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APPENZELLER, SIMONE
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Id: biblio-844215
Autor: Frittoli, Renan Bazuco; Longui, Barbara Sugui; Silva, Amanda Meireles; Barros Filho, Antônio de Azevedo; Monteiro, Maria Ângela Reis de Góes; Appenzeller, Simone.
Título: Effects of the use of growth hormone in children and adolescents with juvenile idiopathic arthritis: a systematic review / Efeitos do uso do hormônio de crescimento em crianças e adolescentes com artrite idiopática juvenil: revisão sistemática
Fonte: Rev. bras. reumatol;57(2):100-106, Mar.-Apr. 2017. tab, graf.
Idioma: en.
Projeto: CNPq.
Resumo: Abstract Introduction: Children with juvenile idiopathic arthritis (JIA) often have impaired growth and short stature. There is evidence that the therapeutic use of growth hormone (GH) is useful and safe in these patients. Objective: To analyze the effects of GH use in patients with JIA. Method: A systematic review of the literature over the last 18 years in Medline and Embase databases. The criteria were analyzed independently by the researchers. We used the following keywords: "growth hormone", "arthritis, juvenile", "arthritis, rheumatoid", "child" and "adolescent". Results: Among the 192 identified articles, 20 corresponded to the inclusion criteria. Seventeen longitudinal studies and 3 case reports were found. Most studies analyzed observed increased growth, muscle mass and bone mass using GH. Adverse effects observed were glucose intolerance, diabetes, bone deformities, osteonecrosis, reactivation of the disease and low final height. Conclusion: The majority of studies reported positive effects after the therapeutic use of GH, but some variability in response to treatment was observed. The combination of growth hormone with other drugs seems to be a good option.

Resumo Introdução: Crianças com artrite idiopática juvenil (AIJ) frequentemente apresentam prejuízo no crescimento e baixa estatura. Existem evidências de que o uso terapêutico do hormônio de crescimento (GH) é útil e seguro nesses pacientes. Objetivo: Analisar os efeitos do uso de GH em pacientes com AIJ. Método: Fez-se revisão sistemática da literatura nos últimos 18 anos, nas bases de dados Medline e Embase. Os critérios foram analisados pelos pesquisadores de forma independente. Usaram-se os seguintes descritores: growth hormone, arthritis, juvenile, arthritis, rheumatoid, child e adolescent. Resultados: Entre os 192 artigos identificados, 20 corresponderam aos critérios de inclusão. Foram encontrados 17 estudos longitudinais e três relatos de casos. A maioria dos estudos analisados observou um aumento de crescimento, massa muscular e massa óssea com o uso do GH. Os efeitos adversos observados foram intolerância à glicose, diabetes, deformidades ósseas, osteonecrose, reativação da doença e altura final baixa. Conclusão: A maioria dos estudos relatou efeitos positivos após uso terapêutico do GH, porém certa variabilidade na resposta ao tratamento foi observada. A combinação do hormônio de crescimento com outros medicamentos parece ser uma boa opção.
Descritores: Artrite Juvenil/tratamento farmacológico
Osso e Ossos/efeitos dos fármacos
Hormônio do Crescimento Humano/uso terapêutico
Transtornos do Crescimento/tratamento farmacológico
-Artrite Juvenil/fisiopatologia
Densidade Óssea
Estudos Longitudinais
Puberdade/fisiologia
Resultado do Tratamento
Limites: Humanos
Criança
Adolescente
Tipo de Publ: Research Support, Non-U.S. Gov't
Revisão Sistemática
Responsável: BR1.1 - BIREME


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Id: biblio-1054923 LILACS-Express
Autor: Alonso, Guillermo; Balbi, Viviana; Bazán de Casella, Cristina; Belgorosky, Alicia; Bergadá, Ignacio; Brunetto, Oscar; Cassinelli, Hamilton; Ciaccio, Marta; Keselman, Ana; Miras, Mirta B; Morín, Analía; Comité Nacional, de Endocrinología Pediátrica.
Título: Posición de los endocrinólogos pediatras argentinos acerca de la intercambiabilidad de hormonas de crecimiento / Statement of Argentine pediatric endocrinologists on growth hormone interchangeability
Fonte: Arch. argent. pediatr;117(4):213-215, ago. 2019.
Idioma: en; es.
Descritores: Hormônio do Crescimento Humano
Intercambialidade de Medicamentos
Endocrinologistas
Pediatras
Limites: Humanos
Tipo de Publ: Comentário
Responsável: AR94.1 - Centro de Información Pediatrica


