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Construindo estratégias de resolução de problemas com crianças de 6 a 7 anos de idade
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Miranda, Paulo

; Mamede, Ema

Educação e Pesquisa

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2023, Volume 49 elocation e249924

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

Abstract This study seeks to perceive how students understand problem solving, identifying their solving strategies. It tries to answer the following questions: What strategies do students use to solve problems? How can problem-solving skills be promoted? What difficulties do students reveal in problem solving? The participants were 1st-graders (n=22), aged 6 to 7 years old, from Braga, Portugal. A qualitative case study approach was carried out, in the context of mathematics classes. Ten problem-solving tasks were used. The results suggest that the students felt comfortable with strategies such as the construction of schemes and tables, starting at the end, induction attempts, pattern identification, among others. Regarding the promotion of skills in the context of problem solving, the importance of students’ active involvement in discovering procedures and strategies is highlighted, as well as teacher’s role as a mediator of learning and promoter of tasks that favour the emergence of mathematically relevant strategies. The role of creativity and mathematical communication in this process is also important. Concerning problem-solving difficulties, several were identified regarding the interpretation of statements, lack of experience and previous contact with similar problems, in planning, in organizing and simplifying processes, and in solving arithmetic operations.

Resumo Este estudo procura perceber como os alunos compreendem a resolução de problemas, identificando as suas estratégias de resolução. Procura dar resposta às seguintes questões: Quais as estratégias utilizadas pelos alunos para a resolução de problemas? Como podem ser promovidas competências de resolução de problemas? Que dificuldades manifestam os alunos na resolução de problemas? Participa no estudo uma turma do 1º ano de escolaridade, com idades dos 6 aos 7 anos (n=22), de Braga, Portugal. Recorreu-se a uma metodologia qualitativa de estudo de caso, em contexto de aula de matemática, tendo-se aplicado 10 tarefas de resolução de problemas. Os resultados sugerem que os alunos, ao longo do estudo, se sentiram confortáveis com estratégias como construção de esquemas e tabelas, resolução do fim para o princípio, tentativa com indução, identificação de padrões, entre outras. No que se refere à promoção de competências no âmbito da resolução de problemas, destaca-se a importância do envolvimento ativo dos alunos na descoberta de procedimentos e estratégias, realçando o papel do professor como mediador de aprendizagens e promotor de tarefas que favoreçam o aparecimento de estratégias matematicamente relevantes. Também é relevante o papel da criatividade e da comunicação matemática nesse processo. Foram identificadas dificuldades na resolução de problemas no que se refere à interpretação de enunciados, ao contato prévio com problemas semelhantes, no planejamento, organização e simplificação de processos e na resolução de operações aritméticas.

https://doi.org/10.1590/s1678-4634202349249924por

Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity: A joint position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM), Brazilian Society of Hepatology (SBH), and Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso)
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Moreira, Rodrigo Oliveira

; Valerio, Cynthia Melissa

; Villela-Nogueira, Cristiane Alves

; Cercato, Cintia

; Gerchman, Fernando

; Lottenberg, Ana Maria Pita

; Godoy-Matos, Amélio Fernando

; Oliveira, Ricardo de Andrade

; Mello, Carlos Eduardo Brandão

; Álvares-da-Silva, Mário Reis

; Leite, Nathalie Carvalho

; Cotrim, Helma Pinchemel

; Parisi, Edison Roberto

; Silva, Giovanni Faria

; Miranda, Paulo Augusto Carvalho

; Halpern, Bruno

; Oliveira, Claudia Pinto

Archives of Endocrinology and Metabolism

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2023, Volume 67 Nº 6 elocation e230123

Resumo: En | Texto: En | PDF: En

ABSTRACT Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as Nonalcoholic fatty liver disease (NAFLD), is one of the most common hepatic diseases in individuals with overweight or obesity. In this context, a panel of experts from three medical societies was organized to develop an evidence-based guideline on the screening, diagnosis, treatment, and follow-up of MASLD. Material and methods: A MEDLINE search was performed to identify randomized clinical trials, meta-analyses, cohort studies, observational studies, and other relevant studies on NAFLD. In the absence of studies on a certain topic or when the quality of the study was not adequate, the opinion of experts was adopted. Classes of Recommendation and Levels of Evidence were determined using prespecified criteria. Results: Based on the literature review, 48 specific recommendations were elaborated, including 11 on screening and diagnosis, 9 on follow-up, 14 on nonpharmacologic treatment, and 14 on pharmacologic and surgical treatment. Conclusions: A literature search allowed the development of evidence-based guidelines on the screening, diagnosis, treatment, and follow-up of MASLD in individuals with overweight or obesity.

