tag:blogger.com,1999:blog-6715850398393425022024-03-21T07:25:04.894+02:00Endocrinologie ClujEndocrinologie Cluj - Informatii despre diagnosticarea si tratamentul afectiunilor sistemului endocrin.Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.comBlogger170125tag:blogger.com,1999:blog-671585039839342502.post-13550638139870970312021-01-01T18:57:00.003+02:002021-01-01T19:03:33.541+02:00Sindromul insulinic autoimun<p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyV52zrt8pslE6pPpySFAYiLBTrH8Y7Zzvik0pRGyIuxq-fFiUOQgMTaiL_51J-A1mooDl0wWdK977nubgVSvSg2_I5c3AWdq1r6TE3vKENFCnGuwuZa_Yl_4m-wZS_KUockPB4zRfxfc/s1920/diabetes-528678_1920.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"> <img border="0" data-original-height="1280" data-original-width="1920" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyV52zrt8pslE6pPpySFAYiLBTrH8Y7Zzvik0pRGyIuxq-fFiUOQgMTaiL_51J-A1mooDl0wWdK977nubgVSvSg2_I5c3AWdq1r6TE3vKENFCnGuwuZa_Yl_4m-wZS_KUockPB4zRfxfc/s320/diabetes-528678_1920.jpg" width="320" /></a></div><span style="text-align: left;"><div style="text-align: justify;">Sindromul insulinic autoimun (boala Hirata) este o afectiune extrem de rara, caracterizata prin episoade de <a href="http://www.endocrinopedia.info/2015/07/hipoglicemia-simptome-cauze-diagnostic.html" target="_blank">hipoglicemie</a> determinate de prezenta unui titru inalt de anticorpi antiinsulinici. Astfel, sindromul insulinic autoimun este o forma de hipoglicemie mediata imun declansata de anumiti trigeri (infectii virale, medicamente etc.) pe fondul unei predispozitii genetice. </div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Afectiunea se asociaza cu alte patologii autoimune, precum artrita reumatoida, <a href="http://www.endocrinopedia.info/2015/07/boala-basedow-graves.html" target="_blank">boala Basedow Graves</a>, precum si cu haplotipul HLA DR4. </div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Mecanismul hipoglicemiei este inca incomplet neelucidat, insa interactiunea gruparii sulfhidril cu legatura disulfidica a moleculei de insulina pare a juca un rol important in patogeneza bolii. Astfel, pana in prezent au fost raportate multiple preparate care pot determina hipoglicemie prin acest mecanism, precum metimazolul, procainamida, imipenemul, captoprilul, hidralazina, D-penicilamina si acidul alfa lipoic. </div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Diagnosticul de sindrom insulinic autoimun se stabileste pe baza episoadelor hipoglicemice spontane, asociate cu pozitivarea anticorpilor antiinsulinici, fara un istoric de tratament cu insulina exogena. Profilul hormonal detecteaza un nivel inalt al insulinei (de obicei peste 100 mUI/l) si al peptidului C.</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Tratamenul afectiunii consta intr-un regim alimentar format din mai multe mese pe zi si evitarea preparatelor medicamentoase continand grupari sulfhidril. Tratamentul cu steroizi poate fi folosit la pacientii cu hipoglicemie rezistenta. </div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><span style="font-size: x-small;">Referinte: </span></div><div style="text-align: justify;"><span style="font-size: x-small;">1. Cappellani D, Macchia E, Falorni A, Marchetti P. Insulin Autoimmune Syndrome (Hirata Disease): A Comprehensive Review Fifty Years After Its First Description. Diabetes Metab Syndr Obes. 2020;13:963-978. Published 2020 Apr 1. doi:10.2147/DMSO.S219438</span></div><div style="text-align: justify;"><span style="font-size: x-small;">2. https://www.sciencedirect.com/science/article/pii/S2214624515300058</span></div><div style="text-align: justify;"><span style="font-size: x-small;">sursa foto: https://pixabay.com/photos/diabetes-blood-sugar-diabetic-528678/</span></div><div style="text-align: justify;"><br /></div></span></div></div><p></p>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com2tag:blogger.com,1999:blog-671585039839342502.post-78932435199694783742020-08-01T20:52:00.006+03:002020-08-02T10:49:56.540+03:00Sindromul Cushing: cauze, simptome si tratament<h1 style="text-align: center;"><font size="3" style="font-weight: normal;"><img alt="sindromul cushing" height="390" src="https://i.pinimg.com/originals/a7/23/69/a72369561621fa08b09b57186bdc3005.jpg" title="boala cushing" width="400" /></font></h1><h1 style="text-align: justify;"><font size="3" style="font-weight: normal;">Sindromul Cushing reprezinta un exces de cortizol, asociat sau nu cu excesul de aldosteron si hormoni androgeni suprarenalieni.</font></h1><div><h2 style="text-align: left;"><div style="text-align: justify;"><span style="font-size: medium;">Manifestarile sindromului Cushing <span style="font-weight: normal;">sunt reprezentate de: </span></span></div><ul style="text-align: left;"><li><font size="3" style="font-weight: normal;">obezitate cu distributie la nivelul fetei (determinand aspectul de "luna plina"), gatului si abdomenului, care contrasteaza cu o atrofie musculara a membrelor;</font></li></ul><ul style="text-align: left;"><li><font size="3" style="font-weight: normal;">forta musculara scazuta;</font></li></ul><ul style="text-align: left;"><li><font size="3" style="font-weight: normal;"><span style="text-align: center;">leziuni cutanate: </span>vergeturi rosii sau violacei<span style="text-align: center;"> situate la nivelul abdomenului si radacinii membrelor, echimoze si petesii ce apar</span> la traumatisme minime, acnee, hirsutism, alopecie androgenica la femei (cand se asociaza un exces de hormoni androgeni);</font></li></ul><ul style="text-align: left;"><li><font size="3" style="font-weight: normal;"><span style="text-align: center;">hiperglicemie sau </span><a href="http://www.endocrinopedia.info/search/label/diabet%20zaharat" target="_blank">diabet zaharat</a>;</font></li></ul><ul style="text-align: left;"><li><span style="font-weight: normal; text-align: center;"><font size="3"><a href="http://www.endocrinopedia.info/2015/07/hipertensiunea-arteriala-secundara.html">hipertensiune arteriala</a>;</font></span></li></ul><ul style="text-align: left;"><li><span style="font-weight: normal; text-align: center;"><font size="3">depresie;</font></span></li></ul><ul style="text-align: left;"><li><span style="font-weight: normal; text-align: center;"><font size="3">infectii urinare, infectii respiratorii, infectii cutanate bacteriene sau micotice (onicomicoza);</font></span></li></ul><ul style="text-align: left;"><li><font size="3" style="font-weight: normal;"><span style="text-align: center;">osteopenie sau <a href="http://www.endocrinopedia.info/2015/07/ce-este-osteoporoza.html">osteoporoza</a></span><span style="text-align: center;">, manifestata prin dureri osoase la nivelul coloanei vertebrale, a oaselor lungi, tasari ale corpilor vertebrali;</span></font></li></ul><ul style="text-align: left;"><li><span style="font-weight: normal; text-align: center;"><font size="3">amenoree (menstruatie intarziata mai mult de 3 luni), oligomenoree, infertilitate la femei;</font></span></li></ul><ul style="text-align: left;"><li><font size="3" style="font-weight: normal;">atrofia testiculara<span style="text-align: center;">, libidou scazut, infertilitate si <a href="http://www.endocrinopedia.info/2015/07/ce-este-ginecomastia.html">ginecomastie</a>. </span></font></li></ul></h2><h2 style="text-align: center;"><font size="3"><br /><div style="text-align: justify;">Cauzele sindromului Cushing <span style="font-weight: normal;">includ:</span></div></font><ul><li style="text-align: justify;"><font size="3">dereglarea hipotalamusului (pseudo-Cushing-ul) -</font><font size="3" style="font-weight: normal;"> reprezentata de excesul hormonului eliberator de corticotropina (CRH). Acesta afectiune se manifesta la pacientii cu obezitate morbida, depresie severa, stres psihic cronic sau consum exagerat de alcool;</font></li></ul><ul><li style="text-align: justify;"><font size="3" style="font-weight: normal;">un </font><font size="3">adenom hipofizar secretant de ACTH (boala Cushing)</font><font size="3" style="font-weight: normal;">;</font></li></ul><ul><li style="text-align: justify;"><font size="3" style="font-weight: normal;">diverse </font><font size="3">cancere</font><font size="3" style="font-weight: normal;"> (melanom malign, cancer pulmonar cu celule mici, tumori carcinoide timice, bronsice, pancreatice etc.) care determina o </font><font size="3">secretie paraneoplazica de ACTH</font><font size="3" style="font-weight: normal;">. Aceasta forma de sindrom Cushing este mai frecventa la barbatii cu varsta de peste 40 de ani, manifestandu-se mai frecvent prin hipertensiune arteriala, hipopotasemia si hiperpigmentare cutanata;</font></li></ul><ul><li style="text-align: justify;"><font size="3" style="font-weight: normal;">administrarea tratamentului cronic cu </font><font size="3">glucocorticoizi</font><font size="3" style="font-weight: normal;"> (Dexametazona, Betametazona etc.) - </font><font size="3">sindromul Cushing indus medicamentos sau iatrogen;</font></li></ul><ul><li style="text-align: justify;"><font size="3" style="font-weight: normal;">un a</font><font size="3">denom suprarenalian </font><font size="3" style="font-weight: normal;">- o tumora benigna, de mici dimensiuni care determina o productie exagerata de glucocorticoizi;</font></li></ul><ul><li style="text-align: justify;"><font size="3" style="font-weight: normal;">un </font><font size="3">adenocarcinom suprarenalian</font><font size="3" style="font-weight: normal;"> - o tumora maligna, de mari dimensiuni, intens vascularizata, cu arii de necroza, hemoragii si calcifieri, adesea cu invazie in organele invecinate. </font></li></ul><ul><li style="text-align: justify;"><font size="3">o hiperplazie sau displazie de glande suprarenale:</font></li></ul><ul><ul><li style="text-align: justify;"><font size="3" style="font-weight: normal;">displazia micronodulara pigmentara - o boala genetica determinata de o mutatie a proteinkinazei A, care se manifesta la copii si adolescenti prin exces de cortizol, <a href="http://www.endocrinopedia.info/2019/04/pubertatea-precoce.html" target="_blank">pubertate precoce</a>, schwanoame, mixoame si pete pigmentare;</font></li></ul></ul><ul><ul><li style="text-align: justify;"><font size="3" style="font-weight: normal;">displazia macronodulara, determinata de exprimarea aberanta a unor receptori hormonali (receptorii GIP) la nivelul corticosuprarenalei, fiind caracterizata de hipersecretia de cortizol, dupa ingestia de glucide. </font></li></ul></ul></h2>