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Id: biblio-1050945
Autor: Chiarpenello, Javier.
Título: Baja estatura: algoritmo diagnóstico y terapéutico / Short stature: diagnosis and therapeutic algorithm
Fonte: Rev. med. Rosario;84(2):71-81, mayo-ago. 2018. tab, graf.
Idioma: es.
Resumo: La baja estatura en un motivo de consulta frecuente para el médico del primer nivel de atención y constituye unapreocupación para el niño/a y sus padres. Aproximadamente una de cada 5 consultas con el endocrinólogo estánrelacionadas con este tema.En el crecimiento de un niño intervienen diferentes factores, tales como los nutricionales, genéticos, hormonales ymedioambientales; todos ellos en conjunto modifican el desarrollo y crecimiento durante la infancia y adolescencia.Esto hace que el listado de etiologías que componen la baja estatura sea muy variado y amerite un abordaje minucioso para arribar a un correcto diagnóstico de la misma.La mejor forma de detectar aquellos factores que modifican el carril de crecimiento hasta llegar a la talla final es realizar los controles periódicos (de acuerdo a la edad) de crecimiento y desarrollo. Esta es una práctica recomendableaunque ese no sea el motivo de consulta.La interrelación entre el médico de atención primaria y el especialista constituye un punto muy importante a remarcar en la evaluación de estos niños/as. La fluida comunicación entre ambos facilita y contribuye a llegar lo másprecozmente al diagnóstico.El objetivo de esta revisión es desarrollar un algoritmo diagnóstico que sirva de guía al médico pediatra o generalista y de familia, para lograr una adecuada orientación diagnóstica y, de ser necesaria, una derivación oportuna alespecialista para su seguimiento y tratamiento con el objetivo final de que ese niño/a llegue a una talla final que seencuentre dentro de su talla objetivo genética(AU)

The short stature is afrequent consultation reason to primary care doctor and is a concern for the child and his parents.Approximately one out of every 5 consultations with the endocrinologist is related to this topic.There are different factors that intervene in the growth of a child, such as nutritional, genetical, hormonal and environmental;all of them together modify the development and growth during childhood and adolescence. This makes the list of etiologiesthat make up the short stature very varied and it requires a meticulous approach to arrive to a correct diagnosis.The best way to detect those factors that modify the growth track until a final size is reached is to perform the periodiccontrols (according to the age) of growth and development. This is a recommended practice eve if it is not the reasonforconsultation.The interrelation between the primary care physician and the specialist is a very important point to emphasize in theevaluation of these children. The fluid communication between both of them facilitates and contributes to reach thediagnosis as early as possible.The aim of this review is to develop a diagnostic algorithm that may be used as a guide to the pediatrician or generalist andfamily doctor, in order to achieve an adequate diagnostic guidance and, if necessary, a timely referral to the specialist forfollow-up and treatment with the ultimate purpose that the child reaches a final size that is within their genetic target size (AU)
Descritores: Estatura
Algoritmos
Desenvolvimento Infantil
-Hormônio do Crescimento Humano
Limites: Humanos
Masculino
Feminino
Criança
Tipo de Publ: Revisão
Responsável: AR16.1 - Biblioteca


