: the study involved 60 patients, 78.3% were female, mean age was 38.8±9.6 years, 53.3% were married, and 70% had more than 12 years of education. As for physical activity, 31.7% were sedentary. Regarding nutritional status, the mean BMI was 47.3±6.96kg/m2. Preoperative weight, highest weight reached before surgery and waist circumference were higher in males (p<0.05). There was an association between physical activity and food intake, and sedentary individuals consumed more carbohydrates (p=0.041). On the other hand, sociodemographic data and nutritional status were not associated with food consumption. Conclusion: the level of physical activity showed significant association only with carbohydrate consumption.

ABSTRACT Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called “hook effect”. Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

ABSTRACT The treatment objectives for a patient with Cushing's disease (CD) are remission of hypercortisolism, adequate management of co-morbidities, restoration of the hypothalamic-pituitary-adrenal axis, preservation of fertility and pituitary function, and improvement of visual defects in cases of macroadenomas with suprasellar extension. Transsphenoidal pituitary surgery is the main treatment option for the majority of cases, even in macroadenomas with low probability of remission. In cases of surgical failure, another subsequent pituitary surgery might be indicated in cases with persistent tumor imaging at post surgical magnetic resonance imaging (MRI) and/or pathology analysis of adrenocorticotropic hormone-positive (ACTH+) positive pituitary adenoma in the first procedure. Medical treatment, radiotherapy and adrenalectomy are the other options when transsphenoidal pituitary surgery fails. There are several options of medical treatment, although cabergoline and ketoconazole are the most commonly used alone or in combination. Novel treatments are also addressed in this review. Different therapeutic approaches are frequently needed on an individual basis, both before and, particularly, after surgery, and they should be individualized. The objective of the present review is to provide the necessary information to achieve a more effective treatment for CD. It is recommended that patients with CD be followed at tertiary care centers with experience in treating this condition.

RESUMO Objetivo: investigar as mudanças sofridas na percepção da imagem corporal em pacientes submetidos à cirurgia bariátrica, avaliando a acurácia/inacurácia na estimativa do tamanho corporal e a satisfação/insatisfação com os corpos após a cirurgia. Métodos: pesquisa foi realizada no ambulatório de Cirurgia Geral do Hospital das Clínicas da Universidade Federal de Pernambuco. Participaram 36 pacientes com idade a partir de 18 anos submetidos à cirurgia bariátrica. Foram realizados estudos transversal e quantitativo com a utilização da Escala de Figuras de Silhuetas. Resultados: na análise descritiva do escore de distorção e insatisfação dos pacientes com a imagem corporal, percebeu-se que a média da distorção foi positiva (média= 6,43kg/m²), indicando que a maioria das pessoas se vê maior do que realmente é. Em contrapartida, na insatisfação foi encontrada uma média negativa (média= -6,91kg/m²), indicando que a maioria dos pacientes avaliados tem como “meta” um IMC menor do que aquele apontado como atual (ou seja, gostaria de ter uma silhueta menor). Quanto à satisfação com o tamanho da silhueta, apenas 11,8% das mulheres gostaram do resultado pós-cirúrgico, enquanto que entre os homens houve 50% de satisfação. Conclusão: embora a cirurgia bariátrica tenha diminuído significativamente o IMC, os pacientes apresentaram, em sua maioria, insatisfação com o peso corporal, percebendo-o maior do que realmente era, caracterizando-se, assim, uma inacurácia perceptiva.

ABSTRACT Objective: to investigate changes in body image perception in patients undergoing bariatric surgery, evaluating the accuracy/inaccuracy in body size estimation and satisfaction/dissatisfaction with own body after surgery. Methods: we performed a survey at the General Surgery outpatient clinic of the Clinics Hospital of the Federal University of Pernambuco. Thirty-six patients aged 18 years and older undergoing bariatric surgery participated. We carried out cross-sectional and quantitative studies using the Silhouetted Figures Scale. Results: in the descriptive analysis of the distortion and dissatisfaction score of the patients with the body image, the mean distortion was positive (6.43kg/m²), indicating that most people see themselves greater than they really are. On the other hand, in the dissatisfaction, we found a negative mean (-6.91kg/m²), indicating that the majority of the patients evaluated had a “BMI” lower than the current one (that is, a smaller silhouette). Regarding satisfaction with silhouette size, only 11.8% of women liked the post-surgical result, while among men there was 50% satisfaction. Conclusion: Although bariatric surgery significantly reduced BMI, the patients presented, for the most part, dissatisfaction with body weight, perceiving it greater than it actually was, thus characterizing a perceptual inaccuracy.

