Made available in DSpace on 2016-04-28T18:22:52Z (GMT). No. of bitstreams: 1 Roberta Werlang Isolan Cury.pdf: 1986393 bytes, checksum: 83fd8333740030de880e8caebc69b3a2 (MD5) Previous issue date: 2014-06-24 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Acromegaly is an insidious disease with clinical features resulting from abnormal exposure of tissues and systems to excess growth hormone (GH). Physiognomic changes typically occur such as the enlargement of the nose and the lips, prognathism, malocclusion, macroglossia, in addition to increased extremities. Two major structural changes in the vocal tract are particularly relevant for speech therapists and linguists working on speech disorders: enlargement of laryngeal structures and hypertrophy of the tongue, which tend to cause changes to speech and voice. Objective: perform perceptual and acoustic analyses of the speech of acromegalic patients. After the study was approved by the Human Research Ethics Committee of the Santa Casa Hospital in São Paulo (REC Code number 324/11), analyses were made of the speech samples of acromegalic patients that had been given clinical and laboratory diagnosis and treatment provided by the Endocrinology department of the abovementioned hospital. Corpus for the study: three randomized repetitions of carrier sentences containing keywords with the seven oral vowels found in Brazilian Portuguese: [a][e][ε][i] ][o],[ɔ] and [u]. Anthropometric orofacial measures (middle facial third, lower facial third, and face height) were also taken. The audio samples were subsequently analyzed using the add-on Akustik available on the software Praat for measurements of formant frequencies (F1,F2,F3,F4). The audio samples were also analyzed with the VPAS-PB (Vocal Profile Analysis Scheme VPAS) script by three experienced raters. The data underwent multivariate statistical analysis and were discussed for correlations between perceptual and acoustic data based on the phonetic description of voice quality model. The statistical analysis showed significant voice quality adjustments for acromegalic speakers: protruded jaw, laryngeal hypofunction, retracted tongue body. Acoustically, measures of F1 and F2 showed differences between men and women. For both sexes, significant correlations were detected between tongue movement and position for the acromegalic speakers. The values of F3 and F4, in turn, were correlated with adjustments of pharynx size and larynx height, thus reinforcing the findings of voice quality for the group of acromegalic speakers. The integrated perceptual and acoustic data contribute to the understanding of vocal quality, aided by the phonetic approach and the analysis of formant frequencies. The findings of this study went beyond the issue of pitch lowering as they brought up specific and fundamental information for an approach to speech aimed at people with acromegaly / A acromegalia é uma doença insidiosa com características clínicas resultantes da exposição anormal dos tecidos e sistemas ao excesso de hormônio do crescimento (growth hormone/GH). Ocorrem tipicamente modificações fisionômicas como o alargamento do nariz, aumento dos lábios, prognatismo, má-oclusão dentária, macroglossia, além do aumento das extremidades. Em particular interesse para fonoaudiólogos, e na área de linguística aplicada à fala, há citações das duas maiores alterações estruturais do trato vocal, as quais tendem a promover alterações de fala e voz: o alargamento das estruturas laríngeas e a hipertrofia lingual. Objetivo: analisar a fala de pacientes com acromegalia dos pontos de vista perceptivo e acústico. Após a aprovação do Comitê de Ética e Pesquisa em Seres Humanos