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<h3 style="text-align: justify;"><span style="text-align: center;">Diagnosticul de sindrom Cushing<span style="font-weight: normal;"> se stabileste pe baza prezentei manifestarilor clinice expuse anterior, a analizelor biochimice care evidentiaza hipercolesterolemie, hipertrigliceridemie, hiperglicemie, </span></span><span style="font-weight: normal; text-align: center;">cresterea nivelului leucocitelor, neutrofilelor si scaderea limfocitelor si eozinofilelor. Profilul hormonal evidentiaza un cortizol seric de ora 8 crescut, respectiv un cortizol salivar nocturn sau un cortizol liber urinar/24 h crescut. De asemenea, poate fi detectat un nivel crescut al aldosteronului si/sau al hormonilor androgeni suprarenalieni. In cele mai multe cazuri, pentru decelarea exacta a cauzei bolii este necesara </span><span style="font-weight: normal;">determinarea nivelului hormonului adrenocorticotrop (ACTH), efectuarea testelor de</span> <a href="http://www.endocrinopedia.info/2015/07/testul-de-supersie-la-dexametazona.html" style="font-weight: normal; text-align: center;">supresie la dexametazona</a><span style="font-weight: normal; text-align: center;"> si a examinarilor imagistice (ecografie abdominala, computer tomografie abdominala, RMN hipofizar etc). Un nivel crescut al ACTH-ului este sugestiv pentru o boala Cushing, un pseudo-Cushing sau un sindrom Cushing paraneoplazic. Un nivel scazut de ACTH este sugestiv pentru afectarea glandelor suprarenale sau pentru un sindrom Cushing iatrogen. In cazul in care se impune diferentierea dintre boala Cushing si sindromul Cushing paraneoplazic, se recurge la efectuarea cataterizarii de sinusuri pietroase inferioare, cu dozarea gradientului ACTH-ului central/ACTH periferic. Electrocardiograma pune in evidenta un interval scurtat al PQ si ST, cu largirea intervalului QRS, unda T fiind plata sau inversata.</span></h3><div style="text-align: justify;"><span style="text-align: center;"><br /></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdKSscUBONG7uDUCsio2M5coeTIlEY6L8CsexhLj6rQkS9rs4G3m90GPvFD7lgQosCwQTEDbXTNYdupNu6mcA9pFSB0l1mfU6Vca9vQGS-t-z_mBLp_DvUItRO22FLFYajj8MwM0bs9z8/s1600/381629.jpg" style="margin-left: auto; margin-right: auto;"><img alt="" border="0" data-original-height="722" data-original-width="910" height="316" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdKSscUBONG7uDUCsio2M5coeTIlEY6L8CsexhLj6rQkS9rs4G3m90GPvFD7lgQosCwQTEDbXTNYdupNu6mcA9pFSB0l1mfU6Vca9vQGS-t-z_mBLp_DvUItRO22FLFYajj8MwM0bs9z8/s400/381629.jpg" title="adenom suprarenalian" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Aspect de adenom suprarenalian pe computer tomografia abdominala</td></tr>
</tbody></table><h3 style="text-align: left;"><div style="text-align: justify;"><span style="font-weight: normal;"> </span></div><div style="text-align: justify;"><span style="text-align: center;">Tratamentul sindromului Cushing</span><span style="font-weight: normal; text-align: center;"> depinde de cauza acestuia, urmarindu-se normalizarea nivelului cortizolului in vederea eliminarii simptomatologiei si tratarea complicatiilor. </span></div><span style="text-align: center;"><div style="text-align: justify;"><span style="font-weight: normal;">De prima intentie, se prefera tratamentul chirurgical (interventie chirurgicala a adenoamelor suprarenaliene sau hipofizare implicate in producerea bolii). De asemenea, se recomanda extirparea tumorilor producatoare de substante ACTH-like, implicate in producerea sindromului Cushing paraneoplazic. In cazul persistentei sau recurentei bolii Cushing, dupa interventia chirurgicala, se poate recomanda <a href="http://www.endocrinopedia.info/2015/07/radiochirurgia-gamma-knife.html">radioterapia gamma knife</a>. Tratamentul medicamentos este unul adjuvant, folosindu-se, in principiu, pentru pregatirea preoperatorie sau ca terapie in asteptarea raspunsului radioterapiei. Preparatele medicamentoase care reusesc sa inhibe secretia de cortizol sunt reprezentate de (levo)ketoconazol, metyrapone, pasireotide, cabergolina, mifepristona, etomidat, mitotane, aminoglutetimida, gefitinib, osilodrostat etc. De asemenea, se recomanda tratamentul complicatiilor: hipolipemiante, antihipertensive, antidiabetice, tratamentul osteoporozei si al depresiei</span></div></span></h3>
<font size="2"><span><span style="text-align: center;">sursa foto: </span></span><a href="https://ro.pinterest.com/pin/327496204125381620/">https://ro.pinterest.com/pin/327496204125381620/</a></font></div>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-19507553154369838792020-05-16T12:38:00.001+03:002020-05-17T12:37:21.867+03:00Sistemul Bethesda - interpretarea citopatologiei tiroidiene<div style="text-align: justify;">
Clasificarea Bethesda reprezinta sistemul validat international pentru interpretarea materialului recoltat prin punctia aspirativa cu ac fin, cunoscut sub denumirea de citologie tiroidiana. </div>
<div style="text-align: justify;">
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<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.95pt;" valign="top" width="281"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Clasa
Bethesda<o:p></o:p></span></b></div>
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<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.2pt;" valign="top" width="236"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Semnificaţie<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 73.95pt;" valign="top" width="99"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Risc
de malignitate<o:p></o:p></span></b></div>
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</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.95pt;" valign="top" width="281"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">I<span style="mso-spacerun: yes;"> </span>Frotiu<span style="mso-spacerun: yes;">
</span>neconcludent prin<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>celularitate insuficienta<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.2pt;" valign="top" width="236"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">frotiu neinterpretabil sau leziune
chistica<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 73.95pt;" valign="top" width="99"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">1-4%<o:p></o:p></span></div>
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</tr>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.95pt;" valign="top" width="281"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">II<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>Frotiu benign<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.2pt;" valign="top" width="236"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">leziune benigna (nodul folicular tiroidian benign, <a href="http://www.endocrinopedia.info/2015/07/tiroidita-hashimoto-tiroidita-autoimuna.html">tiroidita cronica autoimuna</a>, <a href="http://www.endocrinopedia.info/2015/07/tiroidita-subacuta-de-quervain.html">tiroidita subacuta</a>)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 73.95pt;" valign="top" width="99"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">0-3%<o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.95pt;" valign="top" width="281"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">III<span style="mso-spacerun: yes;"> </span>Frotiu cu atipii cu semnificatie<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>neclara sau leziune foliculara cu <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>semnificatie incerta<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.2pt;" valign="top" width="236"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">leziune folicularã suspecta<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 73.95pt;" valign="top" width="99"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">5-15%<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.95pt;" valign="top" width="281"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">IV<span style="mso-spacerun: yes;"> </span>Frotiu cu aspect cert de neoplasm<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>folicular sau aspect suspect de <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>neoplasm folicular/celule Huthle<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.2pt;" valign="top" width="236"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">carcinom folicular sau suspiciune de
carcinom folicular<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 73.95pt;" valign="top" width="99"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">15-30%<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.95pt;" valign="top" width="281"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">V<span style="mso-spacerun: yes;"> </span>Frotiu cu aspect suspectat de <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>carcinom papilar, medular, <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>anaplazic, limfom<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.2pt;" valign="top" width="236"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">suspiciune de malignitate<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 73.95pt;" valign="top" width="99"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">60-75%<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.95pt;" valign="top" width="281"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">VI<span style="mso-spacerun: yes;"> </span>Frotiu malign<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.2pt;" valign="top" width="236"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">malignitate (carcinom papilar, medular, slab diferentiat, anaplazic, carcinom cu celule scuamoase, limfom etc.)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 73.95pt;" valign="top" width="99"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">97-99%<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div style="text-align: center;">
<br />
<div style="text-align: left;">
<b>Care este abordarea terapeutica in functie de clasificarea Bethesda?</b></div>
<div style="text-align: left;">
<b><br /></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.pathologyoutlines.com/imgau/thyroidfollicularjiang01.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://www.pathologyoutlines.com/imgau/thyroidfollicularjiang01.jpg" height="313" style="text-align: center;" width="400" /></a></div>
<div style="text-align: justify;">
In cazul identificarii claselor Bethesda I si III se recomanda repetarea punctiei aspirative cu ac fin. Pentru formatiunile tiroidiene incadrate in clasa Bethesda II se recomanda monitorizare clinica. Pentru formatiunile tiroidiene incadrate in clasa Bethesda IV se recomanda efectuarea lobectomiei (extirparea lobului tiroidian afectat). Pentru formatiunile tiroidiene incadrate in clasa Bethesda V se recomanda <a href="http://www.endocrinopedia.info/search/label/tratamente">tiroidectomia</a> cvasi-totala sau lobectomia. Pentru formatiunile tiroidiene incadrate in clasa Bethesda VI se recomanda tiroidectomia cvasi-totala. </div>
<div style="text-align: justify;">
<span style="font-size: x-small; text-align: left;"><br /></span>
<span style="font-size: x-small; text-align: left;">sursa foto: </span><a href="http://www.pathologyoutlines.com/topic/thyroidfollicular.html" style="font-size: small; text-align: center;">http://www.pathologyoutlines.com/topic/thyroidfollicular.html</a></div>
</div>
Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-55986274299208985922020-05-09T13:21:00.001+03:002021-01-30T01:04:08.020+02:00Timusul ectopic<div class="separator" style="clear: both; text-align: center;">
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<div style="margin-left: 1em; margin-right: 1em;">
</div>
<div style="text-align: justify;">