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Id: lil-641962
Autor: Ballerini, María G; Scaglia, Paula; Domené, Horacio M; Martinez, Alicia; Keselman, Ana; Pipman, Viviana; Bengolea, Sonio V; Cassinelli, Hamilton; Karabatas, Liliana; Calcagno, María L; Heinrich, Juan J; Jasper, Héctor G; Ropelato, María G.
Título: Evaluación de los niveles séricos de la proteína de unión de alta afinidad de la hormona de crecimiento humana (GHBP) y del polimorfismo del exón 3 del gen del receptor de GH en niños con talla baja idiopática / Evaluation of serum levels of the high affinity binding protein of human growth hormone (GHBP) and exon 3 polymorphism of the GH receptor gene in children with idiopathic short stature
Fonte: Rev. argent. endocrinol. metab;47(1):3-12, ene.-abr. 2010. graf, tab.
Idioma: es.
Projeto: Pfizer Global Pharmaceutical; . SECYT. FONCYT. PICT/2003 Nº 05-14354.
Resumo: La talla baja idiopática (TBI) incluye a un grupo heterogéneo de pacientes con fallas en su crecimiento. Una causa probable de TBI puede ser la insensibilidad a la GH (IGH). La proteína de unión de GH de alta afinidad (GHBP) se genera por el clivaje proteolítico de la porción extracelular del receptor de GH (GHR) y su determinación se propone como un marcador periférico del nivel de GHR en los tejidos. El objetivo de este trabajo fue evaluar los niveles de GHBP circulantes y su asociación con factores de crecimiento y el polimorfismo del exón 3 del gen GHR en niños con TBI. Los niños con TBI presentaron talla, IMC, IGF-I, IGFBP-3, ALS y niveles de GHBP significativamente más bajos que un grupo de niños de edad comparable (p<0.001). El genotipo del exón 3 del GHR no fue un factor determinante de las diferencias observadas. La máxima respuesta de GH de los tests de estímulo de secreción correlacionó negativa y significativamente con los niveles de GHBP (r= -0.28, p= 0.012). Los perfiles de distribución de la concentración de GHBP, IGF-I, ALS y BP3 expresadas en score de desvío estándar (SDE) en la TBI, mostraron un sesgo hacia niveles bajos. En conclusión, los marcadores de acción de GH y los niveles de GHBP fueron bajos en la TBI, independientemente del genotipo del exón 3 del gen GHR. En un subgrupo de niños con TBI, niveles disminuidos de GHBP y de componentes del sistema de los IGFs, colaborarían en la evaluación de la IGH sugiriendo la búsqueda de defectos en el GHR.

Idiopathic Short Stature (ISS) includes a heterogeneous group of children with growth failure. One possible explanation for the growth failure is a reduced responsiveness to growth hormone (GH). Human circulating GH is partially bound to a highaffinity binding protein (GHBP) which is derived from proteolytical cleavage of the extracellular domain of the GH receptor. Many reports have demonstrated a close relationship between GHBP and liver GH receptor status in physiological conditions and diseases. Moreover, serum GHBP measurement has been proposed as an useful peripheral index of GH receptor abundance. Our objective was the evaluation of serum GHBP levels and its probable association with serum growth factors (IGF-I, IGFBP-3 and ALS) and the exon 3 polymorphism of the extracellular domain of the GHR gene in ISS children. Children with ISS presented significantly lower height SDS, BMI SDS, serum components of the IGFs system and GHBP concentration as compared to an age-matched control group of normal children (p<0.001). Interestingly, exon 3 genotype did not influence the differences observed in these parameters. The maximal GH response obtained after two GH provocative tests inversely and significantly correlated to GHBP serum levels (r= -0.28, p= 0.012). A frequency study showed a deviation to low SDS values of serum GHBP, IGF-I, IGFBP-3 and ALS. Conclusion: 1- in children with ISS the exon 3 genotype of the GHR gene is not a factor that could explain the lower levels observed in circulating GHBP concentration and components of the IGFs system; 2- low serum GHBP together with low IGF-I, IGFBP-3 or ALS levels would help pointing to GH insensitivity due to GH receptor gene abnormalities in ISS.
Descritores: Hormônio do Crescimento Humano/biossíntese
Insuficiência de Crescimento/etiologia
-Biomarcadores/metabolismo
Hormônio do Crescimento Humano/genética
Peptídeos e Proteínas de Sinalização Intercelular/genética
Limites: Humanos
Masculino
Feminino
Pré-Escolar
Criança
Adolescente
Tipo de Publ: Estudo Comparativo
Ensaio Clínico Controlado
Responsável: AR635.1 - FCVyS - Servicio de Información y Documentación


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Id: lil-281775
Autor: Bergadá, I; Ropelato, M. G; Heinrich, J. J; Bergadá, C.
Título: Evaluación de la secreción de cortisol en el test de hipoglucemia insulínica en niños bajos normales / Evaluation of the cortisol secretion in insulin hypoglucemia test in short normal children
Fonte: Med. infant;2(1):63-63, mar. 1995.
Idioma: es.
Conferência: Apresentado em: Reunión anual de SLAIP, 32 y SLEP, 8, s.l, s.f.
Descritores: Hidrocortisona/metabolismo
Hormônio do Crescimento Humano
Hipoglicemia
-Argentina
Limites: Humanos
Masculino
Feminino
Lactente
Pré-Escolar
Tipo de Publ: Relatos de Casos
Responsável: AR305.1 - SID - Servicio de Información y Documentación