da Santa Casa de São Paulo (CEP número 324/11), foram analisadas as amostras de fala de pacientes com o diagnóstico clínico e laboratorial da doença e em tratamento no serviço de Endocrinologia da Irmandade da Santa Casa de São Paulo. Corpus para o estudo: três repetições aleatorizadas de sentença veículo, contendo palavras chaves com as sete vogais orais do português brasileiro[a][e][ε][i] ][o],[ɔ] e [u]. Também foram extraídas as medidas antropométricas orofaciais (terço médio da face, terço inferior da face e altura da face). As amostras de áudio foram posteriormente analisadas por meio do Plug in Akustik disponível no software Praat para a extração de medidas de frequência dos formantes (F1,F2,F3,F4). As amostras de áudio foram também analisadas por meio do roteiro VPAS-PB (Vocal Profile Analises Scheme VPAS) por três juízes experientes. Os dados foram submetidos à análise estatística multivariada e discutidos quanto às correlações entre os dados perceptivos e acústicos com base no modelo fonético da qualidade vocal. A análise estatística evidenciou os ajustes de qualidade vocal relevantes para os falantes com acromegalia: mandíbula extensão diminuída e protraída, hipofunção laríngea, corpo de língua recuado. No âmbito acústico, as medidas de F1 e F2 revelaram diferenças diferentes entre as mulheres e os homens. Para ambos os sexos foram detectadas correlações significativas com o movimento e postura lingual entre os falantes acromegálicos. Os valores de F3 e F4, por sua vez, mostraram correlação com ajustes de dimensão faríngea e altura da laringe, reforçando os achados de qualidade vocal para o grupo de falantes acromegálicos. Os dados integrados, perceptivos e acústicos, contribuem para a compreensão da qualidade vocal, propiciada pela abordagem fonética e pela análise das frequências formânticas. Os achados deste estudo foram além da questão do rebaixamento do pitch, e trouxeram informações específicas e fundamentais para uma abordagem de fala direcionada para a população com acromegalia

Submitted by FERNANDA BOLFI null (febolfi@gmail.com) on 2017-05-08T16:04:44Z No. of bitstreams: 1 Dissertacao Final Fernanda Bolfi - 05 maio 2017.pdf: 3208040 bytes, checksum: c59f4d1e79a78aa785e21f71d553f965 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-05-08T17:11:23Z (GMT) No. of bitstreams: 1 bolfi_f_me_bot.pdf: 3208040 bytes, checksum: c59f4d1e79a78aa785e21f71d553f965 (MD5) / Made available in DSpace on 2017-05-08T17:11:23Z (GMT). No. of bitstreams: 1 bolfi_f_me_bot.pdf: 3208040 bytes, checksum: c59f4d1e79a78aa785e21f71d553f965 (MD5) Previous issue date: 2017-02-22 / Objetivo: esta revisão sistemática da literatura e metanálise comparou a taxa da mortalidade na acromegalia com a taxa esperada na população geral dos estudos publicados antes de 2009 versus estudos publicados após. Métodos: foram criadas três estratégias de busca gerais e adaptáveis às bases de dados eletrônicas na área da saúde: Embase (1980–2015), Pubmed (1966–2016) e Biblioteca Virtual da Saúde (1982–2016). Foram incluídos estudos observacionais em que a mortalidade na acromegalia foi comparada à da população geral, por meio do número de mortes observadas nessa doença em comparação à taxa de mortalidade esperada para população geral (O/E). A partir do O/E, recalculamos todos os Standardized Mortality Ratio (SMR) e os seus respectivos intervalos de confiança (IC) que foram plotados em uma metanálise. Resultados: foram identificadas 1005 referências, dois revisores independentemente leram os títulos e resumos desses artigos. Dos 27 estudos potencialmente elegíveis, 23 foram incluídos e quatro foram excluídos por não preencherem os critérios de elegibilidade. A