<a href="http://www.endocrinopedia.info/2015/07/ce-este-timusul-si-ce-rol-are.html"></a><div class="separator" style="clear: both; text-align: center;"><a href="http://www.endocrinopedia.info/2015/07/ce-este-timusul-si-ce-rol-are.html"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi11BG4_LOhbL8aRaG-ObR43jOMlU19lLccXrWVmxXotgZS5JiIXI1ZT27cEevxZ6FHBzYN0A1fHAW425ICYiQoktXG5A7hAs9vvX5FN7zm__lx-gzW6Ay1jI-s3LX-yFarO70w3FnnZx8/" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="timus ectopic" data-original-height="768" data-original-width="625" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi11BG4_LOhbL8aRaG-ObR43jOMlU19lLccXrWVmxXotgZS5JiIXI1ZT27cEevxZ6FHBzYN0A1fHAW425ICYiQoktXG5A7hAs9vvX5FN7zm__lx-gzW6Ay1jI-s3LX-yFarO70w3FnnZx8/w260-h320/image.png" width="260" /></a></div>Timusul ectopic reprezinta localizarea anormala a acestei glande, alta decat cea fiziologica, de la nivelul mediastinului. Afectiunea este mai frecventa in randul copiilor si se datoreaza unui deficit de migrare a timusului in perioada embrionara, fiind adesea asimptomatica si diagnosticata incidental. In situatii rare, timusul ectopic poate determina stridor, disfagie sau dispnee. Cea mai frecventa pozitionare anormala a timusului este cea intratiroidiana. Examenul obiectiv poate detecta prezenta unei formatiuni nodulare, nedureroase, la nivelul regiunii cervicale anterioare. </div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;"><br />
Aspectul ecografic al timusului intratiroidian este reprezentat de o leziune hipoecogena, bine delimitata, cu multiple puncte ecogene in interior care se aseamana cu calcificarile specifice cancerului tiroidian. RMN-ul cervical evidentiaza timusul ectopic sub forma unei formatiuni omogene, cu izo-/hipersemnal in secventa T1 si hipo-/izosemnal in secventa T2. In cazul in care timusul ectopic este dificil de diagnosticat, se poate efectua rezectia chirurgicala si analiza aspectul histopatologic al acestuia. Rezectia chirurgicala a timusului ectopic se mai poate recomanda si in cazul in care pacientul prezinta semne de compresiune traheala (stridor, dispnee) sau esofagiana (disfagie). In cazul in care diagnosticul se poate stabili pe baza ecografiei/RMN-ului cervical, timusul ectopic se poate trata conservator, adoptand abordarea "wait and see".</div>
<br />
<span style="font-size: x-small;">sursa foto: https://epos.myesr.org/posterimage/esr/ecr2015/128808/media/623669</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-15004989302553625272020-05-01T16:47:00.000+03:002020-05-01T18:13:45.259+03:00Pubertatea intarziata<br />
<div style="text-align: justify;">
<a href="http://www.bebelu.ro/wp-content/uploads/2013/04/copil-300x187.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="pubertate tardiva" border="0" src="http://www.bebelu.ro/wp-content/uploads/2013/04/copil-300x187.jpg" title="pubertate intarziata" /></a><b>Pubertatea intarziata</b> reprezinta lipsa dezvoltarii glandei mamare pana la varsta de 13 ani la fetite, respectiv lipsa dezvoltarii volumului testicular pana la vartsa de 14 ani la baieti. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Pubertatea intarziata poate fi clasificata in doua forme:</div>
<div style="text-align: justify;">
</div>
<ul>
<li style="text-align: justify;"><b>retard pubertar de cauza centrala (hipogonadism hipogonadotrop);</b></li>
<li style="text-align: justify;"><b>retard pubertar de cauza perferica (hipogonadism hipergonadotrop).</b></li>
</ul>
<div style="text-align: justify;">
<b><br /></b></div>
<div style="text-align: justify;">
<b>Retardul pubertar de cauza centrala </b>se datoreaza urmatoarelor entitati:</div>
<div>
<ul>
<li style="text-align: justify;">retard constitutional de crestere si dezvoltare pubertara</li>
<li style="text-align: justify;">hipogonadism hipogonadotrop: </li>
<ul>
<li style="text-align: justify;"><a href="http://www.endocrinopedia.info/2016/01/sindromul-kallmann-de-morsier.html">sdr Kallmann</a> - deficit de GnRH asociat cu anosmie (lipsa mirosului);</li>
<li style="text-align: justify;">hipogonadism hipogonadotrop idiopatic - deficit de GnRH fara anosmie;</li>
<li style="text-align: justify;">deficit izolat de LH (sindromul eunucilor fertili) sau FSH;</li>
<li style="text-align: justify;">sindroame genetice: <a href="http://www.endocrinopedia.info/2015/07/sindromul-prader-willi.html">sindromul Prader Willi</a>, <a href="http://www.endocrinopedia.info/2015/07/sindromul-laurence-moon-bardet-biedl.html">sindromul Laurence-Moon-Bardet-Biedl</a>, sindromul Charge;</li>
<li style="text-align: justify;"><a href="http://www.endocrinopedia.info/2015/07/insuficienta-hipofizara-adultului.html">panhipopituitarism </a>(traumatisme, infectii, inflamatii, postiradiere, postchirurgie);</li>
<li style="text-align: justify;">malformatii ale sistemului nervos central: <a href="http://www.endocrinopedia.info/2015/07/empty-sella-sau-sindromul-de-sa.html">empty sella</a>, displazia opto-chiasmatica, holoprozencefalia;</li>
<li style="text-align: justify;">tumori cerebrale (mai frecvente la baieti): <a href="http://www.endocrinopedia.info/2015/07/ce-este-craniofaringiomul.html">craniofaringiom</a>, adenom, germinom, astrocitom, meningiom;</li>
<li style="text-align: justify;">traumatisme cerebrale; </li>
<li style="text-align: justify;">infectii cerebrale;</li>
<li style="text-align: justify;"><a href="http://www.endocrinopedia.info/2016/07/apoplexia-hipofizara.html">apoplexie hipofizara</a>;</li>
<li style="text-align: justify;">boli infiltrative: histiocitoza, hemocromatoza, granulomatoza, tuberculoza;</li>
<li style="text-align: justify;">chimioterapie;</li>
<li style="text-align: justify;">radioterapie;</li>
<li style="text-align: justify;">droguri (marijuana);</li>
<li style="text-align: justify;">alte cauze: boli cronice in copilarie: talasemie, <a href="http://www.endocrinopedia.info/2015/07/anorexia-nervoasa-teama-de-manca.html">anorexie</a>, deficit ponderal sever/obezitate morbida, boli inflamatorii intestinale, boala celiaca, artrita reumatoida, fibroza chistica, SIDA, astm bronsic, <a href="http://www.endocrinopedia.info/2015/07/hipotiroidismul-congenital-mixedemul.html">hipotiroidism</a>, <a href="http://www.endocrinopedia.info/2017/09/deficitul-de-hormon-de-crestere.html">deficit de hormon de crestere</a>, <a href="http://www.endocrinopedia.info/2015/07/cum-se-manifesta-sindromul-cushing.html">boalã Cushing</a>, <a href="http://www.endocrinopedia.info/search/label/diabet%20zaharat">diabet zaharat</a>,<a href="http://www.endocrinopedia.info/2015/07/prolactinomul-si-hiperprolactinemia.html"> hiperprolactinemie</a>;</li>
<li style="text-align: justify;">exercitiu fizic intens;</li>
<li style="text-align: justify;">stres emotional.</li>
</ul>
</ul>
<div style="text-align: justify;">
<b><br /></b></div>
<div style="text-align: justify;">
<b>Retardul pubertar de cauza periferica</b> se datoreaza urmatoarelor entitati: </div>
<div>
<ul>
<li style="text-align: justify;"><a href="http://www.endocrinopedia.info/2015/07/ce-este-sindromul-turner.html">sindrom Turner</a>; </li>
<li style="text-align: justify;"><a href="http://www.endocrinopedia.info/2015/07/ce-este-sindromul-klinefelter.html">sindrom Klinefelter</a>; </li>
<li style="text-align: justify;">disgenezie gonadala cu cariotip 46, XX;</li>
<li style="text-align: justify;">disgenezie gonadala 46, XY (sdr Swyer);</li>
<li style="text-align: justify;">tulburari de diferentiere sexuala: </li>
<ul>
<li style="text-align: justify;">deficit de 5α reductaza; </li>
<li style="text-align: justify;">deficite in sinteza hormonilor steroizi (deficit de 17 α-hidroxilaza, 17-20-liaza si 3β-hidroxisteoiddehidrogenaza); </li>
<li style="text-align: justify;"><a href="http://www.endocrinopedia.info/2017/09/sindromul-testiulul-feminizant.html">sindromul de insensibilitate de androgeni</a>. </li>
</ul>
<li style="text-align: justify;">agenezia celulelor Leydig/defect de receptor al LH; </li>
<li style="text-align: justify;">anorhidie sau <a href="http://www.endocrinopedia.info/2015/07/ce-este-criptorhidia.html">criptorhidie</a>;</li>
<li style="text-align: justify;">sindromul ovarelor rezistente; </li>
<li style="text-align: justify;">boli metabolice: galactozemie, cistinoza;</li>
<li style="text-align: justify;">sindroame genetice: </li>
<ul>
<li style="text-align: justify;"><a href="http://www.endocrinopedia.info/2018/06/sindromul-noonan.html">sindrom Noonan</a>; </li>
<li style="text-align: justify;">sindrom Down; </li>
<li style="text-align: justify;">distrofia miotonicã Steinert; </li>
<li style="text-align: justify;">sindrom Louis-Barr; </li>
<li style="text-align: justify;">sindom Robinow.</li>
</ul>
<li style="text-align: justify;">afectiuni dobandite: insuficienta gonadica autoimuna, postinfectioasa, iatrogena (radioterapie, citostatice, postchirurgie). </li>
</ul>
<b style="text-align: justify;"><b><br /></b></b>
<b style="text-align: justify;"><b>Care este tabloul clinic al pubertatii intarziate?</b> </b><b></b><br />
<b>
</b></div>
<div style="text-align: justify;">
Tabloul clinic al pubertatii intarziate consta in lipsa de dezvoltare a caracterelor sexuale secundare, asociata cu un retard statural si de maturare osoasa. Retardul constitutional de crestere si dezvoltare pubertara afecteaza de obicei baietii care au un istoric familial de intarziere pubertara. In acest caz, debutul pubertatii survine spontan la atingerea varstei osoase corespunzatoare, iar talia finala va fi normala. Alte manifestari specifice se pot asocia in functie de etiologia pubertatii intarziate. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<b>Diagnosticul de pubertate intarziata</b> se bazeaza pe: </div>
<div style="text-align: justify;">
<ul>
<li><b>tabloul clinic</b> expus anterior; </li>
<li><b>profilul hormonal:</b> </li>
<ul>
<li>FSH, LH, testosteron (baieti), estradiol (fete) cu valori scazute - hipogonadism hipogonadotrop; </li>
<li>FSH si LH cu valori crescute, testosteron (baieti) si estradiol (fete) cu valori scazute - hipogonadism hipergonadotrop; </li>
<li>test de stimulare cu GnRH:</li>
<ul>
<li>raspuns pozitiv al gonadotropilor in retardul pubertar constitutional;</li>
<li>raspuns negativ al gonadotropilor in hipogonadismul hipogonadotrop; </li>
<li>valori foarte mari ale gonadotropilor in hipogonadismul hipergonadotrop. </li>
</ul>
<li>test la HCG - poate diferentia un hipogonadism hipogonadotrop de un retard pubertar constitutional; </li>
<li>TSH, FT4, IGF-1, cortizol bazal;</li>
</ul>
</ul>
</div>
</div>
<div style="orphans: 2; text-align: start; text-decoration-color: initial; text-decoration-style: initial; text-indent: 0px; widows: 2;">
<div>
<ul>
<li style="text-align: justify;"><b>radiografia de pumn/genunchi</b> care deceleaza un retard de varsta osoasa;</li>
<li style="text-align: justify;"><b>RMN-ul cerebral</b></li>
<li style="text-align: justify;"><b>ecografia organelor genitale</b> ce evidentiaza un uter de aspect infantil sau absenta acestuia in sindromul de insensibilitate la androgeni;</li>
<li style="text-align: justify;"><b>ecografia mamara</b> ce evidentiaza absenta tesutului mamar;</li>
<li style="text-align: justify;"><b>ecografia testiculara</b> ce evidentiaza testiculi de aspect infantil;</li>
<li style="text-align: justify;"><b>spermograma;</b></li>
<li style="text-align: justify;"><b>cariograma</b> - ce confirma/infirma prezenta unei anomalii cromozomiale.</li>
</ul>
