453 research outputs found
Controle da artrite encefalite caprina através do uso de tecnologias reprodutivas aplicadas às fêmeas.
No full text[ALICE ANDRIOLI PINHEIRO
Elastographic presentation of synchronous renal cell carcinoma metastasis to the thyroid gland
No full textSynchronous metastasis of renal cell carcinoma (RCC) are extremely uncommon with only few sporadic cases published in the literature and data on their elastographic appearance are lacking. Here we described a case of woman with multinodular goiter bearing a RCC metastasis, in which exhaustive ultrasonographic and qualitative elastographic evaluation were performed. The metastatic lesion presented some suspicious ultrasonographic features but was mainly "soft" at qualitative elastographic evaluation, suggesting that RCC metastasis may represent a possible pitfall for the qualitative elastographic evaluation of thyroid nodules
Elastographic techniques of thyroid gland : current status
No full textThyroid nodules are very common with malignancies accounting for about 5 %. Fine-needle biopsy is the most accurate test for thyroid cancer diagnosis. Elastography, a new technology directly evaluating the elastic property of the tissue, has been recently added to the diagnostic armamentarium of the endocrinologists as noninvasive predictor of thyroid malignancy. In this paper, we critically reviewed characteristics and applications of elastographic methods in thyroid gland. Elastographic techniques can be classified on the basis of the following: source-of-tissue compression (free-hand, carotid vibration, ultrasound pulses), processing time (real-time, off-line), stiffness expression (qualitative, semi-quantitative, or quantitative). Acoustic radiation force impulse and aixplorer shear wave are the newest and most promising quantitative elastographic methods. Primary application of elastography is the detection of nodular lesions suspicious for malignancy. Published data show a high sensitivity and negative predictive value of the technique. Insufficient data are available on the possible application of elastography in the differential diagnosis of indeterminate lesions and in thyroiditis. Elastography represents a noninvasive tool able to increase the performance of ultrasound in the selection of thyroid nodules at higher risk of malignancy. Some technical improvements and definition of more robust quantitative diagnostic criteria are required for assigning a definite role in the management of thyroid nodules and thyroiditis to elastography
NODULI TIROIDEI NELL'ACROMEGALIA: RUOLO DELL'ELASTOSONOGRAFIA
No full textObjective: Ultrasound-elastography (US-E) appears to be a helpful tool for the diagnosis of thyroid cancer. In acromegaly multinodular goiter is a common occurrence while the prevalence of thyroid cancer is still debated. Aims were to evaluate thyroid nodules in acromegaly and to establish the accuracy of US-E in providing information on their nature, using cytological analysis as a reference.
Subjects and Methods: US-E was applied to 90 nodules detected in 25 acromegalic patients and to 94 nodules found in 31 non acromegalic goitrous subjects. The lesions were classified according to the elastographic scores (ES) as soft (ES 1-2) or hard (ES 3-4). FNAC could be performed in 60.8% of hard nodules in acromegalic patients and in 86.7% of hard nodules in controls.
Results: The prevalence of hard nodules in patients with active acromegaly (68.9%) was greater, though not to a statistically significant extent, than that observed in cured (44.4%) and controlled (52.5%) patients. Citology revealed malignancy or suspect malignancy in none of the nodules of acromegalic patients.
Conclusions: This study has demonstrated a high prevalence of stiff thyroid nodules in acromegaly, greater than that found in non acromegalic goitrous subjects. Such nodules, appeared not to be malignant and are probably of fibrous nature. Thus, US-E appears to be of limited value for the diagnosis of thyroid cancer in acromegaly
Standardized ultrasound report for thyroid nodules : the endocrinologist's viewpoint
No full textBACKGROUND:
Ultrasonography (US) plays a crucial role in the diagnostic management of thyroid nodules, but its widespread use in clinical practice might generate heterogeneity in ultrasound reports.
OBJECTIVES:
The aims of the study were to propose (a) a standardized lexicon for description of thyroid nodules in order to reduce US reports of interobserver variability and (b) a US classification system of suspicion for thyroid nodules in order to promote a uniform management of thyroid nodules.
