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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
41

Polimorfismos dos genes dos receptores de dopamina D2 e de somatostatina subtipos 2 e 5 e resposta ao tratamento medicamentoso de pacientes portadores de adenomas hipofisários / The influence of dopamine receptor type 2 and somatostatin receptors type 2 and 5 polymorphisms in medical treatment of pituitary adenomas

Cristina Bellotti Formiga Bueno 04 November 2016 (has links)
Os adenomas hipofisários podem ser tratados clinicamente com agonistas dopaminérgicos (AD) e/ou ligantes dos receptores de somatostatina (LRS). Alguns estudos apontam para o papel de polimorfismos dos genes DRD2, SSTR2 e SSTR5 na eficácia desses tratamentos clínicos. O objetivo do estudo foi avaliar o papel dos polimorfismos no gene DRD2 em pacientes com prolactinomas (n=118), corticotrofinomas (n=15), adenomas clinicamente não funcionantes (ACNF) (n=35) e somatotrofinomas (n=40), bem como de polimorfismos nos genes SSTR2 e SSTR5 em pacientes com somatotrofinomas (n=88), na resposta ao tratamento clínico com AD e LRS. Adicionalmente, comparar a frequência desses polimorfismos em pacientes portadores de adenomas hipofisários, de diferentes naturezas, a indivíduos saudáveis. Os polimorfismos foram genotipados por PCR em tempo real (sistema TaqMan) e seqüenciamento automático (método Sanger). Todos os genótipos estavam em equilíbrio de Hardy-Weinberg. Em nosso estudo, não houve correlação entre os polimorfismos de DRD2, SSTR2 e SSTR5 e a resposta ao tratamento clínico, com cabergolina (CAB) e/ou octreotida-LAR (OCT-LAR) respectivamente, em pacientes com prolactinomas, somatotrofinomas e corticotrofinomas. Nossos dados estão de acordo com estudos prévios em acromegálicos, no entanto não confirmaram associação de polimorfismo de DRD2 (rs6275) com resistência à CAB, anteriormente descrita em prolactinomas. Adicionalmente, os polimorfismos rs1800497 (alelo T) e rs1076560 (alelo A) de DRD2 foram correlacionados a macroadenomas, este último fator preditivo de resistência à CAB em prolactinomas. Quanto aos ACNF, nossos dados são inéditos e o polimorfismo rs6275 (alelo T) de DRD2 se correlacionou à progressão tumoral nos casos tratados com CAB. Comparando os adenomas hipofisários com indivíduos saudáveis, a presença do alelo raro A de rs1079597 de DRD2 foi inversamente associada à frequência de ACNF, enquanto que nos outros tipos tumorais não houve diferença. Em conclusão, os polimorfismos rs1079597 e rs6275 de DRD2 podem estar associados à tumorigênese e à resposta a CAB, no grupo ACNF respectivamente. Outros estudos ainda são necessários para definir o papel das variantes genéticas desses genes como um mecanismo envolvido na resistência aos AD e LRS e na tumorigênese hipofisária / Medical treatment of pituitary adenomas is mainly performed with dopamine agonist (DA) and/or somatostatin ligant receptor (SLR) drugs. In addition to dopamine receptor 2 (DRD2) and somatostatin receptors 2 and 5 (SSTR2 and SSTR5) tumor density, results of some studies pointed to the role of polymorphisms in the efficacy of clinical treatment. One of the goals of this study was to evaluate the association between DRD2 polymorphisms in patients with prolactinomas (n=118), corticotrophinomas (n=15), clinically nonfunctioning pituitary adenomas (CNFPA) (n=35) and somatotrophinoma (n=101) and polymorphisms in STTR2 and SSTR5, only in the last group; and response to treatment with DA and/or SLR. Another objective was to evaluate the frequency of polymorphisms in patients with different types of pituitary adenomas and compare them to healthy subjects. Polymorphisms were genotyped by real-time PCR (TaqMan system) and Sanger sequencing. All genotypes were in Hardy-Weinberg equilibrium. In patients with prolactinomas, somatotrophinomas and corticotrophinomas there was no association between genetic variants in DRD2 and response to treatment, like data in literature. However, an association between rs6275 (allele T) in DRD2 and CAB resistance in prolactinomas has been proposed. In addition, there was an association betweenrs1800497 (allele T) and rs1076560 (alelle A) in DRD2 and macroprolactinomas, this one predictive factor related to CAB resistance. The presence of rs6275 (allele T) in DRD2 was correlated with tumoral progression in CNFPA treated with CAB, never published previously. Comparing pituitary adenomas and health subjects, the presence of rs1079597 (allele A) was inversely associated with the frequency of CNFPA, otherwise there was no association for others pituitary adenomas. In conclusion, rs1079597 and rs6275 DRD2 polymorphisms might have an influence in tumorigenesis and CAB efficacy in patients with CNFPA, respectively. However, the results in the literature are conflicting and more studies are necessary to determine the role of these genetic variants like a mechanism involving in dopamine and somatostatin resistance and pituitary tumorigenesis

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