https://doi.org/10.20945/2359-4292-2023-0123

Desafiando as Crianças na Formulação de Problemas
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Miranda, Paulo

; Mamede, Ema

Bolema: Boletim de Educação Matemática

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2023, Volume 37 Nº 76 Páginas 754 - 772

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

Abstract Creativity is a component that has been increasingly valued in the mathematical experience. As the relationship between mathematics and creativity is recognized in the academic community, the transposition of this reality to the school environment is still infrequent. Students should also have opportunities to experience and develop tasks that stimulate their mathematical creativity. Problem formulation can be understood as a link between these two aspects, enriching the students’ experiences and mathematical learnings. This article analyses the reactions and performances of first graders (N=22) when challenged to formulate problems. It addresses two questions: 1) How do children react to problem-formulation tasks? 2) How do children perform when developing problem-formulation tasks? In this article, qualitative methods were adopted, in a case study approach, to describe children's reactions and productions in the face of problem-formulation tasks. The results revealed that the children were able to propose adequate and original problems, noting that no errors were identified in their mathematical solving, but there were identified cases of difficulties in establishing the conceptualized situation. Generally, students assumed themselves as protagonists in their problems, creating situations that involved them or their colleagues. It was also identified that these tend to agglutinate problem formulation and solving processes. Students showed enthusiasm and motivation to learn mathematics through problem formulation, conceiving mathematical situations that were meaningful and close to their context.

Resumo A criatividade é um componente que tem sido cada vez mais valorizado na experiência matemática. Sendo a relação entre a Matemática e a criatividade reconhecida na comunidade acadêmica, ainda é pouco frequente a transposição dessa realidade para o meio escolar. Também os alunos devem ter oportunidades de experienciar e desenvolver tarefas que estimulem a sua criatividade matemática. A formulação de problemas pode ser entendida como um elo de ligação entre a estimulação da criatividade e as aprendizagens matemáticas dos alunos. Este artigo analisa as reações e os desempenhos de alunos do primeiro ano de escolaridade (N=22) quando desafiados a formular problemas. Aborda duas questões: 1) Como reagem os alunos às tarefas de formulação de problemas? 2) Como realizam os alunos tarefas de formulação de problemas? Neste artigo foram adotados métodos qualitativos, numa abordagem de estudo de caso, para descrever as reações e produções das crianças perante duas tarefas de formulação de problemas. Os resultados revelaram que as crianças foram capazes de propor problemas adequados e originais, observando-se que nenhum erro foi identificado na sua resolução matemática, mas identificando-se casos de dificuldades no estabelecimento da situação conceitualizada. Geralmente, os alunos assumiram-se como protagonistas nos seus problemas, criando situações que os envolviam a si ou aos seus colegas. Também se identificou que estes tendem a aglutinar os processos de formulação e resolução de problemas. Os alunos demonstraram entusiasmo e motivação ao aprender Matemática através da formulação de problemas, concebendo situações matemáticas significativas e próximas do seu contexto.

https://doi.org/10.1590/1980-4415v37n76a18

“Anti-obesity medications” or “medications to treat obesity” instead of “weight loss drugs” – why language matters – an official statement of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM)
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Halpern, Bruno

; Mancini, Marcio C.

; Sande-Lee, Simone van de

; Miranda, Paulo Augusto Carvalho

Archives of Endocrinology and Metabolism

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2023, Volume 67 Nº 4 elocation e230174

Resumo: En | Texto: En | PDF: En

ABSTRACT Obesity is largely undertreated, in part because of the stigma surrounding the disease and its treatment. The use of the term “weight loss drugs” to refer to medications for the treatment of obesity may contribute to this stigma, leading to the idea that anyone who wants to lose weight could use them and that short-term use, only in the active weight loss phase would be enough. On the contrary, the use of terms such as “medications to treat obesity” or “anti-obesity medications” conveys the idea that the treatment is directed at the disease rather than the symptom. This joint statement by the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM) intends to alert the press, healthcare professionals and scientific community about the importance of the appropriate use of language, with the aim of improving obesity care.