Hyperprolactinemia is a frequent condition in clinical practice, responsible for 20-25% of secondary amenorrhea cases. We performed an electronic survey among members of the Brazilian Society of Metabolism and Endocrinology (SBEM) and the Brazilian Federation of Association of Gynecology and Obstetrics (FEBRASGO) to assess diagnostic and therapeutic preferences for management of hyperprolactinemia. Electronic addresses of SBEM and FEBRASGO members were obtained from the directories of these societies, and these members were invited, through electronic messages (e-mail), to answer an online questionnaire that included 10 questions about the treatment of micro and macropro-lactinomas, maximum dose of dopamine agonist, how to exclude primary hypothyroidism and macroprolactinemia, hyperprolactinemia and pregnancy. We received responses to the questionnaire by e-mail from 521 SBEM members and 233 FEBRASGO members. The results of this survey demonstrate that there are many area of agreement between SBEM and FEBRASGO members and most of their responses follow the latest Endocrine Society Guideline. Relative to a survey performed several years ago, our findings show that SBEM members have incorporated some of latest recommendations in this field. The principal issues of concern for both groups are duration of dopamine agonist treatment for patients with microprolactinoma and dopamine agonist withdrawal during pregnancy.

La hiperprolactinemia es una alteración frecuente, siendo responsable del 20 al 25% de los casos de amenorrea secundaria. Se realizó una investigación electrónica entre los miembros de la Sociedad Brasileña de Endocrinología y Metabología (SBEM) y de la Federación Brasileña de Ginecología y Obstetricia (FEBRASGO) para evaluar sus preferencias en el diagnóstico y el tratamiento de la hiperprolactinemia. Las direcciones electrónicas de miembros SBEM y de FEBRASGO se obtuvieron a partir de los directorios de esas sociedades. Se invitó a estos miembros a responder un cuestionario que incluía 10 cuestiones sobre el tratamiento de los micro y macroprolactinomas, dosis máxima del agonista dopaminérgico, hiperprolactinemia e hipotiroidismo primario, macroprolactinemia, prolactinoma y embarazo. Hemos recibido respuestas de 521 miembros de la SBEM y de 233 miembros FEBRASGO. Los resultados demuestran que hay bastantes áreas de concordancia entre los miembros de la SBEM y de la FEBRASGO y que la mayoría de las respuestas están de acuerdo con el último consenso de la Endocrine Society. En cuanto a una encuesta similar realizada hace años, nuestros resultados muestran que los socios de SBEM incorporaron algunas de las últimas recomendaciones propuestas en esa área. Los principales aspectos de interés en ambos grupos son la duración del tratamiento con el agonista dopaminérgico y la retirada del mismo durante el embarazo.