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<b>Managementul pubertatii intarziate</b> consta in admnistrarea de hormoni sexuali (estrogeni la fetite, respectiv testosteron la baieti) in doze mici pentru o perioada de cateva luni. In cazul hipogonadismului hipogonadotrop se poate administra tratamentul pulsatil cu GnRH. Copii cu retard pubertar constitutional nu ncecesita tratament, dezvoltarea pubertatii fiind spontana si completa.</div>
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<span style="font-size: x-small;">sursa foto: http://www.bebelu.ro/pubertatea-intarziata-cauze-si-rezolvari.html</span></div>
Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-20882550284518334782020-04-25T17:09:00.000+03:002020-04-26T09:50:50.992+03:00Sindromul MEN 4 (neoplazia endocrina multipla tip 4)<div style="text-align: justify;">
<a href="https://www.oncolink.org/var/ezdemo_site/storage/images/media/oncolink/images/megan-images/thyroid-anatomy/362681-1-eng-US/thyroid-anatomy_large_x2_0.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="neoplazia endocrina multipla tip 4" border="0" height="251" src="https://www.oncolink.org/var/ezdemo_site/storage/images/media/oncolink/images/megan-images/thyroid-anatomy/362681-1-eng-US/thyroid-anatomy_large_x2_0.jpg" title="sindromul MEN 4" width="320" /></a>Sindromul MEN 4 (neoplazia endocrina multipla tip 4) este o afectiune genetica extrem de rara care asociaza la acelasi individ un <a href="http://www.endocrinopedia.info/2015/07/hiperparatiroidismul-primar.html">hiperparatiroidism primar</a> generat de un adenom paratiroidian si un adenom hipofizar. Adenomul hipofizar poate fi secretant (<a href="http://www.endocrinopedia.info/2015/07/cum-se-manifesta-sindromul-cushing.html">corticotropinom</a>, <a href="http://www.endocrinopedia.info/2015/07/gigantismul-adenom-hipofizar-secretant.html">somatotropinom</a>, <a href="http://www.endocrinopedia.info/2015/07/prolactinomul-si-hiperprolactinemia.html">prolactinom</a>) sau nesecretant. Hiperparatiroidismul primar si adenoamele hipofizare sunt mai putin agresive fata de pacientii cu <a href="http://www.endocrinopedia.info/2015/07/neoplazia-endocrina-multipla-tip-1.html">sindrom MEN 1</a>. Inconstant, in cadrul sindromului MEN 4, se pot asocia si alte formatiuni tumorale precum cancerul gastric, <a href="http://www.endocrinopedia.info/2015/07/sindromul-zollinger-ellison-gastrinomul.html">gastrinomul</a>, cancerul bronho-pulmonar, cancerul organelor reproducatoare (cancer testicular, cancer de col uterin), tumori renale si suprarenale.</div>
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Afectiunea se transmite autozomal dominant si se datoreaza mutatiilor genei CDKN1B localizata pe cromozomul 12p13, care codeaza gena supresoare tumorala p27Kip1. </div>
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Tratamentul sindromului MEN 4 este reprezentat de chirurgia adenoamelor paratiroidiene si hipofizare. </div>
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<span style="font-size: x-small;">sursa foto: </span><a href="https://www.oncolink.org/cancers/endocrine-system/parathyroid-cancer/surgical-procedures-surgery-and-staging-for-parathyroid-cancer" style="font-size: small;">https://www.oncolink.org/cancers/endocrine-system/parathyroid-cancer/surgical-procedures-surgery-and-staging-for-parathyroid-cancer</a></div>
Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-42059651457409051152020-04-18T19:51:00.002+03:002023-12-03T15:06:41.752+02:00Sindromul secretiei inadecvate de hormon antidiuretic (SIADH)<div style="text-align: justify;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeTxLC2RuIeIuCkCM3nkMbWNv3ogVmwhPQ8WcyjFpS91S2WXHLbsLwqMAQCjvuSsVqJ2wVG-05ARAzA9AdCet_jgpCpuJ2wGLjRM7yTZJ-jgM1jzUM1wWNNy1cVeHDBmBpGiGhRxB5fLI/s1600/Untitled.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: justify;"><img alt="sindromul secretiei inadecvate de adh" border="0" data-original-height="674" data-original-width="630" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeTxLC2RuIeIuCkCM3nkMbWNv3ogVmwhPQ8WcyjFpS91S2WXHLbsLwqMAQCjvuSsVqJ2wVG-05ARAzA9AdCet_jgpCpuJ2wGLjRM7yTZJ-jgM1jzUM1wWNNy1cVeHDBmBpGiGhRxB5fLI/s320/Untitled.png" title="siadh" width="298" /></a></div>
<b>Hormonul antidiuretic (ADH)</b> cunoscut si sub numele de <b>vasopresina</b> se sintetizeaza la nivelul hipotalamusului, fiind responsabil de mentinerea echilibrului hidric, prin cresterea resorbtiei lichidiene la nivel renal. </div>
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<b>Sindromul secretiei inadecvate de ADH (SIADH) </b>consta intr-o eliberare excesiva si nemodulata de ADH, in ciuda hipo-osmolaritatii serice.</div>
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Cauzele SIADH-ului sunt variate, incluzand:<br />
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<ul>
<li><b>medicamente</b>: vasopresina, desmopresina, oxitocina, antidepresive (antidepresive triciclice, inhibitori selectivi ai recaptarii serotoninei), anticonvulsivante (carbamazepina, fenitoina, valproat de sodiu), antagonisti dopaminergici (metoclopramid, antipsihotice, proclorperazina), colchicina, opioide, ecstasy, chimioterapice (vincristina, vinblastina, vinorelbina, cisplatin, ciclofosfamida, metotrexat);</li>
<li><b>malignitati</b>: cancer pulmonar cu celule mici, mezoteliom, cancer pancreatic, cancer duodenal, cancere din sfera capului/gatului, timom, sarcom, limfom, leucemia, cancer mamar, cancer prostata, cancer vezica urinara etc;</li>
<li><b>afectiuni neurologice</b>: AVC, traumatisme, hemoragii, infectii, scleroza multipla, sindrom Guillain-Barre, sindrom Dhy-Drager, tumori cerebrale;</li>
<li><b>afectiuni pulmonare</b>: pneumonie, pneumotorace, astm, fibroza chistica, ventilatie cu presiune pozitiva;</li>
<li><b>afectiuni metabolice:</b> hipotiroidism, insuficienta corticosuprarenala, porfiria acuta intermitenta;</li>
<li><b>interventii chirurgicale</b>: chirurgie hipofizara, chirurgia toraco-abdominala;</li>
<li><b>anestezie generala;</b></li>
<li><b>efort fizic excesiv;</b></li>
<li><b>cauza genetica</b> (mutatii de tip castig de functie in gena
receptorului V2);</li>
<li><b>idiopatic.</b></li>
</ul>
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<b>Tabloul clinic al sindromului secretiei inadecvate de ADH </b>depinde de nivelul hiponatremiei. Astfel, in formele usoare ale bolii (Na > 120 mEq/l) manifestarile clinice sunt absente sau discrete (greturi, varsaturi, confuzie, iritabilitate, anorexie). In formele severe ale bolii (Na < 110 mEq/l) predomina aritmiile cardiace si manifestarile neurologice (areflexie, letargie, convulsii si coma prin intoxicatie cu apa). </div>
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<b>Diagnosticul sindromului secretiei inadecvate de ADH</b> consta in identificarea unei:</div>
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<ul>
<li>hiponatremii (usoare – Na=130-134 mEq/l; moderate – Na=125-129 mEq/l; severe – Na <125 mEq/l)</li>
<li>osmolaritati plasmatice < 280 mOsm/l (la un pacient euvolemic, fara edeme, hipotensiune arteriala, insuficienta renala, insuficienta cardiaca, hipotiroidism, insuficienta corticosuprarenala sau in absenta unui tratament diuretic);</li>
<li>osmolaritati urinara > 100 mOsm/kg;</li>
<li>pierderii urinare de sodiu > 20 mEq/l.</li>
</ul>
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Alte examinari sunt indicate pentru identificarea cauzei SIADH-ului (radiografie toracica/CT toracic, RMN cerebral, profil hormonal tiroidian, test la Synacthen, bronhoscopie, punctie lombara etc).</div>
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<b>Tratamentul sindromului secretiei inadecvate de ADH </b>consta in:</div>
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<ul>
<li>tratamentul chirurgical al malignitatilor responsabile de secretia ectopica de ADH;</li>
<li>restrictie hidrica (500-750 ml/zi);</li>
<li>corectarea treptata a hiponatremiei (ser fiziologic hiperton, diuretice osmotice sau de ansa);</li>
<li>tratament medicamentos cu derivate de tetraciclina (demeclociclina) sau vaptani (conivaptan, tolvaptan).</li>
</ul>
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<span style="font-size: x-small;">sursa foto: <a href="https://www.youtube.com/watch?v=hKFGGv0E-5A">https://www.youtube.com/watch?v=hKFGGv0E-5A</a></span></div>
Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-42537529319528815692019-08-24T21:45:00.001+03:002021-08-20T09:44:35.337+03:00Tirotoxicoza indusa de amiodarona<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7l-1XUyV8ifxYgTZpyBzbF5Fs_B5iQ6gkJSJhMFVuB-digeJcEcsO9E-YXWGC_et6cEtjVKQ9qdC2LlHCSwMMjVukoaC3J9agCx_55LBNoRkcll2hur648z9lPkwimAsbTBvaVFuuhy8/s1600/Amiodarone-group-web-343x400.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="amiodarona" border="0" data-original-height="268" data-original-width="343" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7l-1XUyV8ifxYgTZpyBzbF5Fs_B5iQ6gkJSJhMFVuB-digeJcEcsO9E-YXWGC_et6cEtjVKQ9qdC2LlHCSwMMjVukoaC3J9agCx_55LBNoRkcll2hur648z9lPkwimAsbTBvaVFuuhy8/s1600/Amiodarone-group-web-343x400.jpg" title="tirotoxicoza indusa de miodarona" /></a></div>
Tirotoxicoza indusa de amiodarona este o afectiune care se instaleaza la aproximativ 15-18% din pacientii tratati cu aceasta medicatie pentru artimiile ventriculare si supraventriculare. Incidenta bolii este de trei ori mai mare la sexul masculin fata de cel feminin. </div>
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Amiodarona este un antiaritmic de casa III, avand in compozitie 39% iod, ce se depoziteaza la nivelul tesutului adipos, ficatului, miocardului, plamanilor si glandei tiroide. </div>
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Din punct de vedere al mecanismului patogenetic, exista urmatoarele tipuri de tirotoxicoza:</div>
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1. <b>Tirotoxicoza indusa de amiodarona tip 1</b> - afecteaza pacientii cunoscuti cu o afectiune tiroidiana preexistenta (gusa nodulara, boala Basedow Graves subclinica), datorandu-se aportului crescut de iod (fenomenul Jod-Basedow). Acest tip de afectiune este mai frecventa in regiunile deficitare in iod si se instaleaza la scurt timp de la introducerea tratamentului cu amiodarona (aproximativ 3 luni);</div>
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2. <b>Tirotoxicoza indusa de amiodarona tip 2</b> - afecteaza pacientii fara patologie tiroidiana preexistenta, datorandu-se toxicitatii directe a medicamentului asupra glandei tiroide, fiind responsabila de aparitia unei tiroidite distructive, cu eliberarea de hormoni tiroidieni preformati in circulatia sistemica. Acest tip de afectiune se instaleaza dupa aproximativ 30 de luni de la introducerea tratamentului cu amiodarona.</div>
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3.<b> Forma mixta </b>- in care sunt intricate caracteristici ale celor doua entitati expuse anterior.</div>
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<b>Manifestarile clinice</b> ale tirotoxicozei induse de amiodarona sunt reprezentate de: scadere ponderala importanta, astenie, slabiciune musculara, transpiratii, tremor, labilitate psiho-afectiva, accelerarea tranzitului intestinal. Manifestarile cardio-vasculare de tipul aritmiilor sunt adesea cupate, prin efectul antiaritmic al amiodaronei. Insa exacerbarea tulburarilor de ritm cardiac preexistente, de tipul tahicardiei sau a fibrilatiei atriale atrage atentia asupra instalarii tirotoxicozei. </div>
