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ABSTRACT Obesity is a chronic disease associated with impaired physical and mental health. A widespread view in the treatment of obesity is that the goal is to normalize the individual's body mass index (BMI). However, a modest weight loss (usually above 5%) is already associated with clinical improvement, while weight losses of 10%-15% bring even further benefits, independent from the final BMI. The percentage of weight reduction is accepted as a treatment goal since a greater decrease in weight is frequently difficult to achieve due to metabolic adaptation along with environmental and lifestyle factors. In this document, the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO) propose a new obesity classification based on the maximum weight attained in life (MWAL). In this classification, individuals losing a specific proportion of weight are classified as having “reduced” or “controlled” obesity. This simple classification – which is not intended to replace others but to serve as an adjuvant tool – could help disseminate the concept of clinical benefits derived from modest weight loss, allowing individuals with obesity and their health care professionals to focus on strategies for weight maintenance instead of further weight reduction. In future studies, this proposed classification can also be an important tool to evaluate possible differences in therapeutic outcomes between individuals with similar BMIs but different weight trajectories.

https://doi.org/10.20945/2359-3997000000465

Prevalence of sarcopenia in women at stable weight phase after Roux-en-Y gastric bypass
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Buzza, Andreia Fabiana Bueno

; Machado, Cristina Aquino

; Pontes, Felipe

; Sampaio, Letícia Guadanhim

; Contador, Júlia Soares

; Sampaio, Carolina Labigalini

; Radominski, Rosana Bento

; Boguszewski, Cesar Luiz

; Borba, Victoria Zeghbi Cochenski

Archives of Endocrinology and Metabolism

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Jun 2022, Volume 66 Nº 3 Páginas 362 - 371

Resumo: En | Texto: En | PDF: En

ABSTRACT Objective: Evaluating the prevalence of sarcopenia in women submitted to bariatric surgery – Roux-en-Y gastric bypass. Design: Observational, cross-sectional study. Subjects and methods: Women (18-65 years old) who underwent bariatric surgery (BG) ≥ 2 years and reached stable weight ≥ 6 months, were investigated. Control group (CG) comprised non-operated matched women with obesity. Body composition was determined through dual-energy X-ray absorptiometry. Low lean mass (LLM) was defined as appendicular lean mass index (ALM kg/height m2) < 5.5 kg/m2. Physical strength was assessed through dynamometer and sit-to-stand test (SST), whereas performance was assessed through 4-m gait speed and Short Physical Performance Battery Tests (SPPB). Sarcopenia was diagnosed in the presence of LLM and low strength. Results: One-hundred and twenty women (60 in each group, 50 ± 9.7 years old) were investigated. All anthropometric and body composition parameters were lower in BG than in CG, whereas strength and performance were similar between groups. Women with reduced strength presented high total fat mass and low physical activity level (p < 0.005). LLM was observed in 35% of BG and in 18.3% of CG (p = 0.04), whereas sarcopenia was diagnosed in 28.3% of BG and in 16.6% of CG (p = 0.12). Sarcopenic women in BG had better performance both in SST (p = 0.001) and SPPB (p = 0.004). Total lean mass (OR:1.41, 95% CI [1.18; 1.69], p < 0.001) and obesity (OR: 38.2 [2.27; 644.12], p < 0.001) were associated with sarcopenia in the multivariate analysis. Conclusion: Despite great weight loss, sarcopenia prevalence did not increase in BG and its presence was influenced by total lean mass and obesity.

https://doi.org/10.20945/2359-3997000000494

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Halpern, Bruno

; Mancini, Marcio C.

; Melo, Maria Edna de

; Lamounier, Rodrigo N.

; Moreira, Rodrigo O.

; Carra, Mario K.

; Kyle, Theodore K.