mortalidade geral na acromegalia foi significativamente superior a da população geral (SMR: 1,66, IC 1,44 - 1,93, p < 0,00001, I2 84%). Separando os artigos publicados a partir de 2009, a mortalidade na acromegalia não foi significativamente diferente 1,29 (IC 0,95-1,76, p=0,10, I2 86%). Nas análises por subgrupo de acordo com o status da doença, sete estudos consideraram como curados os pacientes que apresentaram a normalização do IGF-1 associado ao GH randômico < 2,5 ng/mL. Nesses indivíduos o SMR da metanálise foi 0,93 (IC 0,74-1,18, p=0,57, I2 33%) e dos que não atingiram esses critérios foi 2,23 (IC 1,53-3,27, p<0,00001, I² 61%). A mortalidade manteve-se significativamente maior nas causas cardiovasculares, respiratórias e cerebrovasculares [SMR: 1,78 (IC 1,52-2,10, p<0,00001, I² 49%), SMR: 2,29 (IC 1,63-3,23, p<0,00001, I² 49%), SMR: 2,62 (1,72-3,98, p<0,00001, I² 83%), respectivamente]. A metanálise dos que realizaram radioterapia evidenciou SMR de 2,15 (1,83-2,53, p<0,00001, I² 0%) e dos que não realizaram de 1,27 (0,95-1,69 p=0,11, I² 65%). Conclusão: apesar da alta inconsistência, não há diferença na mortalidade na acromegalia atualmente em comparação com períodos anteriores (antes e após 2009), e o controle bioquímico da doença com IGF-1 normal e GH randômico < 2,5 ng/mL está relacionado com normalização das taxas de mortalidade. / Objective: This systematic literature review and meta-analysis compared the mortality rate in acromegaly with the expected rate in the general population of studies published before 2009 versus studies published after. Methods: three general and adaptive search strategies were created from the electronic databases in the health area: Embase (1980-2015), Pubmed (1966-2016) and Virtual Health Library. Observational studies were included in which the mortality in acromegaly was compared to the general population, the number of deaths observed compared to the expected mortality rate in the general population (O/E). From O/E, we recalculated all the Standardized Mortality Ratio (SMR) and their respective confidence intervals (CI) that were plotted in a meta-analysis. Results: 1005 references were identified and two reviewers independently read the titles and abstracts of these articles. Of the 27 potentially eligible studies, 23 were included and four were excluded because they did not meet the eligibility criteria. Overall mortality in acromegaly was significantly higher than the general population (SMR: 1.66, CI 1.44 - 1.93, p <0.00001, I² 84%). Analyzing articles published as of 2009, the mortality in acromegaly was not significantly different, SMR 1.29 (CI 0.95-1.76, p = 0.10, I² 86%). In subgroup analyzes according to disease status, seven studies considered patients with IGF-1 normalization associated with random GH <2.5 ng / mL as cured. In these individuals, the SMR was 0.93 (CI 0.74-1.18, p = 0.57, I² 33%) and in those who did not meet these criteria were 2.23 (CI 1.53-3.27, p<0.00001, I² 61%). Mortality was significantly higher in cardiovascular, respiratory and cerebrovascular causes [SMR: 1.78 (CI 1.52-2.10, p <0.00001, I² 49%), SMR: 2.29 (CI 1.63-3.23, p <0.00001, I² 49%), SMR: 2.62 (1.72-3.98, p <0.00001, I² 83%), respectively]. The meta-analysis of those who underwent radiotherapy showed SMR 2.15 (1.83-2.53, p <0.00001, I² 0%) and those who did not performed, 1.27 (0.95-1.69 p = 0.11, I² 65%). Conclusion: Although there is a lot of inconsistency, there is no difference in acromegaly mortality compared to previous periods (before and after 2009), and the biochemical control of the disease with normal IGF-1 and random GH <2.5 ng / ml is related to normalization in mortality rates.