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<b>Profil hormonal </b>pe linie tiroidiana evidentiaza un nivel crescut al FT4, FT3 si un nivel scazut al TSH-ului. In cazul tirotoxicozei indusa de amiodarona tip 1 se poate identifica un titru inalt al anticorpilor antitiroglobulina, ATPO sau TRAb. Interleukina 6 este adesea crescuta in tirotoxicoza indusa de amiodarona tip 2.</div>
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Ecografia tiroidiana deceleaza o vascularizatie crescuta in cazul tirotoxicozei indusa de amiodarna tip 1 si o vascularizatie scazuta in tirotoxicoza indusa de amiodarona tip 2.</div>
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Scintigrafia tiroidiana este fixanta in tirotoxicoza indusa de amiodarona tip 1 si necaptanta in tirotoxicoza indusa de amiodarona tip 2 </div>
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<b>Managementul terapeutic</b> al bolii difera in functie de etiologie, astfel:</div>
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- in tirotoxicoza indusa de amiodarona tip 1 se recomanda antitiroidienele de sinteza (tiamazol, metimazol) in doze inalte sau percloratul de potasiu (pentru cazurile selectionate). In cazul lipsei eficacitatii tratamentului medicamentos sau in cazul aparitiei recurentei bolii, se poate apela la tratamentul curativ reprezentat de <a href="http://www.endocrinopedia.info/2015/07/tiroidectomia-totala-si-subtotala.html">tiroidectomia totala</a>;</div>
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- in tirotoxicoza indusa de amiodarona tip 2 se recomanda tratament cu <a href="http://www.endocrinopedia.info/2016/03/corticoterapia.html">glucocorticoizi</a> timp de cateva luni, cu scaderea progresiva a dozelor;</div>
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- in forma mixta de boala se recomanda asocierea antitiroidienelor de sinteza cu corticoterapia.</div>
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<span style="font-size: x-small;">sursa foto: <a href="https://auromedics.com/products/amiodarone-hcl-injection/">https://auromedics.com/products/amiodarone-hcl-injection/</a></span></div>
Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-2609680279654468832019-04-04T22:36:00.003+03:002019-04-05T20:30:15.839+03:00Pubertatea precoce<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOhTlSFsJJgITwK5Ru2O47RVzr_G-kzT5EysjSx7kwMUo7xy1LjCij3YofyxckUNVEn6wC4wiETzhF0tMNuNJ-sQK432j82zVfYr9xTYiEDAA0z3Cyaom28wLJ1yI-fX6fJk3G7ZcBc8k/s1600/2znynyrq-1364880062.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="telarha" border="0" data-original-height="619" data-original-width="926" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOhTlSFsJJgITwK5Ru2O47RVzr_G-kzT5EysjSx7kwMUo7xy1LjCij3YofyxckUNVEn6wC4wiETzhF0tMNuNJ-sQK432j82zVfYr9xTYiEDAA0z3Cyaom28wLJ1yI-fX6fJk3G7ZcBc8k/s400/2znynyrq-1364880062.jpg" title="pubertate precoce" width="400" /></a>Pubertatea precoce este reprezenta de instalarea caracterelor sexuale secundare inainte de varsta de 8 ani la fetite, respectiv 9 ani la baieti. Afectiunea este de 5 ori mai frecventa la fete decat la baieti.<br />
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In functie de mecanismul care sta la baza declansarii bolii, pubertatea precoce se clasifica in:<br />
<ul>
<li><b>pubertatea precoce adevarata</b> (pubertatea precoce gonadotrop-dependenta);</li>
<li><b>pseudopubertatea precoce</b> (pubertatea precoce gonadotrop-independenta);</li>
<li><b>forme partiale de pubertate precoce.</b></li>
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<b>Pubertatea precoce adevarata</b> este cel mai frecvent idiopatica, instalandu-se cu precadere la fetitele adoptate din tarile subdezvoltate. Alte cauze implicate in producerea acestui tip de pubertate precoce sunt tumorile hipotalamice (hamartoame) sau cerebrale (glioame, ependimoame, neuroblastoame, astrocitoame), chistele pineale, gliale sau arahnoidiene, anomaliile congenitale (hidrocefalie, displazie septo-optica, mielomeningocel), leziunile infiltrative (sarcoidoza) si vasculare etc.<br />
Pubertatea precoce adevarata poate, de asemenea, sa apara in contextul unor boli rare precum <a href="http://www.endocrinopedia.info/2016/01/ce-este-neurofibromatoza-tip-1.html">neurofibromatoza tip 1</a>, scleroza tuberoasa, sindromul Russel Silver si sindromul Williams.<br />
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<b>Pseudopubertatea precoce</b> se datoreaza urmatoarelor cauze:<br />
<ul>
<li><b>hiperplazie adrenalã congenitalã</b>: <a href="http://www.endocrinopedia.info/2015/07/deficitul-de-21-hidroxilaza-sau.html">deficit de 21 hidroxilaza</a>, <a href="http://www.endocrinopedia.info/2015/07/hiperplazie-adrenala-congenitala-prin_23.html">deficit de 11 hidroxilaza</a>;</li>
<li><b>neoplasm suprarenal virilizant;</b></li>
<li><b>tumori secretante de gonadotropina (hCG)</b>: choriocarcinoame, germinoame, hepatoame, teratoame;</li>
<li><b>tumori gonadale: </b></li>
<ul>
<li>tumori ovariene secretante de estrogeni (tumori ale celulelor granuloase, tumori tecale, disgerminoame, teratoame);</li>
<li>tumori testiculare: tumori cu celule Leydig sau cu celule Sertoli;</li>
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<li><b><a href="http://www.endocrinopedia.info/2016/03/sindromul-mccune-albright.html">sindrom Mccune Albright</a></b></li>
<li><b>testotoxicoza (pubertate precoce masculina familiala)</b> – boala genetica determinata de mutatii activatoare ale subunitatii α a proteinei Gs din constitutia receptorului pt LH;</li>
<li><b>chiste ovariene</b> - tumori benigne, rare, secretante de estrogeni, ce determinã aparitia telarhai, iar uneori prin spargerea lor, sangerari de deprivare hormonala. Chistele mari se pot chiar necroza, cauzand simptome ce mimeaza un abdomen acut. Evolutia este, de obicei, regresiva, dar uneori se impune interventia chirurugicala;</li>
<li><b>administrarea exogena de hormoni steroidieni</b> (steroizi anabolizanti, androgeni, estrogeni);</li>
<li><b>hipotiroidism primar sever (sindromul Van Wyk Grunbach) </b>- determinat printr-un nivel crescut al TSH-ului ce poate actiona pe receptorii de FSH, inducand o serie de efecte specifice acestui hormon. Afectiunea se caracterizeaza prin galactoree, chiste ovariene si maturizare sexuala precoce la fete, respectiv semne de virilizare si criptorhidie la baieti. Simptomatologia remite dupa initierea tratamentului substitutiv cu hormoni tiroidieni. </li>
</ul>
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<b>Forme partiale de pubertate precoce:</b></div>
<ul>
<li><b>Telarha precoce</b> reprezinta dezvoltarea glandelor mamare (uni- sau bilateral), fara asocierea altor semne de pubertate. Afectiunea se instaleaza inainte de varsta de 3 ani si, in majoritatea cazurilor, regreseaza spontan. Uneori telarha precoce poate persista pana la varsta de instalare fiziologica a pubertatii. Talia finala nu este influentata. Aspectul ecografic al ovarelor este de tip prepubertar. Dozarile hormonale evidentiaza valori normale ale gonadotropilor (FSH, LH) si estradiolului. Testul de stimulare la GnRh prezintã o crestere izolata a FSH-ului. Afectiunea nu necesita tratament medicamentos.</li>
<li><b>Adrenarha precoce</b> reprezinta aparitia pilozitatii axilare si pubiene inainte de varsta de 8 ani la fetite si 9 ani la baieti, fara alte semne de maturizare sexuala. Afectiunea se datoreaza maturizarii precoce a glandei suprarenale (zona reticulata), ce determina cresterea hormonului dehidroepiandrosteron (DHEA). Patologia este autolimitata, cu dezvoltarea pubertara ulterioara normala si nu necesita tratament.</li>
<li><b>Menarha precoce</b> reprezinta aparitia precoce a menstrei, fara alte semne de dezvoltare pubertara. Afectiunea se datoreaza, mai probabil, unei cresterii a receptivitatii uterine la concentratii joase de estrogeni sau existentei unui chist ovarian secretant de estrogeni, care s-a spart si a determinat instalarea unei menstre de deprivare hormonala. Menarha precoce dispare spontan, dezvoltarea pubertara ulterioara fiind normala. </li>
<li><b>Ginecomastia </b>(cresterea in volum a tesutului mamar la baieti) apare la 75% dintre baieti in perioada pubertatii, avand insa caracter regresiv. </li>
</ul>
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<b>Manifestarile clinice </b>specifice pubertatii precoce sunt reprezentate de:</div>
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<ul>
<li>crestere staturala exagerata, urmata de telarha, adrenarha si menarha inainte de varsta de 8 ani la fetite;</li>
<li>cresterea
precoce a volumului testicular si aparitia primelor polutii cu spermatozoizi inainte de varsta de 9 ani la baieti;</li>
<li>rata de crestere accelerata, cu varsta osoasa avansata, cu inchiderea precoce a cartilajelor de crestere la ambele sexe;</li>
<li>tulburari psiho-comportamentale;</li>
<li>alte manifestari în raport cu etiologia (aspect de ovar multichistic in pubertatea precoce idiopatica; mase tumorale palpabile abdominale sau testiculare, cefalee, diabet insipid, tulburari de camp vizual etc.).</li>
</ul>
<div>
<b><br /></b>
<b>Diagnosticul de pubertate precoce</b> se bazeaza pe:</div>
</div>
<div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTsbtnBYLqRQghPD6Ud_LWA-RrlI23dL9Hn8s-bn4Wh_UOcCJPpnkvU9RiDJ8oS11RW_q4F69csExQMHDShAFHHBtOh4tulUD7K_9-5iXsTRG4u83cTPIjk6fy4vxYHhMLs9lovx2iS1s/s1600/pag7Fig-4.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img alt="varsta osoasa" border="0" data-original-height="500" data-original-width="434" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTsbtnBYLqRQghPD6Ud_LWA-RrlI23dL9Hn8s-bn4Wh_UOcCJPpnkvU9RiDJ8oS11RW_q4F69csExQMHDShAFHHBtOh4tulUD7K_9-5iXsTRG4u83cTPIjk6fy4vxYHhMLs9lovx2iS1s/s320/pag7Fig-4.jpg" title="radiografie pumn" width="277" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Radiografie pumn - decelarea varstei osoase</td></tr>
</tbody></table>
<ul>
<li><b>tabloul clinic </b>expus anterior;</li>
<li><b>avans</b> <b>de varsta osoasa</b> stabilita pe radiografie de pumn/genunchi;</li>
<li><b>radiografia oaselor carpiene/oaselor lungi</b> in cazul sindromului Mccune Albright;</li>
<li><b>profil hormonal:</b> </li>
<ul>
<li>pubertatea precoce adevarata:</li>
<ul>
<li>FSH, LH, estradiol (la fetite) sau testosteron (la baieti): valori pubertare;</li>
<li>testul la GnRh cu raspuns pozitiv;</li>
<li>DHEAS, androstendion - valori crescute.</li>
</ul>
<li>pseudopubertatea precoce:</li>
<ul>
<li>FSH si LH cu valori scazute si estradiol (la fetite) sau testosteron (la baieti) cu valori pubertare;</li>
<li>testul la GnRh cu raspuns negativ.</li>
</ul>
</ul>
<li><b>ecografia organelor genitale:</b></li>
<ul>
<li>cresterea axului lung uterin (> 34 mm), raport corp/col uterin >1, ingrosarea mucoasei endometriale, cresterea dimensiunilor ovarelor (volum ovarian > 1-3 ml), cu foliculi > 4 mm sau mai mult de 6 foliculi; </li>
<li>aspect de chiste ovariene multiple in sindromul Mccune Albright.</li>
</ul>
<li><b>ecografia testiculara: </b></li>
<ul>
<li>cresterea în volum a testiculelor si a prostatei;</li>