; Cercato, Cintia

; Boguszewski, Cesar Luiz

Archives of Endocrinology and Metabolism

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Abr 2022, Volume 66 Nº 2 Páginas 139 - 151

Resumo: En | Texto: En | PDF: En

https://doi.org/10.20945/2359-3997000000465

What’s in a name? What we call growth hormone is much more than just a growth-related peptide
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Boguszewski, Cesar Luiz

; Boguszewski, Margaret Cristina da Silva

Archives of Endocrinology and Metabolism

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Nov 2019, Volume 63 Nº 6 Páginas 546 - 548

Resumo: En | Texto: En | PDF: En

https://doi.org/10.20945/2359-3997000000183 364 downloads

Body composition and nutritional and metabolic parameters in postmenopausal women sufficient, insufficient and deficient in vitamin D
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Simas, Luisa Amábile Wolpe

; Zanatta, Leila Caroline Bianchet

; Moreira, Carolina Aguiar

; Borba, Victoria Zeghbi Cochenski

; Boguszewski, Cesar Luiz

Archives of Endocrinology and Metabolism

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Jun 2019, Volume 63 Nº 3 Páginas 265 - 271

Resumo: En | Texto: En | PDF: En

ABSTRACT Objective We investigated changes in body composition and nutritional and metabolic parameters in a group of postmenopausal women who were classified as sufficient, insufficient and deficient in vitamin D. Subjects and methods A total of 106 postmenopausal women were included in this cross-sectional study and classified according to their serum levels of 25-OH-vitamin D as sufficient (≥ 30 ng/mL; group S), insufficient (20.1 and 29.9 ng/mL; group I) or deficient (≤ 20 ng/mL; group D) in vitamin D. Body composition was measured by dual-energy X-ray absorptiometry (DXA); dietary recall questionnaires were completed; and blood samples were analysed to compare the metabolic and nutritional status of the study groups. Results Eleven (10.4%) of the women were classified in group S, 50 (47.2%) in group I and 45 (42.4%) in group D, with a mean serum level for 25-OH-D of 21.1 ± 7.0 ng/mL in all participants. Body composition did not differ among the groups. Serum levels of 25-OH-D were negatively correlated with serum levels of triglycerides, total cholesterol and LDL cholesterol. Conclusions Vitamin D insufficiency and deficiency were highly prevalent in our group of postmenopausal women, showing an association with an unfavourable lipid profile.

https://doi.org/10.20945/2359-3997000000121 696 downloads

Controversial issues in the management of hyperprolactinemia and prolactinomas – An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism
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Vilar, Lucio

; Abucham, Julio

; Albuquerque, José Luciano

; Araujo, Luiz Antônio

; Azevedo, Monalisa F.

; Boguszewski, Cesar Luiz

; Casulari, Luiz Augusto

; Cunha Neto, Malebranche B. C.

; Czepielewski, Mauro A.

; Duarte, Felipe H. G.

; Faria, Manuel dos S.

; Gadelha, Monica R.

; Garmes, Heraldo M.

; Glezer, Andrea

; Gurgel, Maria Helane

; Jallad, Raquel S.

; Martins, Manoel

; Miranda, Paulo A. C.

; Montenegro, Renan M.

; Musolino, Nina R. C.

; Naves, Luciana A.

; Ribeiro-Oliveira Júnior, Antônio

; Silva, Cíntia M. S.

; Viecceli, Camila

; Bronstein, Marcello D.

Archives of Endocrinology and Metabolism

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Mar 2018, Volume 62 Nº 2 Páginas 236 - 263

Resumo: En | Texto: En | PDF: En

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.

https://doi.org/10.20945/2359-3997000000032 36158 downloads

Endoscopic versus microscopic transsphenoidal surgery in the treatment of pituitary tumors: systematic review and meta-analysis of randomized and non-randomized controlled trials
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Bastos, Rodrigo V. S.

; Silva, Carla Maria D. M.

; Tagliarini, Jose Vicente

; Zanini, Marco Antonio

; Romero, Flavio R.

; Boguszewski, Cesar Luiz

; Nunes, Vania dos Santos

Archives of Endocrinology and Metabolism

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Out 2016, Volume 60 Nº 5 Páginas 411 - 419

