ABSTRACT Introduction: Graves' orbitopathy (GO) is a debilitating disorder in patients with autoimmune thyroid disease, mainly Graves' disease, which develops in 30 to 50% of cases. Objectives: To describe the clinical-ophthalmological characteristics and evolution of patients with moderate-to- severe active GO treated with methylprednisolone boluses who attended the Central Hospital of the Institute of Social Security between January 2018 and September 2021. Materials and methods: Observational design research, descriptive, retrospective study. Results: Records of 34 patients with active moderate-to-severe GO who received boluses of methylprednisolone based on the EUGOGO 2016 guidelines, were reviewed, of which 3 patients were excluded due to having incomplete records and another 3 patients since they required second-line treatment prior to end the 12-session scheme. Of the 28 patients studied, the average age was 43.6 ±13.1 years, 89% were female and 28.5% were smokers. Regarding the thyroid function of the population prior to treatment, hyperthyroidism was found in 82%, hypothyroidism in 11% and euthyroidism in 7%; and after treatment, hyperthyroidism was found in 78.6% (subclinical), euthyroidism in 17.9% and hypothyroidism in 3.5%. The majority (92.6%) had positive thyrotropin receptor antibodies, with an average of 18 ± 9.9 mIU/Ml. Regarding the activity of orbitopathy according to the CAS scale, an average of 4.1 ±1.0 was found before treatment and 1.2 ±1.4 after; Of them, 46.4% presented a mild condition according to the severity scale, 39% without severity criteria and 14% persisted in moderate-severe. Improvement in visual acuity was noted after treatment (57.1%), the average exophthalmia before treatment was 22.2 mm and after 21.1 mm; Diplopia occurred in 7.1% before treatment and in 3.6% after treatment. Conclusion: Treatment with intravenous glucocorticoids in moderate-severe Graves' orbitopathy (EUGOGO 2016 scheme) was very effective, reversing the activity and consequently helping to reduce the severity, in the vast majority of our patients. This could be explained because the orbitopathy was incipient and by the high degree of patient adherence in the context of well-protocolized multidisciplinary management.

RESUMEN Introducción: La oftalmopatía tiroidea (OT) es un trastorno debilitante en pacientes con enfermedad tiroidea autoinmune, principalmente enfermedad de Graves, que se desarrolla entre el 30 a 50% de los casos. Objetivos: Describir las características clínico-oftalmológicas y la evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social en el tiempo comprendido entre enero de 2018 y setiembre de 2021. Materiales y métodos: Investigación de diseño observacional, con estudio descriptivo, retrospectivo. Resultados: Se revisaron fichas de 34 pacientes con OT activa moderada severa que recibieron bolos de metilprednisolona basado en las guías EUGOGO 2016, de los cuáles se excluyeron 3 pacientes por tener fichas incompletas y otros 3 pacientes ya que requirieron tratamiento de segunda línea previo al término del esquema de 12 sesiones. De los 28 pacientes estudiados, la edad promedio fue de 43,6 ±13,1 años, el 89% de sexo femenino y el 28,5%, fumadores. En cuanto a la función tiroidea de la población previo al tratamiento, se constató hipertiroidismo en el 82%, hipotiroidismo en el 11% y eutiroidismo en el 7%; y posterior al tratamiento, se constató hipertiroidismo en el 78,6% (subclínico), eutiroidismo en el 17,9% e hipotiroidismo en el 3,5%. La mayoría (92.6%) contaba con anticuerpos contra el receptor de TSH positivo, con un promedio de 18 ± 9,9 mIU/Ml. Respecto a la actividad de la oftalmopatía según la escala CAS, se constató un promedio de 4,1 ±1,0 previo al tratamiento y posterior 1,2 ±1,4; de ellos el 46,4% presentó un estado leve según escala de gravedad, 39% sin criterios de gravedad y 14 % persistió en moderada -severa. Se constató mejoría de la agudeza visual tras el tratamiento (57,1%), el promedio de exoftalmía previo al tratamiento fue 22,2 mm y posterior 21,1 mm; se presentó diplopía en el 7,1% previo al tratamiento y en el 3,6% posterior al tratamiento. Conclusión: El tratamiento con glucocorticoides endovenosos en la oftalmopatía de Graves moderada-severa (esquema EUGOGO 2016) fue muy efectivo, revirtiendo la actividad y consecuentemente ayudando a disminuir la gravedad, en la gran mayoría de nuestros pacientes. Esto podría explicarse porque la oftalmopatía era incipiente y por el alto grado de adherencia de los pacientes en el contexto de un manejo multidisciplinar bien protocolizado.

RESUMEN El síndrome de interrupción del tallo hipofisario es una anomalía congénita de probable origen genético causante de hipopituitarismo, que radiológicamente se caracteriza por hipoplasia de la adenohipófisis, neurohipófisis ectópica e interrupción del tallo hipofisario. Suele presentarse con baja estatura y deficiencia de hormonas adenohipofisarias. El retraso en el diagnóstico se relaciona con alta morbimortalidad. Se reporta el caso de una mujer de 24 años que consulta por amenorrea primaria. Presentaba talla baja y ausencia de caracteres sexuales secundarios, con genitales infantiles. Los exámenes paraclínicos mostraron compromiso de dos ejes hipofisarios. Una resonancia magnética nuclear mostró hallazgos consistentes con síndrome de interrupción de tallo hipofisario.