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Id: lil-617901
Autor: Ribeiro, Eliane Beraldi(org).
Título: Fisiologia endócrina / Endocrine physiology.
Fonte: São Paulo; Unifesp;Manole; 2012. 320 p. ilus, tab, graf. (Ciências Básicas de Saúde e Biomedicina - Unifesp).
Idioma: pt.
Descritores: Doenças do Sistema Endócrino/fisiopatologia
Hormônios/fisiologia
Sistema Endócrino/fisiologia
-Adipocinas/fisiologia
Desnutrição/metabolismo
Glândulas Endócrinas/fisiologia
Hormônio do Crescimento Humano/fisiologia
Hormônios Esteroides Gonadais/fisiologia
Hormônios Gastrointestinais/fisiologia
Limites: Humanos
Responsável: BR1.1 - BIREME
BR1.1/4026.00; BR1.2; WK102 F537 2012 (BSP)


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Id: biblio-1025979
Autor: Mariscal, Gonzalo; Barrios, Carlos; Platero, José Luis; Platero, Felix; de la Rubia Orti, José Enrique; Doménech, Pedro.
Título: Growth hormone effects on childrens height with achondroplasia and hypochondroplasia: a systematic review and metanalysis
Fonte: Prensa méd. argent;105(10):700-709, oct 2019. tab, graf.
Idioma: en.
Resumo: Introduction: Achondroplasia (Ach) is the most frequent cause of dwarfism. The first therapeutic strategy offered to patients with Ach was. However, GH has played un important role in Ach and Hypochondroplasia (Hch), despite short-term and long-term effects. Purpose: The aim of this systematic review and meta-analysis was to assess the efficacy of GH in the height of patients with Ach and Hch in the short and long term. Methods: 12 studies were included selected from the Pubmed database (3 Randomized Clinical trials (RCTs) and 9 prospective studies) from 1993 to 2014. Comparing high and low doses of GH. The systematic review included 9 prospective studies and the high-dose GH arm of the 3 RCTs. Inclusion criteria was focused on paediatric patients with Ach and Hch treated with GH. Demographic variables were collected including age, gender, dose, height and follow-up. The height variables included height increase and height velocity. Finally, 363 patients with Ach and 41 patients with Hcb were included. A was performed with a follow-up from one to 3 years. Results: In patients with Ach the average height velocity at one, two and three years were 2.65, 1.07 and -0.87 cm/years respectively (p<0.05). The RCTs showed a significant increase in height velocity in patients treated with high dose of GH (MD= 1.38, 95% CI: 0.68-2.07, p=0.0001, I2=0%) . Height at one year increased 0.61 cm. The RCTs did not show significant differences (MD 0.11, 95% CI: 0.17-0.39, p=0.44, I2 = 0%). Finally, patients with Hch increased height velocity 4 cm/year at the first year (p<0.05). Conclusion: GH treatment is beneficial in the shor-term height of children with Ach and Hch. GH effect on different ages and subgroups is unknown, as well as its possible long--term consequences
Descritores: Acondroplasia/terapia
Demografia/estatística & dados numéricos
Avaliação de Resultados em Cuidados de Saúde
Hormônio do Crescimento Humano/administração & dosagem
Hormônio do Crescimento Humano/uso terapêutico
FUCOSEABDOMINAL NEOPLASMS
Limites: Humanos
Recém-Nascido
Lactente
Pré-Escolar
Tipo de Publ: Metanálise
Responsável: AR392.1 - Biblioteca