https://doi.org/10.20945/2359-4292-2023-0174

Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism
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Garmes, Heraldo Mendes

; Boguszewski, César Luiz

; Miranda, Paulo Augusto Carvalho

; Martins, Manoel Ricardo Alves

; Silva, Silvia Regina Correa da

; Abucham Filho, Julio Zaki

; Musolino, Nina Rosa de Castro

; Vilar, Lucio

; Portari, Luiz Henrique Corrêa

; Gadelha, Mônica Roberto

; Kasuki, Leandro

; Naves, Luciana Ansaneli

; Czepielewski, Mauro Antônio

; Almeida, Tobias Skrebsky de

; Duarte, Felipe Henning Gaia

; Glezer, Andrea

; Bronstein, Marcello Delano

Archives of Endocrinology and Metabolism

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Abr 2021, Volume 65 Nº 2 Páginas 212 - 230

Resumo: En | Texto: En | PDF: En

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.

https://doi.org/10.20945/2359-3997000000335 625 downloads

Energia do Hidrogênio e a Área de Materiais no Brasil
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Miranda, Paulo Emílio V. de

Matéria (Rio de Janeiro)

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2021, Volume 26 Nº 1 elocation e-12953

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

https://doi.org/10.1590/s1517-707620210001.1253 296 downloads

PSICOLOGIA NOS CRAS: UMA ANÁLISE DO DISSENSO E DOS PROCESSOS DE COLETIVIZAÇÃO
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Maheirie, Kátia

; Miranda, Paulo Ricardo de Araújo

; Sawaia, Bader Burihan

; Iñiguez-Rueda, Lupicinio

Psicologia & Sociedade

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2021, Volume 33 elocation e232754

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

Resumo O presente trabalho busca analisar os modos como se organizam os Centros de Referência em Assistência Social (CRAS), a partir de experiências coletivas e práticas comunitárias realizadas pelas equipes-território, destacando os processos de dissensos e consensos nas relações de trabalho. Metodologicamente, com base na análise de discurso, foram realizadas coletivamente 14 entrevistas semiestruturadas com cada equipe dos CRAS de dois estados da macrorregião sul do Brasil. Os resultados apontam que trabalhar as divergências internas sem tentar homogeneizá-las, compondo práticas transdisciplinares e horizontalizantes, se mostrou um modo potente de organização das equipes de trabalho. Ademais, foi relatado também a potência na produção dos fazeres de territorialização, com e a partir do território, por meio de seus significantes e possibilidades singulares. Finalmente, apontam-se as práticas comunitárias com grupos e coletivos nos CRAS como um dos vetores potentes no enfrentamento ao sofrimento ético-político produzido pelas desigualdades sociais.

Abstract This paper analyzes the ways through which the Social Assistance Reference Centers (CRAS) is organized, based on collective experiences and community practices carried out by the territory-teams, highlighting the processes of dissent and consensus in working relations. Methodologically, based on discourse analysis, 14 semi-structured interviews were conducted collectively with each CRAS team from two states of the Brazilian southern region. The results indicate that working internal differences without trying to homogenize them, composing transdisciplinary and horizontal practices, proved to be a powerful way of organizing the work teams. Besides, the power in the production of territorialization actions, with and from the territory, was also reported through its significant and singular possibilities. Finally, the community practices with groups and collectives in CRAS are pointed as one of the potent vectors in facing the ethical-political suffering produced by social inequalities.

Resumen El presente trabajo busca analizar las formas en que se organizan los Centros de Referencia de Asistencia Social (CRAS), a partir de experiencias colectivas y prácticas comunitarias realizadas por los equipos del territorio, destacando los procesos de desacuerdos y consensos en las relaciones laborales. Metodológicamente, con base en el análisis del discurso, se realizaron colectivamente 14 entrevistas semiestructuradas con cada equipo de los CRAS de dos estados del macrorregión sur del Brasil. Los resultados muestran que trabajar las diferencias internas sin tratar de homogeneizarlas, componiendo prácticas transdisciplinarias y horizontales, resultó ser una forma poderosa de organizar equipos de trabajo. Además, también se informó del poder en la producción de actividades de territorialización, con y desde el territorio, a través de sus significantes y posibilidades singulares. Finalmente, las prácticas comunitarias con grupos y colectivos en los CRAS se señalan como uno de los vectores poderosos para enfrentar el sufrimiento ético-político que producen las desigualdades sociales.

https://doi.org/10.1590/1807-0310/2021v33232754 114 downloads

A Matéria autossuficiente: Garantindo o acesso aberto e amplo à comunidade científica
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Sarruf, ernardo Jordão M.