<li>macroorhitism in sindromul Mccune Albright.</li>
</ul>
<li><b>ecografia mamara</b>: prezenta tesutului mamar;</li>
<li><b>RMN cerebral:</b> evidentiaza tumori ale zonei hipotalamo-hipofizare/cerebrale;</li>
<li><b>RMN abdominal</b>: identifica hiperplazia glandelor suprarenale la pacientii cu sindrom Mccune Albright/ sindrom Cushing sau deficite enzimatice.</li>
<li><b>teste genetice:</b> GNAS1, kisspeptina 1 (KISS 1R), MKRN 3, neurokinina B (NKB), FGF8, WDR 11, SOX 10, FEZF1, DAX 1, tahikinina 3 (TAC3/TACR3), mutatia leptinei, GnRHR, LHbeta, FSH beta);</li>
<li><b>examen neurologic</b>: în cazul afectiunilor cerebrale;</li>
<li><b>examen oftamologic: </b>camp vizual, fund de ochi.</li>
</ul>
</div>
<b><br /></b>
<b>Managementul terapeutic al pubertatii precoce:</b><br />
<ul>
<li><b>Obiective: </b>oprirea dezvoltarii caracterelor sexuale secundare pana la varsta fiziologica, cu scopul:</li>
<ul>
<li>asigurarii unei maturizari sexuale si scheletale corespunzatoare;</li>
<li>prevenirii tulburarilor psiho-comportamentale;</li>
<li>scaderea riscului de cancer de san, deseori asociat cu pubertatea precoce la fete.</li>
</ul>
<li><b>Mijloace terapeutice:</b></li>
<ul>
<li>pentru pubertatea precoce adevarata/hamartoame cerebrale: agonisti potenti de GnRh cu actiune retard (Triptoreline) administrati in doza continua, determinand o desensibilizarea pituitara, cu scaderea receptorilor pentru gonadotropi, scaderea secretiei gonadotropilor, a hormonilor sexuali si oprirea progresiei pubertatii;</li>
<li>pentru formele tumorale cerebrale - tratament chirurgical asociat sau nu cu radioterapie;</li>
<li>pentru pseudopubertatea precoce: </li>
<ul>
<li>tratament chirurgical pentru tumorile hormono-secretante;</li>
<li>inhibitori de aromatazã (letrozol, anastrozol) – in neoplaziile estrogen-dependente;</li>
<li>bifosfonati, preferabil in forma injectabilã (bonviva, ibandronat)/modulatori selectivi ai receptorilor estrogenici (tamoxifen) – în displazia osoasa din sindromul. Mccune Albright;</li>
<li>tratament specific al disfunctiilor endocrine asociate sindromului Mccune Albright;</li>
<li>antiandrogenic la nivel de receptor (spironolactona), inhibitori de aromataza (testolactona) sau inhibitor de steroidogeneza (Ketoconazol) - in testotoxicoza;</li>
<li>hidrocortizon acetat 10-20 mg/m²/zi sau dexametazona 0.25 mg/zi - in hiperplazia congenitala a glandelor suprarenale; </li>
<li>tiroxina - in hipotiroidismul primar sever.</li>
</ul>
</ul>
</ul>
<div>
<br /></div>
sursa foto: <a href="http://theconversation.com/growing-up-too-fast-early-puberty-and-mental-illness-13159">http://theconversation.com/growing-up-too-fast-early-puberty-and-mental-illness-13159</a>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-54926987040811042992018-06-10T16:20:00.000+03:002019-08-25T00:29:53.100+03:00Sindromul Noonan<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkANfgtWxOVMrwDMD9Ct_RrhVWAN4zPZCXvukdPqnfgqvjUqqGbVFkgSrCe0tnL5vRxdqKy8q2e52gSALW_A-iwfE4G6D03GzFT-_Q1IeCyOyzFqO_xW3T88u_tl8KHdSYk-zsKXB41UE/s1600/Noonan-Syndrome-6.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" border="0" data-original-height="360" data-original-width="540" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkANfgtWxOVMrwDMD9Ct_RrhVWAN4zPZCXvukdPqnfgqvjUqqGbVFkgSrCe0tnL5vRxdqKy8q2e52gSALW_A-iwfE4G6D03GzFT-_Q1IeCyOyzFqO_xW3T88u_tl8KHdSYk-zsKXB41UE/s320/Noonan-Syndrome-6.jpg" title="sindrom noonan" width="320" /></a></div>
<b>Sindromul Noonan</b>, cunoscut si sub denumirea de sindrom pseudoTurner, este o afectiune genetica, cu transmitere autosomal dominanta, cauzata in peste 50% din cazuri de mutatii ale genei PTPN11. Mutatiile genelor SOS1, PIT1, RAF1 si KRAS au fost, de asemenea, descrise ca fiind implicate in producerea bolii.<br />
Afectiunea apare in egala masura la ambele sexe, avand o frecventa de 1 la 1000-2500 de nou-nascuti.<br />
<br />
<br />
<b>Tabloul clinic</b> al copiilor cu sindrom Noonan cuprinde urmatoarele elemente:<br />
<ul>
<li><b>deficitul statural</b>, ce apare in peste 80% din cazuri;</li>
<li><b>dismorfismul facial caracteristic:</b> fata triunghiulara, cu micrognatism, hipertelorism (largirea distantei dintre globii oculari), epicantus, fante palpebrale oblice - antimongoloide, urechi jos inserate, adancirea santului subnazal, bolta ogivala, malocluzii dentare, gat scurt, cu exces tegumentar, par ondulat, lanos, friabil si cu insertie joasa; </li>
<li><b>malformatii cardio-vasculare</b> prezente in peste 80% din cazuri: stenoza pulmonara, cardiomiopatie hipertrofica, defect de sept atrial, defect de sept ventricular, tetralogia Fallot, intoarecerea venoasa pulmonara anormala, presistenta ductului arterial si malformatia Epstein;</li>
<li><b>anomalii ale sistemului osteoarticular:</b> pectus excavatum sau carinatum (> 90% din cazuri), cifoza, scolioza, picior var-equin, hiperlaxitate ligamentara, contracturi articulare si vertebre cervicale sudate;</li>
<li><b>anomalii hematologice:</b> hepatosplenomegalie si tulburari de coagulare;</li>
<li><b>anomalii ale sistemului nervos central:</b> hipotonie musculara, malformatia Arnold-Chiari, neuropatie periferica, convulsii;</li>
<li><b>anomalii ale sistemului uro-genital:</b> anomalii renale, <a href="http://www.endocrinopedia.info/2015/07/ce-este-criptorhidia.html">criptorhidie</a>, pubertate intarziata;</li>
<li><b>manifestari tegumentare:</b> limfedem (la nastere), nevi pigmentari, pete cafe-au-lait, predispozitia de a dezvolta cicatrici cheloide, pernute proeminente ale degetelor;</li>
<li><b>tulburari vizuale</b>: strabism, ambiopie, tulburari de refractie;</li>
<li><b>anomalii ORL:</b> hipoacuzie neuro-senzoriala.</li>
</ul>
<div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji1SxyypK6XwFVOL4TPdKilkvyymdoJ2eNhq-ghmo5qpUIb4s5IYp82jgBj4ZbYrNy3Qz24wV3YG6xBDK6eWjToeb_Ko7t9MifYjyrqAh8PC0lbEzD8eeAm5_SCxxP6hvlosuG01xtKuY/s1600/afp20140101p37-f3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="sindrom noonan imagini" border="0" data-original-height="568" data-original-width="1151" height="314" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji1SxyypK6XwFVOL4TPdKilkvyymdoJ2eNhq-ghmo5qpUIb4s5IYp82jgBj4ZbYrNy3Qz24wV3YG6xBDK6eWjToeb_Ko7t9MifYjyrqAh8PC0lbEzD8eeAm5_SCxxP6hvlosuG01xtKuY/s640/afp20140101p37-f3.jpg" title="sindrom noonan poze" width="640" /></a></div>
<span style="font-size: x-small;"><br /></span>
<b>Diagnosticul pozitiv</b> se stabileste pe baza tabloului clinic, si cel mai important, pe baza testarii genetice. De asemenea, evaluarea profilului hormonal deceleaza un nivel scazut al IGF-1 si a IGF-BP3 la pacientii cu deficit statural.<br />
<br />
<b>Diagnosticul diferential</b> al sindromului Noonan se face cu urmatoarele entitati:<br />
<ul>
<li><a href="http://www.endocrinopedia.info/2015/07/ce-este-sindromul-turner.html">sindromul Turner;</a></li>
<li><a href="http://www.endocrinopedia.info/2016/01/ce-este-neurofibromatoza-tip-1.html">neurofibromatoza tip 1</a>;</li>
<li>sindromul LEOPARD;</li>
<li>sindromul Costello;</li>
<li>sindromul craniofaciocutanat.</li>
</ul>
<div>
<b>Managementul terapeutic </b>al afectiunii consta in tratament cu hormon de crestere pentru deficitul statural si tratament chirurgical pentru malformatiile cardiace.</div>
<br />
<span style="font-size: x-small;">sursa foto: http://medicalpicturesinfo.com/noonan-syndrome/</span></div>
Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-27284643075134734912018-05-20T10:16:00.003+03:002019-08-25T00:37:58.859+03:00Infertilitatea feminina<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0_l8xj5kXZxhnxugG-fGgXIoL2ObiX2X3Bkq2ODg5P4tOwoO_6aiJbOIcWaXe38Jw_oO712j7ZT664oo_ESR7xlXlYGlSe7-Erbf3DvB-PYTemy-H-oHEYxH5BNR0vvcUUfkrJbqR3Vs/s1600/shutterstock_251244184-1-554x350.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="sterilitate" border="0" data-original-height="350" data-original-width="554" height="251" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0_l8xj5kXZxhnxugG-fGgXIoL2ObiX2X3Bkq2ODg5P4tOwoO_6aiJbOIcWaXe38Jw_oO712j7ZT664oo_ESR7xlXlYGlSe7-Erbf3DvB-PYTemy-H-oHEYxH5BNR0vvcUUfkrJbqR3Vs/s400/shutterstock_251244184-1-554x350.jpg" title="infertilitate" width="400" /></a></div>
Infertilitatea reprezinta incapacitatea de a obtine o sarcina dupa 12 luni de raporturi sexuale neprotejate. In peste 35% din cazuri, factorii feminini sunt responsabili de aparitia infertilitatii, acestia fiind reprezentati de:<br />
<ul>
<li><b>afectiuni ovariene</b>: <a href="http://www.endocrinopedia.info/2015/07/sindromul-ovarelor-polichistice-sop.html">sindromul ovarelor polichistice</a> (> 80 din cazuri), tumorile ovariene secretante de androgeni, sindromul foliculului luteinizant nerupt, disgeneziile ovariene, insuficienta ovariana de cauza autoimuna, tratamentul chimioterapic/radioterapic sau chirurgical la nivelul ovarelor;</li>
<li><b>afectiuni uterine</b>: <a href="http://www.endocrinopedia.info/2015/07/endometrioza-cauze-simptome-diagnostic.html">endometrioza</a>, fibrom uterinul, sinechiile uterine;</li>
<li><b>afectiuni ale trompelor uterine: </b>infectii cu Clamydia sau Gonococ, leziuni postchirurgicale ale trompelor uterine;</li>
<li><b>afectiuni ale tractului mullerian</b>: obstructia congenitala de tract mullerian (imperforatia himenala, sept transvaginal), sindrom Asherman, <a href="http://www.endocrinopedia.info/2015/07/sindromul-rokitansky-cauze.html">agenezia mulleriana Rokitansky</a>, <a href="http://www.endocrinopedia.info/2017/09/sindromul-testiulul-feminizant.html">insensibilitatea la androgeni</a>, anomalii uterine (uter didelf, unicorn, bicorn sau septat);</li>
<li><b>afectiuni hipotalamo-hipofizare</b>: <a href="http://www.endocrinopedia.info/2015/07/insuficienta-hipofizara-adultului.html">insuficienta hipofizara</a>, amenoreea de cauza functionala, <a href="http://www.endocrinopedia.info/2015/07/prolactinomul-si-hiperprolactinemia.html">hiperprolactinemia</a>, <a href="http://www.endocrinopedia.info/2016/01/sindromul-kallmann-de-morsier.html">sindromul Kallmann</a> sau diverse mutatii (ale receptorului GnRH/betaFSH/LH, PIT sau PROP 1);</li>
<li><b>alte boli endocrine: </b><a href="http://www.endocrinopedia.info/2015/07/boala-basedow-graves.html">hipertiroidismul</a> sau <a href="http://www.endocrinopedia.info/2015/07/mixedemul-insuficienta-tiroidiana.html">hipotiroidismul</a>, <a href="http://www.endocrinopedia.info/search/label/diabet%20zaharat">diabetul zaharat</a>, <a href="http://www.endocrinopedia.info/2015/07/cum-se-manifesta-sindromul-cushing.html">sindromul Cushing</a>, hiperplazia adrenala congenitala, hipercolesterolemia;</li>
<li><b>boli cronice:</b> cancere, infectie HIV;</li>
<li><b>consum de medicamente si droguri</b>: antiinflamatoare nesteroidiene (aspirina, ibuprofen), anabolice steroidiene, cocaina, morfina, marijuana, alcool, tutun;</li>
<li><b>obezitatea sau supraponderea</b>;</li>
<li><b>dieta saraca in vitamina B12, acid folic, fier si zinc;</b></li>
<li><b>stres psihic;</b></li>
<li><b>lipsa efortului fizic sau efort fizic excesiv.</b></li>
</ul>
<div>
<b><br /></b>
<b>Diagnosticul de infertilitate feminina </b>se stabileste in baza unei rezerve ovariene scazute reprezentata de:</div>
<div>
<ul>
<li>un nivel inalt al estradiolulul si FSH-ului dozat in ziua 3 a ciclului menstrual si in urma stimularii cu clomifen citrat:</li>