RESUMO CONTEXTO A cirurgia bariátrica é o tratamento mais efetivo para obesidade grave, entretanto aumenta o risco de desenvolvimento de deficiência de nutrientes, como vitamina A. No metabolismo humano, a vitamina A exerce função importante na visão. OBJETIVO Avaliar níveis séricos de vitamina A, função visual e superfície ocular de pacientes submetidos à cirurgia bariátrica. MÉTODOS Estudo transversal e analítico. População de 28 pacientes submetidos à cirurgia bariátrica há pelo menos 6 meses. Foi feita avaliação oftalmológica por meio de teste de visão de cores, teste de sensibilidade ao contraste, acuidade visual com correção, testes de superfície ocular e microscopia confocal, além da dosagem de vitamina A sérica. RESULTADOS Sete (25,0%) pacientes foram submetidos à gastrectomia vertical e 21 (75,0%), à derivação gástrica em Y de Roux. A média do valor sérico de vitamina A foi de 1,7±0,5 µmoL/L. A maioria dos pacientes (60,7%) apresentavam sintomas de olho seco. Cinco (17,9%) pacientes apresentaram alteração da sensibilidade ao contraste e 18 (64,3%) alteração da visão de cores. Quando considerados apenas os pacientes submetidos à derivação gástrica em Y de Roux, a média de vitamina A foi de 1,8±0,6 µmoL/L, enquanto os submetidos à técnica gastrectomia vertical tiveram média de 1,7±0,5 µmoL/L. A análise da influência dos níveis séricos de vitamina A na função visual e na superfície ocular foi realizada pelo teste de correlação de Pearson e não houve correlação significativa. CONCLUSÃO Não houve influência do tipo de técnica de cirurgia bariátrica utilizada nos níveis séricos de vitamina A, na função visual, nem na superfície ocular. Da mesma forma, não houve correlação dos níveis séricos de vitamina A com a função visual nem com as alterações de superfície ocular.

ABSTRACT BACKGROUND Bariatric surgery is the most effective treatment for severe obesity, but the surgery increases the risk of developing nutritional deficiencies, such as vitamin A deficiency. In human metabolism, vitamin A plays a role in vision. OBJECTIVE To evaluate serum vitamin A, visual function and ocular surface of patients undergoing bariatric surgery. METHODS A cross-sectional and analytical study was conduced with 28 patients undergoing bariatric surgery for at least 6 months. Ophthalmologic evaluation was done through color vision test, contrast sensitivity test, ocular surface tests and confocal microscopy, as well as vitamin A serum measurement. RESULTS Vertical sleeve gastrectomy was performed in seven (25.0%) patients and Roux -en-Y gastric by-pass in 21 (75.0%). Mean serum vitamin A level was 1.7±0.5 µmoL/L. Most patients (60.7%) had symptoms of dry eye. Five (17.9%) patients had contrast sensitivity impairment and 18 (64.3%) color vision changes. In the group of patients undergoing Roux -en-Y gastric by-pass , mean vitamin A levels were 1.8±0.6 µmoL/L, whereas they were 1.7±0.5 µmoL/L in patients submitted to the restrictive technique vertical sleeve gastrectomy . The analysis of the influence of serum levels of vitamin A in the visual function and ocular surface was performed by Pearson correlation test and there was no significant correlation between any of the variables and vitamin A. CONCLUSION There was no influence of the bariatric surgery technique used on serum vitamin A levels, on the visual function or on the ocular surface. Moreover, there was no correlation between serum levels of vitamin A and the visual function or the ocular surface changes.

ABSTRACT Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors’ experience. Arch Endocrinol Metab. 2016;60(4):374-90

ABSTRACT Although it is a rare condition, the accurate diagnosis and treatment of Cushing’s disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing’s syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing’s syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing’s disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86

Racional: Sobrepeso e obesidade estão associados à síndrome metabólica e obesidade abdominal, aumentando o risco de diabete melito tipo 2 e doenças cardiovasculares. No Brasil, ainda não há dados precisos sobre a prevalência destas alterações, principalmente entre pessoas que estão realizando algum tipo de atividade física em ambientes públicos; também não há programas de educação e prevenção da obesidade. Objetivo: Investigar a prevalência da obesidade e síndrome metabólica em frequentadores de um parque em Recife. Métodos: Realizou-se um estudo prospectivo, transversal e descritivo, onde 619 indivíduos foram avaliados e estratificados por perfil definido em protocolo específico, apresentando as seguintes características: sexo feminino (50,1%) e média de idade = 50,6 ± 14,8, havendo predomínio entre 50 e 59 anos (26,8% dos casos) e de indivíduos com ensino superior (68%) e renda familiar entre 4 e 10 salários mínimos (29,2%). Resultados: Prática regular de exercícios físicos foi relatada por 78% das pessoas e foi constatado ainda que 70,7% apresentavam excesso de peso: 45% com sobrepeso e 25,7% obesidade, dos quais 20,7% com obesidade grau I, 3,9% com grau II e 1,1% com grau III. A prevalência de síndrome metabólica foi de 4,3%, com predomínio nos homens (6,3%). Hipertensão arterial e diabetes mellitus tipo 2 foram detectados em 17,8% e 5,5%, respectivamente. Devido a influência da obesidade na ocorrência de diabetes mellitus 2 e síndrome metabólica, foi constatado que esta associação não é significativa para as duas condições (p=0,014 e 0,017, respectivamente). Conclusão : Os achados demonstram elevada prevalência de sobrepeso e obesidade da população avaliada, e síndrome metabólica em 4,3%, apesar do relato de que 70% dos transeuntes realizavam atividade física regular.