ABSTRACT Pituitary stalk disruption syndrome is a congenital abnormality of probable genetic origin that causes hypopituitarism, which is radiologically characterized by adenohypophysis hypoplasia, ectopic neurohypophysis, and pituitary stalk disruption. It usually presents with short stature and adenohypophyseal hormone deficiency. The delay in diagnosis is related to high morbidity and mortality. The case of a 24-year-old woman who consulted for primary amenorrhea is reported. She had short stature and no secondary sexual characteristics, with infantile genitalia. Paraclinical examinations showed involvement of two pituitary axes. An MRI scan showed findings consistent with pituitary stalk disruption syndrome.

RESUMEN Se presenta un caso de sarcoidosis que presentó afectación suprarrenal. Hombre de 44 años fue diagnosticado de sarcoidosis pulmonar y ganglionar según hallazgos clínicos, laboratoriales y anatomopatológicos. Tres años después acude por debilidad generalizada, náuseas, hiponatremia persistente, hipotensión arterial, pérdida de peso e hiperpigmentación cutánea. La evaluación endocrinológica confirma insuficiencia suprarrenal primaria, lo que sugiere la infiltración de la sarcoidosis en las glándulas suprarrenales.

ABSTRACT We present a case of sarcoidosis that presented adrenal involvement. A 44-year- old man was diagnosed with pulmonary and lymph node sarcoidosis based on clinical, laboratory, and pathological findings. Three years later, he presented with generalized weakness, nausea, persistent hyponatraemia, arterial hypotension, weight loss, and skin hyperpigmentation. Endocrinologic evaluation confirms primary adrenal insufficiency, suggesting infiltration of sarcoidosis into the adrenal glands.

Avaliou-se o efeito da idade de desmame no desempenho e nas características de carcaça de bezerros filhos de vacas cruzas zebuínas x taurinas, primíparas aos 3 anos de idade. As vacas foram mantidas durante dois invernos/primaveras, do desmame à primeira estação de monta, em pastejo rotativo em dois grupos (ponta e rapador), em pastagens de azevém anual (Lolium multiflorum Lam) e trevo vesiculoso (Trifolium vesiculosum cv. Yuchi) e, posteriormente, durante o verão e o outono, em campo nativo. Os bezerros foram distribuídos aleatoriamente, segundo o grupo racial e o grupo de pastejo das vacas, em duas idades de desmame: desmame precoce (DP) = sete bezerros desmamados aos 70 dias de idade com 83,2 kg de PV médio; e idade convencional (DC) = dez bezerros desmamados com 180 dias de idade e 152,0 kg de PV médio. O delineamento experimental foi o completamente casualizado. Os novilhos foram abatidos aos 2 anos de idade. O grupo de manejo das vacas (ponta ou rapador) não teve efeito sobre o desempenho e as características de carcaça dos novilhos. Os animais do desmame convencional foram mais pesados até 1 ano de idade (DP = 183,0 kg vs DC = 202,1 kg), mas não diferiram dos demais quando abatidos aos 2 anos de idade (DP = 411,2 kg vs DC = 408,5 kg). As carcaças não diferiram quanto ao acabamento, à conformação, à classificação "Cota Hilton" e ao rendimento. Portanto, o desmame precoce não influenciou o desenvolvimento e as características de carcaça ao abate aos 2 anos de idade.

The objective of this trial was to evaluate the effect of weaning age on growth and carcass characteristics of calves from primiparous Bos indicus x Bos taurus crossbred cows. Heifers were divided in two groups according to the order of access to pasture and rotationally grazed pastures of ryegrass (Lolium multiflorum Lam) and arrowleaf clover (Trifolium vesiculosum cv. Yuchi) from weaning until their first mating season (two winter/spring seasons); animals were then transferred to native pasture in the following summer-autumn season. Calves were randomly assigned, according to breed and heifers grazing group order, to one of two weaning ages: early weaning (EW) - 07 calves weaned at 70 days of age with an average body weight of 83.2 kg or conventional weaning (CW) -10 calves weaned at 180 days of age and with an average body weight of 152.0 kg in a completely randomized design. Steers were slaughtered with two years of age. Heifers grazing group did not affect calves performance. Calves in the CW treatment were heavier (202.1 kg) at one year old than those on EW (183.0 kg), but no significant difference was observed when animals were slaughtered at two years of age (CW=408.5 kg vs. EW=411.2 kg). Carcass traits such as fat thickness, conformation, "Hilton Quote" classification, and hot yield did not differ comparing EW with CW steers. Therefore, early weaning did not affect performance and carcass characteristics of steers slaughtered at two years of age.