Resumo: En | Texto: En | PDF: En

ABSTRACT We conducted a systematic review and meta-analysis of randomized and non-randomized controlled trials that compared pure endoscopic with microscopic transsphenoidal surgery (TSS) in the resection of pituitary tumors. Embase, PubMed, Lilacs, and Central Cochrane were used as our data sources. The outcomes were total tumor resection, achievement of biochemical control of functioning adenomas, hospital stay and surgery complications. The randomized trials were analyzed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Two randomized and three prospective controlled non-randomized studies were included. Two studies, including 68 patients, evaluated total tumor resection and the meta-analysis did not show differences between the groups [RR: 1.45 (95% CI: 0.87, 2.44)]. Three studies involving 65 patients analyzed the achievement of biochemical control and no statistical difference was found [RR: 0.94 (95% CI: 0.7, 1.26)]. All five studies compared the frequency of postoperative complications between intervention and control group and meta-analysis favored for a low rate of postoperative complications in the endoscopic TSS group [(RR: 0.37 (95% CI: 0.16, 0.83)]. Due to the low evidence level and low number of observations, the results of our meta-analysis should not be viewed as a final proof of inferiority or superiority of one approach in relation to the other. More data including higher numbers of observations are needed.

https://doi.org/10.1590/2359-3997000000204 1688 downloads

10.

Application of genetic testing to define the surgical approach in a sporadic case of multiple endocrine neoplasia type 1
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Boguszewski, Cesar Luiz

; Bianchet, Leila Caroline

; Raskin, Salmo

; Nomura, Luiz M.

; Borba, Luis Alencar

; Cavalcanti, Teresa Cristina Santos

Arquivos Brasileiros de Endocrinologia & Metabologia

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Nov 2010, Volume 54 Nº 8 Páginas 705 - 710

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Relatamos o uso de teste genético para decisão terapêutica em um caso de hiperparatireoidismo primário associado com doença de Cushing (DC). Uma jovem de 20 anos foi avaliada por ganho de peso gradual, astenia, mialgias e hipertensão. Os exames complementares confirmaram DC e ela foi submetida à cirurgia transesfenoidal. A análise imuno-histoquímica do microadenoma foi positiva para hormônio adrenocorticotrófico (ACTH). No seguimento, a paciente apresentou hipercalcemia com níveis elevados de hormônio de paratireoide (PTH), nefrolitíase e densidade mineral óssea baixa em coluna e fêmur. A cintilografia de paratireoide mostrou captação do traçador em região inferior do lobo esquerdo da tireoide e a ecografia cervical revelou nódulo heterogêneo na mesma área, sugestivo de adenoma da paratireoide (AP). O teste genético detectou mutação no gene MEN 1 e ela foi submetida à paratireoidectomia total com implante de fragmento de uma das glândulas no antebraço. A patologia confirmou AP e as outras três glândulas normais, sem hiperplasia, apesar do diagnóstico de MEN 1. Esse caso ilustra a importância do teste genético para definir a abordagem terapêutica em um caso esporádico de MEN 1.

We report the use of a genetic test for therapeutic decision making in a case of primary hyperparathyroidism associated with Cushing's disease (CD). A 20-year-old woman was evaluated for gradual weight gain, asthenia, muscle pain, and hypertension. Biochemical and radiologic tests confirmed CD and she underwent transsphenoidal surgery. Immunohistochemistry of the microadenoma was positive for adrenocorticotropic hormone (ACTH). On follow-up, hypercalcemia with high parathyroid hormone (PTH) levels was detected, associated with nephrolithiasis and low bone mineral density in the spine and hip. Parathyroid scintigraphy showed tracer uptake in the inferior region of the left thyroid lobe, and cervical ultrasound showed a heterogeneous nodule in the same area, suggestive of a parathyroid adenoma (PA). Genetic testing detected mutation in the MEN 1 gene and total parathyroidectomy with the implantation of a fragment of one gland in the forearm was performed. Pathology showed a PA and 3 normal parathyroid glands, without hyperplasia, despite the diagnosis of MEN 1. This case illustrates the role of genetic testing in defining the therapeutic approach for sporadic MEN 1.

2616 downloads Citado 1 vez em SciELO

11.

Growth Hormone Deficiency (GHD) in Adults: To Treat or Not To Treat?
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Boguszewski, Cesar Luiz

Revista argentina de endocrinología y metabolismo

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Set 2010, Volume 47 Nº 3 Páginas 30 - 38

Resumo: En | Texto: En | PDF: En

Over the last decade, different guidelines have been published for the diagnosis, treatment and monitoring of adult growth hormone deficiency (AGHD). Themes and recommendations common to the guidelines offer a pragmatic approach to the management of AGHD. Nevertheless, there is a need for more research in some key areas in which recommendations in the guidelines are supported by moderate evidence, at best. Recent meta-analysis and long-term follow-up studies have contributed with valuable information on the efficacy and safety of GH therapy in adults. This review brings a historical perspective of the AGHD, with an emphasis on the following aspects: (I) who are the appropriate candidates for GH therapy in adult life? (II) how to make the diagnosis (III) the impact of GH therapy; (IV) which therapeutic approach should be used? (V) how to follow and monitor the patients; and (VI) special aspects on mortality and longevity related to the GH-IGF-1 axis.