Background - Overweight and obesity are associated with metabolic syndrome and abdominal obesity, thereby increasing the risk of type 2 diabetes mellitus and cardiovascular diseases. In Brazil, there are still no precise data on the prevalence of these disorders, especially among individuals who carry out some kind of physical activity in public spaces and there are no education and prevention programs for obesity. Aim: To investigate the prevalence of metabolic syndrome and obesity among park users. Methods: A prospective, cross-sectional, descriptive study was conducted with 619 individuals assessed and stratified by profile according to a specific protocol. The group was characterized as follows: female (50.1%) and mean age =50.6±14.8, with predominance of individuals aged between 50 and 59 years (26.8%) and with higher education (68%) and a household income of between 4 and 10 minimum wages (29.2%). Results: Regular physical exercise was reported by 78% of the individuals and it was found that 70.7% were nevertheless of above normal weight: 45% overweight and 25.7% obese, of whom 20.7% had obesity grade I, 3.9% grade II and 1.1% grade III. The prevalence of metabolic syndrome was 4.3%, mostly in men (6.3%). Arterial hypertension and type 2 diabetes mellitus were detected in 17.8% and 5.5%, respectively. In view of the influence of obesity on the occurrence of type 2 diabetes mellitus and metabolic syndrome, it was found that this association was not significant for the two conditions (p=0.014 and 0.017, respectively). Conclusion : The findings demonstrate a high prevalence of overweight and obesity in the studied population, and metabolic syndrome in 4.3%, despite the fact that 70% reported engaging in regular physical activity.

A definição da etiologia da hiperprolactinemia muitas vezes representa um grande desafio e um diagnóstico preciso é fundamental antes do tratamento. Embora níveis de prolactina > 200-250 ng/mL sejam altamente sugestivos de prolactinomas, ocasionalmente podem ser encontrados em outras condições. Além disso, até 25% dos pacientes com microprolactinomas podem apresentar-se com níveis de prolactina < 100 ng/mL, os quais são evidenciados na maioria dos pacientes com pseudoprolactinomas, hiperprolactinemia induzida por drogas ou doenças sistêmicas. Por outro lado, deve-se atentar às condições que podem levar a valores de prolactina falsamente baixos, particularmente o chamado efeito gancho. Este último é um artefato causado por um nível extremamente elevado de PRL e que pode ser confirmado pela repetição do exame após diluição do soro a 1:100. O efeito gancho deve ser considerado em todo paciente com grandes adenomas hipofisários e níveis de prolactina dentro da faixa normal ou apenas moderadamente elevados (p. ex., < 200 ng/mL). Um efeito gancho não detectado pode levar a diagnóstico incorreto e intervenção cirúrgica desnecessária em pacientes com prolactinomas. Outro desafio importante é a macroprolactinemia, um achado comum que precisa ser identificado visto que geralmente não requer tratamento. Ainda que a maioria dos pacientes seja assintomática devido à concomitância de outras doenças, muitos podem apresentar galactorreia ou distúrbios menstruais, bem como anormalidades neurorradiológicas. Finalmente, os médicos devem estar cientes de que incidentalomas hipofisários são encontrados em pelo menos 10% da população adulta. Arq Bras Endocrinol Metab. 2014;58(1):9-22