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Id: biblio-1021819
Autor: Santangelo, Liliana Andrea; Ortiz, María Inés; Paissan, Andrea Laura; Fainstein Day, Patricia; Knoblovits, Pablo.
Título: Síndrome de Turner: nuestra experiencia en la creación del Registro Institucional y de la Unidad Interdisciplinaria en el Hospital Italiano de Buenos Aires: un primer paso para el mejor seguimiento / Turner syndrome: our experience in the creation of the Registry Institutional and Interdisciplinary Unit at the Italian Hospital of Buenos Aires: a first step to the best follow-up
Fonte: Rev. Hosp. Ital. B. Aires (2004);39(1):12-18, mar. 2019. ilus., tab..
Idioma: es.
Resumo: El síndrome de Turner (ST) resulta de la ausencia completa o parcial del segundo cromosoma sexual en fenotipos femeninos. Tiene una incidencia de 1:2000- 2500 nacidas vivas. Recién en la última década se ha puesto atención a la salud de las adultas con ST. La mortalidad es 3 veces superior respecto de la población general debido al riesgo de disección aórtica por anomalías cardiovasculares estructurales y aterosclerosis vinculada a hipertensión arterial, diabetes, dislipidemia y obesidad. También presentan elevada prevalencia de enfermedades autoinmunitarias. Objetivo: evaluar la calidad del seguimiento clínico de pacientes adultas con ST, comparando los controles de salud preconformación y posconformación del Registro y de la Unidad Interdisciplinaria. En el año 2017 fuimos convocados para integrar el Programa de Enfermedades Raras del Hospital Italiano de Buenos Aires. A partir de la creación del Registro Institucional y del equipo multidisciplinario obtuvimos mejoría significativa en los controles por las especialidades de cardiología, endocrinología y otorrinolaringología, en los controles bioquímicos del metabolismo lipídico, hidrocarbonado, hepatograma, TSH y anticuerpos para celiaquía e imágenes cardiovasculares y densitometría ósea. En conclusión, el seguimiento sistematizado e institucional, mediante el Registro y la creación de la Unidad Interdisciplinaria de Síndrome de Turner, permitió encontrar las falencias del sistema de atención y optimizar el seguimiento de esta población. (AU)

Turner syndrome (TS) results from the complete or partial absence of the second sex chromosome in female phenotypes. It has an incidence of 1: 2000-2500 girls born alive. Only in the last decade has been paid attention to the health of adults women with TS. Mortality is 3 times higher than in the general population due to the risk of aortic dissection cause to structural cardiovascular anomalies and atherosclerosis related to hypertension, diabetes, dyslipidemia and obesity. They also have a high prevalence of autoimmune diseases. Until nowadays in Argentina do not exist a national registry of this disease that complies with the international follow-up recommendations for these patients. We proposed to develop the institutional register at 2014 and a multidisciplinary team was created to care and follow up girls and women with TS during 2015. It was indexed to Italian Hospital of Buenos Aires' Rare Diseases Program since 2017. After the creation of the institutional registry and the multidisciplinary team we obtained a significant improvement in cardiology, endocrinology and otorhinolaryngology schedule visits, in lipids and hydrocarbon metabolism, liver, thyroid and celiac diseases biochemical controls and in the performance of cardiovascular MNR and bone densitometry. In conclusion, the systematized and institutional follow-up, through the registry and the creation of the Interdisciplinary Unit of Turner Syndrome, allowed us to find the flaws of the care system and to optimize the follow up of this population. (AU)
Descritores: Qualidade de Vida
Síndrome de Turner/prevenção & controle
Assistência ao Convalescente/estatística & dados numéricos
Aneurisma Dissecante/etiologia
-Doenças Autoimunes/epidemiologia
Síndrome de Turner/complicações
Síndrome de Turner/etiologia
Síndrome de Turner/mortalidade
Síndrome de Turner/epidemiologia
Assistência ao Convalescente/métodos
Anormalidades Cardiovasculares/complicações
Hormônio do Crescimento Humano/uso terapêutico
Diabetes Mellitus
Aterosclerose/complicações
Dislipidemias/complicações
Estrogênios/uso terapêutico
Transtornos Gonadais/etiologia
Hipertensão/complicações
Infertilidade Feminina/etiologia
Obesidade/complicações
Limites: Humanos
Feminino
Adolescente
Adulto
Pessoa de Meia-Idade
Adulto Jovem
Tipo de Publ: Estudo Clínico
Responsável: AR2.1 - Biblioteca Central