; Miranda, Paulo Emílio V. de

Matéria (Rio de Janeiro)

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2021, Volume 26 Nº 3 elocation e-13059

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

https://doi.org/10.1590/s1517-707620210003.1359 44 downloads

Pré-Publicação de artigos na revista Matéria
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Miranda, Paulo Emílio V. de

Matéria (Rio de Janeiro)

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2020, Volume 25 Nº 3 elocation e-12838

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

https://doi.org/10.1590/s1517-707620200003.1138 764 downloads

10.

Percepción ambiental de los gestores de medios de hospedaje: El caso de Praia do Francês en el Municipio de Marechal Deodoro - Brasil
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Barbosa de Macêdo Dias, Sheyla Karine

; Santos de Melo Fiori, Ana Paula

; Nascimento, Velber Xavier

; Souto Vieira de Mello, Gabriela

; Barbosa de Miranda, Paulo Rogério

Estudios y perspectivas en turismo

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Out 2019, Volume 28 Nº 4 Páginas 923 - 941

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

The growth of tourism and its infrastructure has led to an increase in the amount of solidwaste, that provoke a negative environmental impact on these destinations. The Francês beach is located in the city of Marechal Deodoro (Brazil) and, despite having a large part of its income concentrated in the tourism sector, no study was carried out to evaluate the perception and management of solid waste generated by tourism in Francês beach. The objective of this paper was to identify the levels of knowledge about solid waste management, as well as the environmental management activities and the environmental perception of the managers of lodging of the French beach in Marechal Deodoro. The research had a qualitative and quantitative character, being carried out interviews with managers of the lodges, application of forms with structured and semistructured questions and the completion of the field diary. The sample had a non-probabilistic character for convenience and for definition of the same were established three criteria: registration in the Ministry of Tourism, means of lodging with a maximum of 30 housing units and interest in participating in the research. After the survey, 21 establishments were able to participate, however, two showed no interest. The forms were applied during the months of July and October 2017. Based on the results obtained, one can affirm that adequate management forms are still evident, because actions such as separation of garbage and training of employees on environmental issues have not yet been carried out for more than 70% of the enterprises surveyed. It is important to highlight that more than 80% of them do not have any policies to minimize the generation of waste in their enterprises. Therefore, there is a real need in the area for works focused on environmental education involving the entire tourism trade, so that a greater awareness of the environment for this sector is created.

El crecimiento del turismo y de la infraestructura turística ha aumentado la cantidad de residuos sólidos, generando un impacto ambiental negativo en los destinos. La Praia do Francês está localizada en el Municipio de Marechal Deodoro (Brasil) y a pesar de que la mayor parte de sus ingresos proviene del sector turístico, no se han evaluado la percepción y el manejo de los residuos sólidos generados por el turismo. Esta investigación busca identificar los niveles de conocimiento sobre la gestión de los residuos sólidos, la gestión ambiental y la percepción ambiental de los gestores de hospedajes en la Praia do Francês. Fue un estudio de carácter cualitativo y cuantitativo, con entrevistas a gestores de los hospedajes y un diario de campo. La muestra no probabilística por conveniencia siguió tres criterios: registro en el Ministerio de Turismo, hospedajes de no más de 30 unidades e interés por participar de la investigación. Los formularios fueron aplicados durante julio y octubre de 2017. Se puede afirmar que la separación de la basura y la capacitación de los empleados sobre temas ambientales, aún no han sido puestas en práctica por más del 70% de los emprendimientos estudiados. Es importante destacar que más del 80% no posee ninguna política para minimizar la generación de residuos en sus emprendimientos. Por lo tanto, existe en el área una necesidad real de trabajos volcados a la educación ambiental que involucren a todo el trade turístico, para despertar mayor consciencia sobre el ambiente en este sector.

316 downloads

11.