<li>un nivel scazut al progesteronului dozat in ziua 21 a ciclului mentrual;</li>
<li>un nivel scazut al hormonului anti-mullerian si</li>
<li>curba termica bazala cu aspect monofazic sau cu amplitudine/durata redusa.</li>
</ul>
<div>
Pentru stabilirea cauzei responsabile de infertilitatea feminina sunt necesare urmatoarele investigatii:</div>
</div>
<div>
<ul>
<li>hormonii tiroidienei, prolactina, 17 OH-Pg, testosteron, SHBG;</li>
<li><a href="http://www.endocrinopedia.info/2015/07/rmn-ul-hipofizar.html">RMN hipofiar</a>;</li>
<li>ecografie endovaginala seriata, incepanad cu a doua jumatate a fazei foliculare a <a href="http://www.endocrinopedia.info/2015/07/ciclul-menstrual-normal.html">ciclului menstrual;</a></li>
<li>histerosalpingografia sau laparoscopia - pentru evaluarea trompelor uterine;</li>
<li>testare pentru Clamydia trachomatis;</li>
<li>testare Barr si cariotip.</li>
</ul>
<div>
<b><br /></b>
<b>Tratamentul infertilitatii </b>depinde de etiologia acesteia:<br />
<ul>
<li><b>hiperprolactinemie</b>: agonisti dopaminergici;</li>
<li><b>endometrioza</b>: tratament chirurgical, tehnici de reproducere asistata;</li>
<li><b>fibrom uterin</b>: tratament chirurgical;</li>
<li><b>afectare trompelor uterine</b>: reconstructie tubara;</li>
<li><b>factori cervicali</b>: antibioterapie pentru ambii parteneri in cazul infectiei cu Clamydia;</li>
<li><b>afectarea glandei tiroide</b>: tratament substitutiv cu <a href="http://www.endocrinopedia.info/2016/05/tratamentul-hipotiroidismului.html">hormoni tiroidieni</a> (hipotiroidism), tratament cu <a href="http://www.endocrinopedia.info/2015/07/thyrozol-prospect-indicatii.html">antitiroidiene de sinteza</a> (hipertiroidism);</li>
<li><b>sindrom de ovare polichistice, afectiuni hipotalamo-hipofizare</b>: tratament pentru inducerea ovulatiei: clomifen citrat, metformin, gonadotrofine (preparate de LH si FSH), analogi de GnRH, inhibitori de aromataza, drilling ovarian (in sindromul ovarelor polichistice) sau fertilizare in vitro.</li>
</ul>
</div>
</div>
<span style="font-size: x-small;">sursa foto: http://www.theamericanconservative.com/articles/sperm-killers-and-rising-male-infertility/</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-20777056756730984622018-04-21T22:14:00.003+03:002019-08-25T00:39:51.173+03:00Tiroidita postpartum<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJxaE_rMf0N22QXhDF69vX8spja8BP98fk2hLlK1io0TutOAe07k8Q1glvM_YCniewqI7qJsg_lqNxjrnfZXVamXG9K3YUz-rzg4uu3b0lZ_fMxZWVRcIcyBNBGHWnbZEfoqVWAqxqh_w/s1600/AdobeStock_170305478.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="tiroidita limfocitara subacuta" border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJxaE_rMf0N22QXhDF69vX8spja8BP98fk2hLlK1io0TutOAe07k8Q1glvM_YCniewqI7qJsg_lqNxjrnfZXVamXG9K3YUz-rzg4uu3b0lZ_fMxZWVRcIcyBNBGHWnbZEfoqVWAqxqh_w/s320/AdobeStock_170305478.jpeg" title="tiroidita postpartum" width="320" /></a></div>
<div style="text-align: justify;">
Tiroidita postpartum (tiroidita subacuta limfocitara) este o afectiune autoimuna, cu caracter tranzitor, ce afecteaza 5-10% dintre femeile care au avut o nastere sau un avort in ultimele 12 luni. Afectiunea este de trei ori mai frecventa in cazul femeilor cunoscute cu<a href="http://www.endocrinopedia.info/search/label/diabet%20zaharat"> diabet zaharat tip 1</a>. In plus, pozitivarea anticorpilor antitiroidieni inainte de sarcina creste riscul aparitiei tiroiditei postpartum de 38 pana la 52%. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
In general, evolutia bolii este una bifazica, debutand cu un hipertiroidism tranzitor, ce este urmat de un hipotiroidism. Aparitia izolata a hipertiroidismului sau a hipotiroidismului nu este insa exclusa. Hipertiroidismul apare la aproximativ 1-6 luni postpartum, avand o durata de 2-3 luni. Manifestarile acestuia sunt reprezentate de oboseala marcata, iritabilitate, palpitatii, scadere ponderala ce contrasteaza cu un apetit crescut. Hipotiroidismul apare la 4-8 luni postpartum, remitand spontan in aproximativ 4-6 luni. Pacientele cu hipotiroidism pot fi asimptomatice sau pot acuza mialgii, artralgii, fatigabilitate, constipatie, pierderea capacitatii de concentrare, crestere ponderala si depresie, putand fi confundata cu depresia postpartum. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Diagnosticul de tiroidita postpartum se stabileste pe baza pozitivarii anticorpilor anti-tiroidieni (80% din cazuri) si a radioiodocaptarii scazute. Profilul hormonal pe linie tiroidiana deceleaza fazele bolii (hiper- sau hipotiroidism). </div>
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<div style="text-align: justify;">
Afectiunea trebuie diferentiata de o <a href="http://www.endocrinopedia.info/2015/07/boala-basedow-graves.html">boala Basedow Graves</a>, care poate recidiva postpartum (radioiodocaptare crescuta) sau de o <a href="http://www.endocrinopedia.info/2015/07/hipofizita-autoimuna-limfocitara.html">hipofizita limfocitara</a>.</div>
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<br /></div>
<div style="text-align: justify;">
Managementul terapeutic al tiroiditei postpartum consta in administrare de betablocante pentru ameliorarea manifestarilor hipertiroidismului, <a href="http://www.endocrinopedia.info/2015/07/thyrozol-prospect-indicatii.html">antitiroidienele de sinteza </a>nefiind necesare. Pentru faza hipotiroidiana se recomanda tratament substitutiv cu <a href="http://www.endocrinopedia.info/2016/05/tratamentul-hipotiroidismului.html">hormoni tiroidieni</a>.</div>
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Evolutia bolii este una favorabila, cu remiterea manifestarilor in 80% din cazuri. In 20% din cazuri, pacientii manifesta un hipotiroidism permanent. In plus, riscul de recurenta a bolii creste cu 25-70% la o sarcina viitoare.</div>
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</div>
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<span style="font-size: x-small;">sursa foto: https://blog.pregistry.com/postpartum-thyroiditis/</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-14274938369744370602018-02-03T19:21:00.000+02:002019-08-25T09:02:34.721+03:00Hiperparatiroidismul tertiar<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNC57ysjFej04Sp6Rjc84Xflj2mK1EZbxJo1d4aJMdYf0a8BqNk85F7Y9j0fPFDX3xipAHGTAjou93DomEEwBubdjwYcdx6aqCdkiRT0mH18argSbPLG1ZLMl9zTYPNZ9E1p2JUtVl5i8/s1600/PMC3813706_rjt03404.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" border="0" data-original-height="285" data-original-width="512" height="222" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNC57ysjFej04Sp6Rjc84Xflj2mK1EZbxJo1d4aJMdYf0a8BqNk85F7Y9j0fPFDX3xipAHGTAjou93DomEEwBubdjwYcdx6aqCdkiRT0mH18argSbPLG1ZLMl9zTYPNZ9E1p2JUtVl5i8/s400/PMC3813706_rjt03404.png" title="hiperparatiroidismul tertiar" width="400" /></a>Hiperparatiroidismul tertiar reprezinta hipersecretia excesiva de parathormon (PTH) asociata cu hipercalcemia, datorata transformarii adenomatoase a hiperplaziei glandelor paratiroide.<br />
Cel mai frecvent, afectiunea apare pe fondul unui <a href="http://www.endocrinopedia.info/2015/07/hiperparatiroidismul-secundar.html">hiperparatiroidism secundar</a> cu evolutie indelungata, in contextul insuficientei renale cronice. In peste 30% din cazuri, hipersecretia de parathormon persista si dupa remiterea insuficientei renale prin transplant renal.<br />
De asemenea, evolutia indelungata a hiperparatiroidismului secundar malabsorbtiilor gastrointestinale prelungite si deficitului de vitamina D (implicate in producerea hipocalcemiei) pot conduce la hiperparatiroidism tertiar. <br />
<br />
Manifestarile bolii sunt similare celor din <a href="http://www.endocrinopedia.info/2015/07/hiperparatiroidismul-primar.html">hiperparatiroidismul primar</a> si secundar, incluzand oboseala musculara, durerile osoase, scaderea densitatii mineralizarii osoase (<a href="http://www.endocrinopedia.info/2015/07/ce-este-osteoporoza.html">osteoporoza</a>), fracturile, pruritul, litiaza renala, ulcerul peptic, pancreatita, calcificarile vasculare si ale tesuturilor moi. Pot aparea, de asemenea, manifestari psihiatrice.<br />
Modificarile biochimice si hormonale specifice bolii sunt reprezentate de hipercalcemie, hiperfosforemie, asociate cu un nivel inalt al parathormonului.<br />
<br />
Tratamentul afectiunii consta in extirparea paratiroidelor transformate adenomatos, avand ca scop normalizarea hipercalcemiei. Interventia chirurgicala se indica in urmatoarele situatii:<br />
<ul>
<li>hipercalcemie severa (calciu seric > 11,5 sau 12 mg/dl);</li>
<li>hipercalcemie persistenta (calciu seric > 10,2 mg/dl) dupa 3 luni - 1 an dupa interventia chirurgicala;</li>
<li>osteoporoza severa;</li>
<li>dureri osoase sau fracturi patologice; </li>
<li>astenie;</li>
<li>prurit;</li>
<li>ulcer peptic;</li>
<li>manifestari psihiatrice;</li>
<li>antecedente de litiaza renala.</li>
</ul>
Evolutia postoperatorie se coreleaza cu o crestere semnificativa a supravietuirii pacientilor si cu o imbunatatire a calitatii vietii.<br />
Tratamentul medicamentos cu calcimimetice (cinacalcet) reprezinta o alternativa in cazul pacientilor la care interventia chirurgicala nu poate fi efectuata. <br />
<br />
<span style="font-size: x-small;">sursa foto: https://openi.nlm.nih.gov/detailedresult.php?img=PMC3813706_rjt03404&req=4</span><br />
<span style="font-size: x-small;">http://boneandspine.com/tertiary-hyperparathyroidism-presentation-and-treatment/ </span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-40168851395168018902017-12-01T11:28:00.000+02:002019-08-25T09:05:04.519+03:00Scintigrafia tiroidiana <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJV2CUSE06eIOqDAi2EQ-rKHnkmpm0Vgz6XgBwqJ-TCYFJkRqiCFTfwhW928_q0OhYgbaUPb0TxUGNrAT9Oc-A5xJqRTQMiOPu3QpC9LomKPj5V9hPN2TZqhpx09jYGoql-Z1ayH01GoQ/s1600/thyroid-symptoms-and-solutions-s18.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="nodul cald" border="0" data-original-height="335" data-original-width="493" height="271" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJV2CUSE06eIOqDAi2EQ-rKHnkmpm0Vgz6XgBwqJ-TCYFJkRqiCFTfwhW928_q0OhYgbaUPb0TxUGNrAT9Oc-A5xJqRTQMiOPu3QpC9LomKPj5V9hPN2TZqhpx09jYGoql-Z1ayH01GoQ/s400/thyroid-symptoms-and-solutions-s18.jpg" title="scintigrafie tiroidiana" width="400" /></a></div>
Scintigrafia tiroidiana reprezinta explorarea imagistica care evalueaza morfologia si functia <a href="http://www.endocrinopedia.info/2015/07/ce-este-tiroida-si-cum-functioneaza.html">glandei tiroide</a>. Investigatia se bazeaza pe proprietatea tiroidei de a extrage din circulatie radiofarmaceuticul administrat (Iod 131, Iod 123 sau Technetium 99m pertchnetat) care este captat la nivel tiroidian prin mecanism activ sau prin difuziune pasiva si care exploreaza prima etapa a hormonogenezei tiroidiene (oxidarea iodului).<br />
<br />
Radiotrasorul cel mai utilizat in practica medicala curenta este Technetium 99m pertchenectat, luand in considerere pretul scazut al acestuia, timpul redus de injumatatire (6-9 ore) si emisia doar a radiatiilor gamma, iradierea fiind in acest caz redusa. Radiofarmaceuticul este administrat intravenos, dupa 20 de minute de la injectare putandu-se obtine imaginea tesutului tiroidian si valoarea radioiodocaptarii.