nÃo hà / INTRODUÃÃO: Estudos epidemiolÃgicos sugerem que o carcinoma de tireoide seja a neoplasia maligna mais frequente nos pacientes acromegÃlicos. Atà este momento nÃo hà relatos de estudos avaliando marcadores moleculares do carcinoma papilÃfero de tireoide (CPT) nessa populaÃÃo. OBJETIVOS: Avaliar a associaÃÃo entre acromegalia, presenÃa da mutaÃÃo BRAFV600E, marcadores imunohistoquÃmicos (galectina-3 e IGF-1) e caracterÃsticas clÃnico-patolÃgicas em pacientes acromegÃlicos com CPT. MATERIAL E MÃTODOS: Trata-se de um estudo transversal realizado no perÃodo de janeiro/09 a dezembro/2011, onde 11 pacientes acromegÃlicos com CPT, provenientes de 5 centros brasileiros de referÃncia no tratamento da acromegalia foram comparados com 45 pacientes com CPT sem acromegalia. Foram estudadas variÃveis clÃnicas e histopatolÃgicas do CPT. Utilizou-se cortes histolÃgicos de CPT emblocados em parafina para o estudo da mutaÃÃo BRAFV600E e para a anÃlise imunohistoquÃmica dos marcadores IGF-1 e galectina-3. Na anÃlise utilizou-se os testes t de student e do qui-quadrado (software SPSS, versÃo 13.0 para Windows) (p<0,05). RESULTADOS: A idade mÃdia dos pacientes acromegÃlicos com CPT foi de 61,5  6,02 anos, sendo 72,7% do sexo feminino. O tempo mÃdio de diagnÃstico da acromegalia foi de 7,7  3,90 anos, sendo o intervalo entre o diagnÃstico da acromegalia e do CPT, em mÃdia, 3,4  2,71 anos. Os nÃveis sÃricos de IGF-1 dos acromegÃlicos ao diagnÃstico do CPT foi de 417,0 ng/mL. NÃo houve diferenÃa quanto ao estadiamento TNM (Tumor, Nodule, Metastasis) e Ãndice prognÃstico AMES (Ages, Metastasis, Extent, Size) entre os grupos. Houve maior prevalÃncia da mutaÃÃo BRAFV600E (90,9% vs 55,6%; p=0,039) e de forte imunoexpressÃo para IGF-1 (88,9% vs 38,1%; p= 0,017) nos acromegÃlicos. NÃo houve diferenÃa na expressÃo de galectina-3 entre os grupos. CONCLUSÃO: Neste trabalho, pela primeira vez se mostrou uma alta prevalÃncia da mutaÃÃo BRAFV600E em CPT de acromegÃlicos, muito superior à descrita na populaÃÃo com CPT neste e em estudos anteriores (cerca de 40%). Contudo essa mutaÃÃo nÃo se mostrou associada a um fenÃtipo mais agressivo do tumor, o que diverge dos achados em populaÃÃo nÃo acromegÃlica com CPT. Conclui-se que a acromegalia à possivelmente associada à mutaÃÃo BRAFV600E em pacientes acromegÃlicos com CPT. Novos estudos serÃo necessÃrios para definir os mecanismos responsÃveis por tal associaÃÃo. / INTRODUCTION: Epidemiological studies suggest that thyroid carcinoma is the most common malignant neoplasm in acromegalic patients. At this moment there are no reports of studies evaluating molecular markers of papillary thyroid carcinoma (PTC) in this population. OBJECTIVES: The present work aimed to evaluate the association between acromegaly, expression of the mutation BRAFV600E, immunohistochemical markers (galectin-3 and IGF-1), and clinical-pathological characteristics in acromegalic patients with PTC. MATERIALS AND METHODS: This is a cross-sectional study conducted from January/09 to December/2011, where 11 acromegalic patients with CPT, from 5 Brazilian centers of reference in the treatment of acromegaly were compared with 45 patients with acromegaly without PTC. We evaluated clinical and histopathological variables of PTC. We used histological PTC embedded in paraffin for mutation study BRAFV600E and immunohistochemical analysis of markers IGF-1 and galectin-3. In the analysis we used the Student t test and chi-square test (SPSS software, version 13.0 for Windows) (p <0.05). RESULTS: The average age of acromegalic patients with PTC was 61.5  6.02 years and 72.7% were female. The average time of diagnosis of acromegaly was 7.7  3.90 years, and the interval between diagnosis of acromegaly and PTC was an average 3.4  2.71 years. The serum levels of IGF-1 in the diagnosis of acromegaly PTC was 417.0 ng / mL. There was no difference in the TNM (Tumor, Nodule, Metastasis) and AMES prognostic index (Ages, Metastasis, Extent, Size) between groups. There was a higher prevalence of the BRAFV600E mutation (90.9% vs 55.6%, p = 0.039) and stronger immunohistochemical expression for IGF-1 (88.9% vs 38.1%, p = 0.017) in acromegaly. There was no difference in the expression of galectin-3 between the groups. CONCLUSION: This work for the first time showed a high prevalence of mutations in BRAFV600E in PTC of acromegalic patients superior to those described in the population with PTC in this and previous studies (approximately 40%). However, this mutation was not associated with a more aggressive tumor phenotype, which differs from the findings in acromegalic population without PTC. We conclude that acromegaly is possibly associated to a mutation BRAFV600E in acromegalic patients with CPT. Further studies are needed to define the mechanisms responsible for this association.

