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Moraes A.B.,Federal University of Rio de Janeiro | Moraes A.B.,State Institute Of Diabetes And Endocrinology Of Rio Of Janeiro | Marques Dos Santos Silva C.,Federal University of Rio de Janeiro | Vieira Neto L.,Federal University of Rio de Janeiro | Gadelha M.R.,Federal University of Rio de Janeiro
Clinical Endocrinology | Year: 2013

Background Giant prolactinomas are an unusual subset of macroprolactinomas and are more commonly found in men. The goal of this review is to propose a giant prolactinoma definition and discuss the available therapeutic options for biochemical and tumour volume control. Methods A comprehensive search of all published studies was performed between April and November 2012 in electronic databases (PubMed and Ovid). Results A giant prolactinoma should be defined as an adenoma with a maximum diameter of more than 4 cm that is associated with serum prolactin above 5300 mIU/l. Regarding treatment, cabergoline is the preferred dopamine agonist for medical management of giant prolactinomas because of its excellent efficacy and tolerability. Normalization of prolactin level and significant tumour reduction may be achieved in the majority of patients. Combined therapy, particularly cabergoline and surgery, may be necessary due to the large tumour load. Radiotherapy and temozolomide may be used for patients with aggressive giant prolactinomas in whom tumour volume control is not achieved with cabergoline and surgery. Conclusion There is a scarcity of large studies about the management of giant prolactinoma. Cabergoline is the first-line treatment. However, caution should be exercised when comparing efficacy rates among the different treatment modalities due to the variability in study design and data quality. In this scenario, a 'standard' definition for giant prolactinomas and larger series may be helpful to assess the real efficacy and safety of each therapeutic modality. © 2013 John Wiley & Sons Ltd.

Mechanick J.I.,Mount Sinai School of Medicine | Marchetti A.E.,Rutgers University | Apovian C.,Boston University | Benchimol A.K.,State Institute Of Diabetes And Endocrinology Of Rio Of Janeiro | And 12 more authors.
Current Diabetes Reports | Year: 2012

Type 2 diabetes (T2D) and prediabetes have a major global impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. To mitigate this disease burden, interventions of proven effectiveness must be used. Evidence shows that nutrition therapy improves glycemic control and reduces the risks of diabetes and its complications. Accordingly, diabetes-specific nutrition therapy should be incorporated into comprehensive patient management programs. Evidence-based recommendations for healthy lifestyles that include healthy eating can be found in clinical practice guidelines (CPGs) from professional medical organizations. To enable broad implementation of these guidelines, recommendations must be reconstructed to account for cultural differences in lifestyle, food availability, and genetic factors. To begin, published CPGs and relevant medical literature were reviewed and evidence ratings applied according to established protocols for guidelines. From this information, an algorithm for the nutritional management of people with T2D and prediabetes was created. Subsequently, algorithm nodes were populated with transcultural attributes to guide decisions. The resultant transcultural diabetes-specific nutrition algorithm (tDNA) was simplified and optimized for global implementation and validation according to current standards for CPG development and cultural adaptation. Thus, the tDNA is a tool to facilitate the delivery of nutrition therapy to patients with T2D and prediabetes in a variety of cultures and geographic locations. It is anticipated that this novel approach can reduce the burden of diabetes, improve quality of life, and save lives. The specific Southeast Asian and Asian Indian tDNA versions can be found in companion articles in this issue of Current Diabetes Reports. © Springer Science+Business Media, LLC 2012.

Papelbaum M.,State Institute Of Diabetes And Endocrinology Of Rio Of Janeiro | Papelbaum M.,Federal University of Rio de Janeiro | Lemos H.M.,State Institute Of Diabetes And Endocrinology Of Rio Of Janeiro | Duchesne M.,State Institute Of Diabetes And Endocrinology Of Rio Of Janeiro | And 4 more authors.
Diabetes Research and Clinical Practice | Year: 2010

Aims: Several studies have demonstrated worse perception of quality of life (QoL) among patients with type 2 diabetes mellitus (T2DM). The purpose of our study was to assess QoL in a clinical sample of patients with T2DM and its association with depressive symptoms and glycemic control. Methods: One hundred outpatients from a sequential sample underwent clinical and psychiatric evaluation. The Problem Areas of Diabetes scale (PAID) and the Beck Depression Inventory (BDI) were used to assess, respectively, QoL and the presence of overall psychopathology. The levels of glycated hemoglobin (HbA1c) were used as the main parameter of glycemic control. Results: The perception degree of the QoL related with diabetes was associated with the severity of depressive symptoms (r=0.503; p<0.001), but not with HbA1c levels (p=0.117). However, the severity of general psychopathology, evaluated through the BDI scores, predicted the metabolic control, measured by HbA1c levels, among the patients in our sample (r=0.233; p=0.019). Conclusions: In our study, PAID was a valuable tool for the evaluation of QoL in T2DM and the screening of depressive symptoms. However, no correlation observed between PAID scores and HbA1c levels. Self-perception evaluation of T2DM patient can help to identify susceptible subjects to current depression. © 2010 Elsevier Ireland Ltd.