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Id: biblio-1000377
Autor: Braslavsky, Debora; Keselman, Ana; Bergadá, Ignacio.
Título: Insuficiencia Hipofisaria Congénita / Congenital Pituitary Hormone Deficiency
Fonte: Rev. Hosp. Niños B.Aires;60(270):250-257, sept. 2018.
Idioma: es.
Resumo: La insuficiencia hipofisaria congénita es un trastorno originado en la alteración de la ontogenia de la glándula hipofisaria que determina la disminución o falta de trofinas hipofisarias: adrenocorticotropina, tirotropina, hormona de crecimiento, prolactina, gonadotrofinas y/u hormona antidiurética. Es una patología compleja e infrecuente que, debido a su signo sintomatología inespecífica, suele ser difícil de reconocer a edades tempranas, derivando en aumento de la morbilidad y eventualmente de la mortalidad. Durante el periodo neonatal, es característica la ictericia colestática asociada a hipoglucemias recurrentes. Puede formar parte de un cuadro sindrómico, siendo el más frecuente la displasia septoóptica, que asocia defectos de línea media y alteraciones oculares. La mayoría presenta anomalías anatómicas de la región selar y supraselar evidenciables en la Resonancia Magnética. El diagnóstico bioquímico tiene especificaciones particulares para la evaluación de cada trofina hipofisaria y de acuerdo a la edad del paciente. El tratamiento consiste en la terapia de reemplazo hormonal observándose buena respuesta en la mayoría de los pacientes. La detección precoz de los niños con insuficiencia hipofisaria permite la activación rápida y efectiva de una estrategia diagnóstica con la toma de muestras bioquímicas apropiadas, la consulta temprana al endocrinólogo infantil y la instauración del tratamiento específico

Congenital pituitary hormone deficiency is a disorder originated in pituitary gland ontogeny generating decrease or lack of pituitary hormones: adrenocorticotropin, thyrotropin, growth hormone, prolactin, gonadotropins and/or antidiuretic hormone. It is a complex and infrequent disease usually difficult to recognize at an early age due to its non-specific symptomatology, resulting in increased morbidity and eventual mortality. During the neonatal period, cholestatic jaundice associated with recurrent hypoglycaemia is frequent. Pituitary hormone deficiency can be part of a syndrome; the most frequent is septo-optic dysplasia, associating midline defects and ocular disorders. Most have anatomical anomalies of the sellar and suprasellar region seen in magnetic resonance imaging. Biochemical diagnosis has particular specifications for the evaluation of each pituitary hormone and varies according to patient´s age. The treatment consists in hormone replacement therapy and generally with good results. The early detection of children with pituitary hormone deficiency allows the rapid and effective activation of a diagnostic strategy, facilitates the appropriate biochemical samples, the early contact with the pediatric endocrinologist and the establishment of specific treatment
Descritores: Hormônio do Crescimento Humano
Hipopituitarismo
-Pediatria
Limites: Humanos
Tipo de Publ: Estudo Observacional
Responsável: AR441.1 - Biblioteca Dr Laureano Rivas Miguez


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Id: lil-641979
Autor: Boero, L; Mallea Gil, M. S; Manavela, M; Stalldecker, G; Danilowicz, K; Guitelman, M; Alfieri, A; Ballarino, M. C; Chervin, A; García Basavilbaso, N; Glerean, M; Loto, M. G; Nahmías, J. A; Rogozinski, A. S; Servidio, M; Vitale, N. M; Katz, D; Fainstein Day, P.
Título: Acromegalia: comparación de los niveles séricos de IGF-I por dos inmunoensayos y su correlación con la prueba de tolerancia oral a la glucosa / Acromegaly: Comparison of serum IGF-1 levels measured by two immunoassays and their correlation with the Oral Glucose Tolerance Test
Fonte: Rev. argent. endocrinol. metab;47(4):18-23, oct.-dic. 2010. graf, tab.
Idioma: es.
Resumo: Introducción: La determinación de IGF-I en suero o plasma es una herramienta esencial en el diagnóstico y seguimiento de la acromegalia. Sin embargo, se deben tener presentes algunos inconvenientes en su medición por diferentes inmunoensayos. Objetivos: Evaluar dos inmunoensayos para la determinación de IGF-I y su correlación con el nadir de GH en el TTOG en pacientes acromegalicos. Materiales y métodos: Se analizaron 37 pacientes acromegálicos, 20 mujeres y 17 hombres. IGF-I fue determinada por Immulite 1000, (IMM) y por IRMA (DSL). Se realizó el TTOG y se determinó glucosa y GH en todos los tiempos (basal, 30, 60, 90 y 120min). Se consideró respuesta normal un nadir de GH <1ng/ml. Nueve pacientes se encontraban bajo tratamiento y 28 sin tratamiento. Análisis estadístico: se utilizaron el test de Wilcoxon, de Bland y Altman y curvas ROC. Se consideró significativa una p<0,05. Resultados: Las concentraciones basales de glucosa fueron 97,86±10,91 mg/dl, de GH 2,8 (1,59-14,4) ng/ml, de IGF-I por IMM 602±318 ng/ml y por DSL 1006±596 ng/ml. IGF-I por IMM y DSL mostró una diferencia significativa con p <0,01 y un bias de - 403,2 ng/ml con valores menores por IMM. IGF-I elevada por IMM y DSL, se encontró en el 84% y en el 97% respectivamente. IGF-I elevada con nadir de GH >1ng/ml se encontró en el 70%, con nadir de GH normal en el 13,5%. IGF-I normal con nadir >1ng/ml en el 2,7% y con nadir de GH normal en el 13,5%. El área bajo las curvas ROC no mostró diferencias significativas. Conclusiones: Los niveles de IGF-I determinados por IMM y DSL fueron significativamente diferentes mostrando un bias negativo para IMM. La mayoría de los valores del nadir de GH fueron consistentes con los niveles de IGF-I observándose una discrepancia en el 30% de los pacientes, estuvieran o no bajo tratamiento.