Este estudo analisa a expressão dos subtipos de receptores da somatostatina (SSTR) em 39 adenomas secretores de GH. Em 19 pacientes acromegálicos, a resposta clínica, laboratorial e radiológica ao análogo da somatostatina (AS) octreotide-LAR foi comparada à expressão dos SSTR. O SSTR mais freqüentemente expresso foi o SSTR5, seguido pelos SSTR3, SSTR2, SSTR1 e SSTR4. O SSTR1 e SSTR2 foram mais expressos nos pacientes que normalizaram GH e IGF-I. Houve correlação positiva entre o grau de redução tumoral e a expressão dos SSTR1, SSTR2 e SSTR3. Portanto, AS específicos para os SSTR´s poderão contribuir para o tratamento de acromegálicos resistentes aos AS atualmente disponíveis / This study aimed to analyze the expression of somatostatin receptor subtypes (SSTR) in 39 GH-secreting pituitary adenomas. In 19 acromegalics the clinical, laboratorial and radiological responses to the somatostatin analog (SA) octreotide-LAR were compared to SSTR´s expression. The most expressed SSTR was SSTR5, followed by SSTR3, SSTR2, SSTR1 and SSTR4. SSTR1 and SSTR2 were more expressed in patients who achieved GH and IGF-I normalization. There was a positive correlation between the degree of tumor reduction with SSTR1, SSTR2 and SSTR3 expression. Therefore, the development of specific SA could contribute to treatment improvement in resistant acromegalics patients to available SA

Introdução: A acromegalia é uma doença rara, caracterizada pela produção aumentada de hormônio do crescimento, causada geralmente por um adenoma hipofisário, ocasionando uma série de comorbidades como apneia do sono e resistência insulínica que acarretam um aumento na mortalidade e redução da expectativa de vida. Objetivo: O objetivo deste estudo foi avaliar o impacto da terapêutica da apneia do sono com um dispositivo de pressão positiva contínuas nas vias aéreas (CPAP) e avaliar o impacto desta terapêutica na resistência insulínica pela realização do clamp euglicêmico hiperinsulinêmico (CEH). Pacientes: De 156 acromegálicos regularmente atendidos na unidade de Neuroendocrinologia do HC-FMUSP, foram selecionados 12 indivíduos com apneia do sono de moderada a grave em uso de análogos da somatostatina (AS). Método: Os pacientes foram randomizados em dois grupos com seis integrantes. O grupo A iniciou o tratamento com CPAP, e o grupo B, um adesivo dilatador nasal com efeito de placebo. A avaliação basal incluiu a polissonografia, determinação do GH, IGF-1, HbA1c, ácidos graxos livres, lípides, CEH, bem como os índices de resistência periférica à insulina (HOMA, HOMA2 e QUICKI). Após 3 meses de tratamento, os pacientes foram reavaliados pelos mesmos exames, sendo trocado o tratamento entre os grupos e feita nova avaliação, após mais 90 dias. Resultados: Analisando os resultados finais de todos os pacientes que fizeram uso do CPAP, foi observada uma redução significante na resistência periférica à insulina, verificada pelo índice de sensibilidade derivado do clamp (ISCLAMP, pré e pós- CPAP, 3,83 versus 6,11, p=0,032). Esta redução não foi observada no grupo que fez uso do adesivo nasal (ISCLAMP, pré e pós-adesivo, 5,53 versus 5,19, p=0,455). Não houve diferença significante nos níveis de lípides, HbA1c nem nos índices de resistência periférica à insulina. Conclusão: O tratamento da apneia do sono moderada a grave com CPAP, em pacientes acromegálicos em uso de AS, levou a uma redução da resistência periférica à insulina aferida pelo CEH, dado não observado por meio dos índices HOMA, HOMA2 e QUICKI / Introduction. Acromegaly is a rare disease, characterized by the production of high GH levels usually by pituitary adenoma leading to comorbidities as sleep apnea and insulin resistance, bringing increase of mortality and life span reduction. Objective: This study aims to assess the impact of treatment of sleep apnea with a continuous positive air pressure device (CPAP) on the insulin resistance by performing the hyperinsulinemic euglycemic clamp (HEC). Patients: From 156 acromegalic patients regularly attended on Neuroendocrine Unit of the