METHODS:
RELEVANT PUBLISHED ARTICLES WERE IDENTIFIED BY SEARCHING MEDLINE AT PUBMED COMBINING THE FOLLOWING SEARCH TERMS: ultrasonography, thyroid, nodule, malignancy, carcinoma, and classification system. Results were supplemented with our data and experience.
RESULTS:
A STANDARDIZED US REPORT SHOULD ALWAYS DOCUMENT POSITION, EXTRACAPSULAR RELATIONSHIPS, NUMBER, AND THE FOLLOWING CHARACTERISTICS OF EACH THYROID LESION: shape, internal content, echogenicity, echotexture, presence of calcifications, margins, vascularity, and size. Combining the previous US features, each thyroid nodule can be tentatively classified as: malignant, suspicious for malignancy, borderline, probably benign, and benign.
CONCLUSIONS:
We propose a standardized US report and a tentative US classification system that may become helpful for endocrinologists dealing with thyroid nodules in their clinical practice. The proposed classification does not allow to bypass the required cytological confirmation, but may become useful in identifying the lesions with a lower risk of neoplasm
Isolated corticotrophin deficiency
No full textIsolated ACTH deficiency (IAD) is a rare disorder, characterized by secondary adrenal insufficiency (AI) with low or absent cortisol production, normal secretion of pituitary hormones other than ACTH and the absence of structural pituitary defects. In adults, IAD may appear after a traumatic injury or a lymphocytic hypophysitis, the latter possibly due to autoimmune etiology. Conversely, a genetic origin may come into play in neonatal or childhood IAD. Patients with IAD usually fare relatively well during unstressed periods until intervening events spark off an acute adrenal crisis presenting with non specific symptoms, such as asthenia, anorexia, unintentional weight loss and tendency towards hypoglycemia. Blood chemistry may reveal mild hypoglycemia, hyponatremia and normal-high potassium levels, mild anemia, lymphocytosis and eosinophilia. Morning serum cortisol below 3 μg/dl are virtually diagnostic for adrenal insufficiency. whereas cortisol values comprised between 5-18 μg/dl require additional investigations: insulin tolerance test (ITT) is considered the gold standard but - when contraindicated - high or low dose-ACTH stimulation test with serum cortisol determination provides a viable alternative. Plasma ACTH concentration and prolonged ACTH infusion test are useful in differential diagnosis between primary and secondary adrenal insufficiency. For some patients with mild, near-to-asymptomatic disease, glucocorticoid replacement therapy may not be required except during stressful events; for symptomatic patients, replacement doses i.e., mean daily dose 20 mg (0.30 mg/kg) hydrocortisone or 25 mg (0.35 mg/kg) cortisone acetate, are usually sufficient. Administration of mineralocorticoids is generally not necessary as their production is maintained
Therapy for adrenal insufficiency
No full textAdrenal insufficiency is a rare disorder in which the adrenal cortex fails to secrete sufficient amounts of steroid hormones. All adrenal hormones are affected in primary adrenal insufficiency, whereas only glucocorticoid secretion is deficient in secondary adrenal insufficiency. Low doses of hydrocortisone/cortisone acetate (20 mg and 25 mg daily, respectively) subdivided in thrice-daily administration approach the physiological cortisol profile and resolve clinical features. Clinical assessment is the mainstay for establishing adequacy of corticosteroid replacement therapy as no biochemical/hormonal marker is fully reliable. Glucocorticoid replacement has to be potentiated during stressful events (e.g., surgery, infection, delivery and trauma). Fludrocortisone (0.05 - 0.2 mg daily) is administered in order to normalise blood pressure and potassium levels, aiming for plasma renin activity in the upper normal range. Dehydroepiandrosterone (20 - 50 mg daily) may prove beneficial, but cannot as yet be recommended for routine clinical use
Systemic nickel allergic syndrome as an immune-mediated disease with an increased risk for thyroid autoimmunity
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