245 downloads

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Decrease in leptin production by the adipose tissue in obesity associated with severe metabolic syndrome
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Paz-Filho, Gilberto Jorge da

; Volaco, Alexei

; Suplicy, Henrique Lacerda

; Radominski, Rosana Bento

; Boguszewski, Cesar Luiz

Arquivos Brasileiros de Endocrinologia & Metabologia

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Dez 2009, Volume 53 Nº 9 Páginas 1088 - 1095

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar as associações entre leptinemia e os componentes da síndrome metabólica (MetS). MÉTODOS: Cinquenta e um adultos obesos (9 homens, 36,7 ± 10,0 anos, índice de massa corpórea, IMC, 46,2 ± 10,0 kg/m²) foram submetidos à avaliação clínica, a determinações da massa adiposa (BF, bioimpedância) e do gasto energético basal (REE, calorimetria indireta) e a análises hormonais e bioquímicas. Os pacientes foram divididos em três grupos, de acordo com o numero de critérios para MetS: Grupo I, nenhum ou 1; Grupo II: 2; e Grupo III: 3 ou 4 critérios. RESULTADOS: A leptinemia absoluta (LepA; 37,5 ± 16,9 ng/mL) se correlacionou diretamente a IMC (r = 0,48; p = 0,0004), circunferência abdominal (r = 0,31; p = 0,028) e BF (r = 0,52; p = 0,0001). A leptinemia ajustada por BF (LepBF) se correlacionou inversamente ao peso (r = -0,41; p = 0,027), ao REE (r = -0,34; p = 0,01) e ao número de critérios para MetS (r = -0,32; p = 0,02). Não houve diferença de LepA entre os grupos. LepBF no Grupo III (0,58 ± 0,27 ng/mL/kg) foi significativamente menor que no Grupo I (0,81 ± 0,22 ng/mL/kg; p = 0,03) e II (0,79 ± 0,30 ng/mL/kg; p = 0,02). CONCLUSÕES: A produção de leptina pelo tecido adiposo está diminuída em pacientes obesos que preenchem três ou mais critérios para MetS, sugerindo um estado de deficiência relativa de leptina na obesidade associada a estágios avançados de MetS.

OBJECTIVE: To evaluate the associations between leptinemia and the components of metabolic syndrome (MetS). METHODS: Fifty-one obese adults (9 men; 36.7 ± 10.0 years; body mass index (BMI) 46.2 ± 10.0 kg/m²) were submitted to clinical examination, determinations of body fat mass (BF, bioimpedance) and resting energy expenditure (REE, indirect calorimetry), and to hormonal and biochemical analysis. Patients were categorized into three groups, according to the number of criteria for MetS: Group I: none or 1; Group II: 2; and Group III: 3 or 4 criteria. RESULTS: Absolute leptinemia (LepA; 37.5 ± 16.9 ng/mL) was directly correlated with BMI (r = 0.48; p = 0.0004), waist circumference (r = 0.31; p = 0.028) and BF (r = 0.52; p = 0.0001). Leptinemia adjusted for BF (LepBF) was inversely correlated with weight (r = -0.41; p=0.027), REE (r = -0.34; p = 0.01) and number of MetS criteria (r = -0.32; p = 0.02). There was no difference in LepA among the groups. LepBF in Group III (0.58 ± 0.27 ng/mL/kg) was significantly lower compared to Group I (0.81 ± 0.22 ng/mL/kg; p = 0.03) and Group II (0.79 ± 0.30 ng/mL/kg; p = 0.02). CONCLUSIONS: Leptin production by the adipose tissue is decreased in obese subjects fulfilling three or more criteria of MetS, suggesting a state of relative leptin deficiency in obesity associated with advanced stages of MetS.

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