Hospital das Clínicas, University of São Paulo Medical School, 12 subjects on somatostatin analogs (SA) harboring moderate to severe sleep apnea were selected. Methods: Patients were randomized in two groups of six subjects. Group A started treatment with CPAP while group B started treatment using a nasal dilator adhesive with placebo effect. Basal assessment included polysomnography, determination of GH, IGF-1, HbA1c, free fat acids, lipids assays, HEC as well as insulin resistance indexes (HOMA, HOMA2 and QUICKI). Patients were reevaluated after three months of treatment by the same tests and then the treatment was switched between groups with new assessment 90 days later. Results: A significant reduction on insulin resistance determined by the clamp derived sensibility index was observed after assessing the final data of all patients on CPAP (SICLAMP, pre and post CPAP, 3,83 versus 6,11, p=0,032). This reduction was not seen in the nasal dilator adhesive group (SICLAMP, pre and post adhesive, 5,53 versus 5,19, p=0,455). There was no significant difference on lipids, HbA1c or on peripheral insulin resistance indexes. Conclusion: CPAP treatment of acromegalic patients on AS with moderate to severe sleep apnea leaded to significant reduction on peripheral insulin resistance assessed by the HEC. HOMA, HOMA2 and QUICK did not detect this data

No description available.

No description available.

Le terme « cément » est utilisé pour désigner l’ensemble des tissus conjonctifs minéralisés retrouvés sur la surface externe de la racine d’une dent ainsi que sur certaines zones de l’émail ou au niveau du foramen apical. Il appartient à deux unités fonctionnelles : la dent et le parodonte et constitue avec l’os alvéolaire un point d’attache essentiel du ligament alvéolo-dentaire. Dans certaines conditions non encore élucidées la synthèse de l’une de ses variétés, le cément cellulaire mixte stratifié, est excessive, elle dépasse la « normalité » : il s’agit d’une hypercémentose. Une revue critique de la littérature nous a permis de mettre en évidence un certain nombre de problématiques concernant sa définition, sa classification, sa fréquence, ses étiologies et certaines de ses caractéristiques anatomiques. Afin d’y répondre nous avons élaboré un protocole d’étude dont le matériel comprenait trois séries d’Hommes sub-actuels (675 individus ; 8861 dents dont 419 hypercémentosées) et dont les méthodes ont fait appel à la photographie, la radiographie, la stéréomicroscopie, la microscopie électronique à balayage et l’histologie. Au terme de notre étude nous avons mis au point une définition et une classification de l’hypercémentose reposant sur des critères reproductibles, nous avons évalué sa fréquence au sein de grands échantillons et déterminé ses principales étiologies (éruption continue liée à la perte des dents antagonistes, parodontite apicale, atteintes parodontales, inclusion dentaire, pathologies générales, syndromes génétiques, hérédité, idiopathie). Nous avons également fourni certaines données inédites concernant les épaisseurs du cément hyperplasique et l’anatomie des foramens apicaux. Nos résultats ont enfin été appliqué à un certain nombre de dents néandertaliennes ce qui nous a permis de reconsidérer l’hypothèse selon laquelle l’importance des contraintes occlusales au sein de ce taxon est la cause principale des hypercémentoses. / The term "cement" is used to refer to all mineralised connective tissue found on the external surface of the root of a tooth and also on certain areas of the enamel or around the apical foramen. It pertains to two functional units, the tooth and the periodontium, and together with the alveolar bone forms an essential point of attachment for the periodontal ligament. In certain conditions that have still to be clarified, synthesis of one variety of cement, cellular mixed stratified cementum, is excessive, going beyond "normal" levels: this is hypercementosis. From a review of the literature, we identified a certain number of questions relating to the