Papelbaum M.,Federal University of Rio de Janeiro | Moreira R.O.,State Institute Of Diabetes And Endocrinology Of Rio Of Janeiro | Coutinho W.,State Institute Of Diabetes And Endocrinology Of Rio Of Janeiro | Kupfer R.,State Institute Of Diabetes And Endocrinology Of Rio Of Janeiro | And 4 more authors.
Diabetology and Metabolic Syndrome | Year: 2011

Background: Comorbid depression in diabetes has been suggested as one of the possible causes of an inadequate glycemic control. The purpose of this study was to investigate the association between major depression and the glycemic control of type 2 diabetes mellitus (T2DM). Methods. Seventy T2DM patients were evaluated. They underwent a psychiatric examination using the following instruments: Structured Clinical Interview for DSM-IV and Beck Depression Inventory. The diabetes status was assessed in the short-term (glycemia, glycated hemoglobin) clinical control. Results: The presence of current depression was observed in 18.6% (13/70). In addition, type 2 diabetes patients who displayed depression evidenced higher levels of glycated hemoglobin (8.6 2.0 vs. 7.5 1.8; p = 0.05) when compared to those who did not exhibit a mood disorder. Conclusions: In our sample, the presence of depression seems to impact on the short-term control of T2DM. The authors discuss the clinical utility of these findings in the usual treatment of diabetes. © 2011 Papelbaum et al; licensee BioMed Central Ltd.

Guedes E.P.,State Institute Of Diabetes And Endocrinology Of Rio Of Janeiro | Madeira E.,State University of Rio de Janeiro | Mafort T.T.,State University of Rio de Janeiro | Madeira M.,Federal University of Rio de Janeiro | And 5 more authors.
Diabetology and Metabolic Syndrome | Year: 2013

Background: Several studies point to a correlation between obesity and the severity of depressive and anxiety symptoms in children and adults, but there are still some controversial points about this association. The aim of this study is to investigate the relationship between body composition and the severity of anxiety/depressive symptoms in overweight and obese individuals with Metabolic Syndrome (MS). Methods. Fifty patients, 18-50 years old, overweight or obese and with the diagnosis of MS based on the International Diabetes Federation (IDF) criteria were selected for this study. Body composition was evaluated using Dual Energy X-ray Absorptiometry (DXA). Depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADS-Depression) and the Beck Depression Inventory (BDI). Anxiety symptoms were evaluated using HADS-Anxiety. Results: No correlation was found between depressive symptoms (HADS-Depression or BDI) and Body Mass Index (BMI) (r = 0.01; p = 0.94 and r = -0.12, p = 0.38; respectively), Waist Circumference (WC) (r = -0.06, p = 0.67 and r = -0.22, p = 0.12; respectively), and Waist-to-Hip Ratio (WHR) (r = -0.12, p = 0.40 and r = -0.17, p = 0.23; respectively). Additionally, no correlation was found among anxiety symptoms (HADS-Anxiety) and BMI (r = -0.15, p = 0.27), and WHR (r = -0.17, p = 0.24). In contrast, a significant correlation was found between percentage of total fat (DXA) and HADS-Depression (r = 0.34, p = 0.019) and HADS-Anxiety (r = 0.30, p = 0.039). Additionally, an inverse and strong correlation was found between lean mass (in grams) and HADS-Depression (r = -0.42, p = 0.004), HADS anxiety (r = -0.57, p < 0.0001), and BDI (r = -0.44, p = 0.026). Conclusions: In individuals with MS, the percentage of body fat, and not central fat, BMI, WC, or WHR, was associated with an increased severity of anxiety and depressive symptoms. In contrast, total lean mass was strongly associated with fewer anxiety/depressive symptoms, suggesting that body composition might be related to psychiatric comorbidity in overweight individuals with MS. © 2013 Guedes et al.; licensee BioMed Central Ltd.

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