The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population. Arq Bras Endocrinol Metab. 2014;58(1):9-22

RACIONAL: Alterações metabólicas têm elevada correlação com formas graves da doença hepática gordurosa não-alcoólica. Todavia, ainda não há método não-invasivo que promova sua adequada estratificação sendo que a biópsia permanece como meio diagnóstico ideal. OBJETIVO: Avaliar a prevalência dessa doença em obesos no pré-operatório de bypass gástrico em Y-de-Roux e correlacionar fatores metabólicos com a histopatologia hepática. MÉTODOS: Do total de 47 pacientes, foram incluídos 35 em pré-operatório e excluídos 12 devido à doenças hepáticas e ingestão alcoólica >80 g/semana. Foi realizada avaliação clínico-laboratorial antes da operação e biópsia hepática transoperatória. A intensidade da esteatohepatite foi classificada nos graus: I (leve a moderada), II (difusa e inflamatória), III (fibrose periportal) e IV (cirrose). Foram comparadas as seguintes variáveis: tempo de obesidade, índice de massa corpórea, relação cintura-quadril, diabete melito tipo 2, hipertensão arterial e dislipidemia. RESULTADOS: Trinta e cinco pacientes (68,6% mulheres, média de idade de 37 anos) foram avaliados. O índice de massa corpórea médio pré-operatório foi de 53,04 kg/m2. Esteatohepatite não-alcoólica foi encontrada em 31 pacientes (88,6%), sendo grau I 32,2% (n=10), grau II 45,2% (n=14), e grau III 25,6% (n=7). A relação cintura-quadril mostrou associação com esteatose hepática; hipertrigliceridemia foi o marcador que melhor se correlacionou com maior grau; não houve correlação entre aminotransferase e a intensidade da doença; houve correlação da intensidade com fatores relacionados à resistência insulínica. CONCLUSÃO: Esteatohepatite não-alcoólica tem elevada prevalência em obesos graves, porém não foi observada correlação positiva entre aminotransferases e o grau de obesidade com histopatologia hepática. Hipertrigliceridemia e relação cintura-quadril correlacionaram-se positivamente com a intensidade de doença.

BACKGROUND: Metabolic disorders have high correlation with severe forms of nonalcoholic fatty liver disease. However, there is no non-invasive method that promotes its proper stratification and biopsy remains the ideal diagnostic tool. AIM: To evaluate the prevalence of this disease in obese in preoperative period of Roux-en-Y gastric bypass and metabolic factors correlated with liver histopathology. METHODS: From a total of 47 patients, 35 were enrolled in the inclusion criteria and 12 excluded due to liver disease and alcohol intake >80 g/week. Were performed clinical and laboratory evaluation before the surgery and intraoperative liver biopsy . The intensity was ranked in grade of steatohepatitis: I (mild to moderate) and II (diffuse inflammation), III ( periportal fibrosis) and IV (cirrhosis). Were compared the following variables: duration of obesity, body mass index, waist-hip ratio, type 2 diabetes mellitus, hypertension and dyslipidemia. RESULTS: Thirty -five patients (68.6 % women , mean age 37 years) were evaluated. The mean body mass index preoperatively was 53.04 kg/m². Nonalcoholic steatohepatitis was found in 31 patients (88.6 %) and 32.2% were in grade I (n=10), grade II 45.2% (n=14), and 25.6% grade III (n=7). The waist-hip ratio was associated with hepatic steatosis; hypertriglyceridemia was the marker that had best correlation with higher grade; there was no correlation between aminotransferase and intensity of the disease; there was correlation of intensity with factors related to insulin resistance. CONCLUSION: Nonalcoholic steatohepatitis is highly prevalent in morbidly obese patients, but there was no positive correlation between aminotransferases and degree of obesity and liver histopathology. Hypertriglyceridemia and waist-hip ratio were positively correlated with the intensity of disease.