definition, classification, frequency, and etiologies of this term, and also to some of its anatomical characteristics. To find answers to these questions, we set up a study protocol on material consisting of three series of modern Humans (675 individuals; 8,861 teeth, 419 with hypercementosis), using photography, radiography, stereomicroscopy, scanning electron microscopy and histology techniques. From this we were able to produce a definition and a classification of hypercementosis based on reproducible criteria, we assessed frequency using a large set of samples and determined the main etiologies (continuous eruption associated with the loss of opposing teeth, apical periodontitis, periodontal injuries, dental inclusion, general pathologies, genetic syndromes, heredity, idiopathy). We were also able to provide new data on hyperplastic cement thicknesses and the anatomy of apical foramens. Finally, our results were applied to a number of Neanderthal teeth, which led us to reconsider the hypothesis according to which the importance of occlusal stress in this taxon is the main cause of hypercementosis.

Die Akromegalie - Folge eines Wachstumshormon (STH) sezernierenden Hypophysentumors - ist eine seltene Erkrankung. Bei früher Diagnose ist die Akromegalie gut behandelbar. Unbehandelt - oder zu spät behandelt - führt sie zu hoher Co-Morbidität und verkürzt das Leben. Endokrinologische Therapieziele wurden kürzlich definiert: Heilung bei STH / Acromegaly, caused by a growth hormone (GH)-secreting pituitary adenoma, is a rare disease. If diagnosed early therapeutic results are good. However, untreated or treated belatedly, acromegaly is associated with a high co-morbidity and reduced life-expectancy. The therapeutic goals have recently been defined as follows: complete remission or cure as GH

GH and IGF-1 play an important role in the regulation of metabolism and body composition. In patients with uncontrolled acromegaly, cardiovascular morbidity and mortality are increased but are supposed to be normalised after biochemical control is achieved. We aimed at comparing body composition and the cardiovascular risk profile in patients with controlled acromegaly and controls. A cross-sectional study. We evaluated anthropometric parameters (height, weight, body mass index (BMI), waist and hip circumference, waist to height ratio) and, additionally, cardiovascular risk biomarkers (fasting plasma glucose, HbA1c, triglycerides, total cholesterol, HDL, LDL, and lipoprotein (a), in 81 acromegalic patients (58% cured) compared to 320 age- and gender-matched controls (ratio 1:4), sampled from the primary care patient cohort DETECT. The whole group of 81 acromegalic patients presented with significantly higher anthropometric parameters, such as weight, BMI, waist and hip circumference, but with more favourable cardiovascular risk biomarkers, such as fasting plasma glucose, total cholesterol, triglycerides and HDL levels, in comparison to their respective controls. Biochemically controlled acromegalic patients again showed significantly higher measurements of obesity, mainly visceral adiposity, than age- and gender-matched control patients (BMI 29.5 ± 5.9 vs. 27.3 ± 5.8 kg/m2; P = 0.020; waist circumference 100.9 ± 16.8 vs. 94.8 ± 15.5 cm; P = 0.031; hip circumference 110.7 ± 9.9 vs. 105.0 ± 11.7 cm; P = 0.001). No differences in the classical cardiovascular biomarkers were detected except for fasting plasma glucose and triglycerides. This effect could not be attributed to a higher prevalence of type 2 diabetes mellitus in the acromegalic patient group, since stratified analyses between the subgroup of patients with acromegaly and controls, both with type 2 diabetes mellitus, revealed that there were no significant differences in the anthropometric measurements. Biochemically cured acromegalic patients pertain an adverse anthropometric risk profile, mainly because of elevated adiposity measurements, such as BMI, waist and hip circumference, compared to an age- and gender-matched primary care population.