Introduction: IGF-I determination in serum or plasma is an essential tool in the diagnosis and follow-up of acromegaly. Hepatic production of IGF-I is regulated by GH and circulates bound to several IGF-I binding proteins which extends its half life. IGF-I is not released in a pulsatile pattern and has no significant variability in 24 h. Objective: To evaluate two different methodologies in IGF-I levels determination and their correlation with GH nadir in OGTT in acromegalic patients. Material and methods: We analyzed 37 acromegalic patients, 20 women and 17 men, mean age was 45±12 years. IGF-I levels were assayed by Immulite 1000, DPC (IMM) and DSL-5600 ACTIVE® IGF-I Coated-Tube IRMA (DSL) and OGTTs (at baseline and at 30, 60, 90 and 120 minutes) were performed by measuring plasma glucose and GH assay by immunochemiluminometric assay (Access); we considered a nadir <1ng/ml as normal response. Nine patients were under medical treatment (cabergoline: 4, octeotride: 4, and cabergoline plus octeotrite: 1) and 28 without treatment. Statistical analysis: Wilcoxon and, Bland and Altman tests and ROC curves. Differences were considered significant at p< 0.05. Results: Basal glucose levels were 97.86±10.91 mg/dl and mean GH was 2.8 (1.59-14.4) ng/ml. Mean IGF-I levels performed by IMM were 602±318 ng/ml and 1006±596 ng/ml by DSL. There was a statistically significant difference between both methodologies (p<0.01). Bland and Altman test showed a bias of - 403.2 ng/ml with lower values by IMM. We observed elevated IGF-I levels in 84% by IMM and in 97% by DSL, and only one patient had normal levels with both methodologies. Elevated IGF-I levels and GH nadir >1ng/ml were observed in 70% of the patients, increased IGF-I with normal GH nadir in 13.5%, normal IGF-I with GH nadir >1ng/ml in 2.7% and normal IGF-I with normal GH nadir in 13.5%. Patients under treatment: 3 showed normal GH nadir with elevated IGF-I levels, in 2 of them by both methodologies, and in the other one it was normal by IMM and elevated by DSL; the other 6 showed GH nadir > 1ng/ml, 5 of them presented elevated IGF-I by both methodologies and the other one showed discrepancy in IGF-I levels. The under ROC curve area and confidence interval (CI) of 95% for IGF-I IMM and DSL were 0.96 (0.90-1.00) and 0.91 (0.82-1.00) respectively. Differences between the ROC curves areas were not significant Conclusions: IGF-I levels determined by IMM and DSL were statistically significantly different. IGF-I levels showed a negative bias by IMM. Most of the results of GH nadir were consistent with IGF-I levels but we observed discrepancy in 30% of the patients, regardless of whether they were under treatment or not.
Descritores: Acromegalia/sangue
Fator de Crescimento Insulin-Like I/análise
Teste de Tolerância a Glucose/estatística & dados numéricos
-Imunoensaio/métodos
Interpretação Estatística de Dados
Hormônio do Crescimento Humano/análise
Limites: Humanos
Masculino
Feminino
Criança
Adolescente
Adulto
Pessoa de Meia-Idade
Tipo de Publ: Relatos de Casos
Estudo Comparativo
Ensaio Clínico
Responsável: AR635.1 - FCVyS - Servicio de Información y Documentación



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