Biomonitoring of Heavy Metals (Fe, Zn, Cu, Mn, Cd and Cr) in Oysters: Crassostrea rhizophorae of Mangrove Areas of Alagoas (Brazil)
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Azevedo, Joaquim Alexandre Moreira

; Barros, Alexandre Bomfim

; Miranda, Paulo Rogério Barbosa de

; Costa, João Gomes da

; Nascimento, Velber Xavier

Brazilian Archives of Biology and Technology

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2019, Volume 62 elocation e19180211

Resumo: En | Texto: En | PDF: En

Abstract Mangroves are tropical and subtropical flooded forests that generally develop in estuarine areas over unstable sediments protected from the action of waves in the intertidal zone with an environment characterized by a great diversity of fauna and flora. Thus, the present study aimed to evaluate the levels of heavy metals that are absorbed by mangrove oysters, in estuarine systems in the Alagoas coast by determining the concentrations of Fe, Cu, Mn, Zn, Cd and Cr. Two areas, which consisted of both a collection during the rainy season and the dry season, were selected for sampling of mangrove oysters. In each collection, seven samples were collected, at seven different points, where each sample contained four oysters. In the laboratory the oysters were dried at 105°C for 72 hours and then macerated. It was then digested with 10 ml of a solution comprising a combination of 4:1 nitric acid and hydrochloric acid, initially in 1h at 40°C, followed by 3 hours at 140°C. In General, the medians followed the order Zn > Fe > Mn > Cu > Cr > Cd in MMELC and Zn > Cu > Fe > Mn > Cr > Cd in Meirim River. It is concluded that the Crassostrea rhizophorae oysters from the studied environments presented concentrations of all the metals proposed in the research and demonstrates its accumulating and bioindicator character.

https://doi.org/10.1590/1678-4324-2019180211 721 downloads

12.

RETRATAÇÃO: Desempenho de ureia revestida compoliuretano como fertilizante de Phaseolus vulgaris L.
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Miranda, Paulo Emílio Valadão de

Matéria (Rio de Janeiro)

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2019, Volume 24 Nº 4 elocation e12532

Resumo: Pt | Texto: Pt | PDF: Pt

https://doi.org/10.1590/s1517-707620190004.0859 206 downloads

13.

Thalidomide in plasma cell balanitis refractory to conventional topical treatment
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Serrão, Lucas Mariano

; Sarmenghi, Karina Demoner de Abreu

; Pinto, Barbara Christina Bonino Pereira

; Miranda, Paulo Bittencourt de

Anais Brasileiros de Dermatologia

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Dez 2018, Volume 93 Nº 6 Páginas 881 - 883

Resumo: En | Texto: En | PDF: En

Abstract: Zoon's plasma cell balanitis is a chronic genital inflammatory dermatosis that affects uncircumcised men, especially the elderly. It's characterized by painless erythematous plaques of orange hue, located on the glans penis and foreskin. Circumcision is the most effective treatment; however, it can be hard for patients to accept. As an alternative, topical calcineurin inhibitors are used, with good response. This article reports the case of a 32-year-old patient, HIV carrier, diagnosed with Zoon's plasma cell balanitis. Treatment with topical tacrolimus was administered, without improvement. A 6-week course of thalidomide resulted in complete remission of the lesions, without recurrence after eight months of follow-up.

https://doi.org/10.1590/abd1806-4841.20187462 971 downloads

14.

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

15.

A review of Cushing's disease treatment by the Department of Neuroendocrinology of the Brazilian Society of Endocrinology and Metabolism
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Machado, Márcio Carlos

; Fragoso, Maria Candida Barisson Vilares

; Moreira, Ayrton Custódio

; Boguszewski, César Luiz

; Vieira Neto, Leonardo

; Naves, Luciana A.

; Vilar, Lucio

; Araújo, Luiz Antônio de

; Musolino, Nina Rosa Castro

; Miranda, Paulo Augusto C.

; Czepielewski, Mauro A.

; Gadelha, Monica R.

; Bronstein, Marcello Delano

; Ribeiro-Oliveira Jr., Antônio

Archives of Endocrinology and Metabolism

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Fev 2018, Volume 62 Nº 1 Páginas 87 - 105

Resumo: En | Texto: En | PDF: En

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.

https://doi.org/10.20945/2359-3997000000014 5266 downloads

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