Avand in vedere riscul scazut de iradiere, utilizarea Technetiumului 99m este indicata in cazul copiilor si a persoanelor alergice la iod.<br />
<br />
Iodul 131 este un radiotrasor cu timp de injumatatire prelungit (8-13 zile), care emite atat radiatii gamma cat si beta, acesta fiind motivul pentru care scintigrafia cu iod 131 este folosita, in general, in scop terapeutic (in<a href="http://www.endocrinopedia.info/2015/07/cancerul-tiroidian-factori-de-risc.html"> cancerul tiroidian</a> sau in hipertiroidism) si mai putin in scop diagnostic. Radiotrasorul se administreaza pe cale orala, captarea acestuia la nivel tiroidian fiind maxima dupa 24 de ore.<br />
<br />
Iodul 123 poate fi utilizat in scop diagnostic, avand in vedere ca emite doar radiatii gamma si are un timp de injumatattire de 13 ore, insa costul ridicat si accesibilitatea redusa a acestuia constituie principalele motive pentru care, in momentul actual, nu este disponibil in Romania.<br />
<br />
<b>Precautii si contraindicatii:</b><br />
Avand in vedere ca unele medicamente pot interfera cu captarea radiofarmaceuticului, este recomandat ca pacientul care urmeaza sa efectueze scintigrafia tiroidiana sa sisteze consumul de:<br />
<ul>
<li>antiroidiene de sinteza (propiltiouracil, metiltiouracil,<a href="http://www.endocrinopedia.info/2015/07/thyrozol-prospect-indicatii.html"> tiamazol</a>), bromuri, tiocianati, penicilina, perclorat, antihistaminice, salicilati, anticoagulante, steroizi, izoniazida cu o saptamana inainte de examinare;</li>
<li>tratamentul cu hormoni tiroidieni (<a href="http://www.endocrinopedia.info/2015/07/euthyrox-prospect-indicatii.html">Euthyrox</a>, Novothyral), antitusive si lugol cu 2-3 saptamani inainte de examinare;</li>
<li>amiodarona si agentii de contrast iodati utilizati in explorarile radiologice cu 3-4 luni inainte de examinare.</li>
</ul>
De asemenea, sarcina reprezinta o contraindicatie absoluta a scintigrafiei tiroidiene.<br />
<br />
<b>Indicatiile</b> scintigrafiei tiroidiene sunt reprezentate de:<br />
<ul>
<li><a href="http://www.endocrinopedia.info/2015/07/ce-este-gusa.html">gusa difuza sau nodulara</a>;</li>
<li><a href="http://www.endocrinopedia.info/2015/07/adenomul-toxic-tiroidian-boala-plummer.html">nodulul toxic Plummer</a>; </li>
<li>statusul functional al unui nodul tiroidian: nodul hipo-/ necaptant (nodul rece), nodul izocaptant sau hipercaptant (nodul cald);</li>
<li>suspiciune de tesut tiroidian ectopic (lingual, substernal);</li>
<li>evaluarea unui posibil tesut tiroidian restant dupa <a href="http://www.endocrinopedia.info/2015/07/tiroidectomia-totala-si-subtotala.html">tiroidectomia totala</a> sau tratamentul cu radioiod in cazul unui cancer tiroidian/ evaluarea prezentei metastazelor cu punct de plecare tiroidian.</li>
</ul>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgggXxcAj5HOIz6Xj7Hw48jwUf5JOKeBZCrndVl3p3g6uqQlPWQ99G1W7EyNuRdFr4FdbKR2hpzlV6Kj2z1J7kEcHkvfPZGQ_u9fi5Q6TL9AqTSth1f7P5D-mOqKX48M2xDsXhUkIjz29A/s1600/30867.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="scintigrafie technetiu" border="0" data-original-height="575" data-original-width="576" height="398" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgggXxcAj5HOIz6Xj7Hw48jwUf5JOKeBZCrndVl3p3g6uqQlPWQ99G1W7EyNuRdFr4FdbKR2hpzlV6Kj2z1J7kEcHkvfPZGQ_u9fi5Q6TL9AqTSth1f7P5D-mOqKX48M2xDsXhUkIjz29A/s400/30867.jpg" title="scintigrafie tiroidiana" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Aspect de scintigrafie tiroidiana cu Iod 123 - A. Aspect tiroidian normal; B. Aspect de gusa difuza (boala Basedow Graves); C. Aspect de gusa toxica multinodulara; D. Aspect de adenom tiroidian toxic</td></tr>
</tbody></table>
<span style="font-size: x-small;">sursa foto: https://www.onhealth.com/content/1/thyroid_disorders</span><br />
<span style="font-size: x-small;">https://emedicine.medscape.com/article/121865-overview </span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-13828090058838546312017-09-29T22:26:00.001+03:002019-08-25T09:16:12.976+03:00Deficitul de hormon de crestere (nanismul hipofizar)<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmESRZTFqaj68uYN-7lREP9T12Ua3Mw6z5eqRDV1TPzpl8tw2US_ErnqaWnaLcnAqVw9Kzxvw_DW1SWbXpIeOTKNTRhQCtObLsqP_uaaK8YAj34EwTXPyt8D2465nbZJQWgI04O-rv8jc/s1600/Cartoon-font-b-Giraffes-b-font-Kids-font-b-Growth-b-font-font-b-Chart-b.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="inaltime prea mica" border="0" data-original-height="800" data-original-width="800" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmESRZTFqaj68uYN-7lREP9T12Ua3Mw6z5eqRDV1TPzpl8tw2US_ErnqaWnaLcnAqVw9Kzxvw_DW1SWbXpIeOTKNTRhQCtObLsqP_uaaK8YAj34EwTXPyt8D2465nbZJQWgI04O-rv8jc/s320/Cartoon-font-b-Giraffes-b-font-Kids-font-b-Growth-b-font-font-b-Chart-b.jpg" title="deficit ponderal" width="320" /></a></div>
Nanismul hipofizar reprezinta afectarea procesului de crestere liniara (deficit statural) caracteristica perioadei copilariei si adolescentei, fiind determinat de insuficienta secretiei sau actiunii hormonului de crestere (GH).<br />
<br />
Cauzele implicate in producerea nanismului hipofizar sunt reprezentate de:<br />
<ul>
<li><b>deficitul de somatoliberina (GHRH)</b> - idiopatic sau in contextul unor afectiuni hipotalamice: displazie septo-optica, holoprozencefalie, traumatisme cranio-cerebrale, tumori hipotalamice (germinoame, <a href="http://www.endocrinopedia.info/2015/07/ce-este-craniofaringiomul.html">craniofaringioame</a>, glioame, meningioame), infectii si infiltratii hipotalamice (sarcoidoza, histiocitoza);</li>
<li><b>deficitul de hormon de crestere </b>- deficit de secretie de GH, deficit neurosecretor de GH, sinteza de GH bioinactiv;</li>
<li><b>absenta receptorilor hepatici pentru GH</b> (nanismul Laron sau carenta de IGF-1);</li>
<li><b>defectul receptorului de IGF-1</b> (rezistenta periferica osoasa la IGF-1). </li>
</ul>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMME44iJiIelHPC-LNvEixKhztH9JWwWIyfOR_Zvh4ioCGrDR5JUe22B0BNGq4HDzegQswJlltvkm_VKqN9pKf5nNWq3tsXAYm5StnxpRWWyASJy4oVySP6x9Ah_Xh9UNeKYQ1vr_HG1E/s1600/Growth-hormone-deficiency.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><b></b></a>Manifestarile clinice ale deficitului de hormon de crestere sunt reprezentate de:<br />
<ul>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMME44iJiIelHPC-LNvEixKhztH9JWwWIyfOR_Zvh4ioCGrDR5JUe22B0BNGq4HDzegQswJlltvkm_VKqN9pKf5nNWq3tsXAYm5StnxpRWWyASJy4oVySP6x9Ah_Xh9UNeKYQ1vr_HG1E/s1600/Growth-hormone-deficiency.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="nanism hipofizar" border="0" data-original-height="574" data-original-width="500" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMME44iJiIelHPC-LNvEixKhztH9JWwWIyfOR_Zvh4ioCGrDR5JUe22B0BNGq4HDzegQswJlltvkm_VKqN9pKf5nNWq3tsXAYm5StnxpRWWyASJy4oVySP6x9Ah_Xh9UNeKYQ1vr_HG1E/s320/Growth-hormone-deficiency.jpg" title="deficit de hormon de crestere" width="278" /></a>
<li>deficit statural (≤ 2,5-3 DS fata de copii de aceeasi rasa, sex si varsta), cu proportionalitate intre membre;</li>
<li>schelet gracil, cu risc de osteoporoza;</li>
<li>hipotrofie musculara;</li>
<li>tesut adipos subcutanat bine reprezentat;</li>
<li>extremitati de mici dimensiuni (acromicrie);</li>
<li>organe interne de dimensiuni reduse (microsplahnie);</li>
<li>facies imatur, "de copil", cu privirea vioaie;</li>
<li>etajul mijlociu si inferior al fetei este slab dezvoltat (nas mic, arcada dentara hipodezvoltata (micrognatie), retrognatie), vicii de implantare dentara;</li>
<li>tendinta la ridare timpurie;</li>
<li>dezvoltare psihica normala;</li>
<li>dezvoltare pubertara intarziata;</li>
<li>infantilo-nanismul poate aparea in cazul asocierii unei insuficiente hipofizare gonadotrope;</li>
<li>disproportionalitatea intre membre, semnele de hipotiroidism si retardul psiho-motor pot aparea in cazul coexistentei unei insuficiente tirotrope;</li>
<li>hipotensiunea arteriala si hipoglicemia apar in cazul coexistentei unei insuficiente corticotrope centrale;</li>
<li>unele manifestari de tipul malformatiei Arnold-Chiari, atreziei esofagiene, polidactiliei, holoprozencefaliei, retardului mental sunt specifice unor mutatii genetice implicate in etiopatogenia deficitului de hormon de crestere.</li>
</ul>
<div>
Diagnosticul de nanism hipofizar se stabileste pe baza:</div>
<div>
<ul>
<li>tabloului expus anterior;</li>
<li>analizelor biochimice care evidentiaza hipercolesterolemie si hipoglicemie;</li>
<li>profilului hormonal care evidentiaza o valoare a hormonului de crestere < 10 ng/ml in cadrul <a href="http://www.endocrinopedia.info/2015/07/testul-hipoglicemiei-indusa-de-insulina.html">testului la insulina</a>;</li>
<li>absentei bioritmului circadian al hormonului de crestere (prin evaluarea profilului de GH/24 h);</li>
<li>absentei peak-ului secretor nocturn de GH;</li>
<li>nivelului scazut de IGF-1 (exceptand valorile crescute ale acestuia din cadrul deficitului periferic de IGF-1);</li>
<li>radiografiei de pumn care pune in evidenta un retard de varsta osoasa;</li>
<li>ecografiei abdominale care obiectiveaza microsplahnia;</li>
<li>testelor genetice;</li>
<li><a href="http://www.endocrinopedia.info/2015/07/rmn-ul-hipofizar.html">RMN-ului hipofizar</a> care poate decela existenta unor tumori hipofizare sau a unor anomalii de dezvoltare pituitara: agenezie/hipoplazie sau ectopie hipofizara;</li>
<li>osteodensitometriei care evidentiaza un capital osos maxim subnormal.</li>
</ul>
</div>
<div>
Tratamentul deficitului de GH consta in administrare de hormon de crestere uman sintetic, subcutanat, in doza de 0,02-0,04 mg/kgc/zi si cu IGF-1 in cazul nanismului Laron. Obiectivul tratamentului consta in reducerea decalajului de crestere in inaltime fata de copii de aceeasi varsta, rasa si sex. In cazul coexistentei insuficientei gonadotrope, tratamentul cu hormon de crestere va precede intotdeauna tratamentul cu hormoni sexuali (pentru prevenirea inchiderii precoce a cartilajelor de crestere).</div>
<br />
<span style="font-size: x-small;">http://build-muscle-101.com/growth-hormone-deficiency/</span><br />
<span style="font-size: x-small;">https://www.aliexpress.com/cheap/cheap-giraffe-growth-chart-wall-decal.html</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-72996746376841395292017-09-03T17:02:00.001+03:002022-09-06T00:02:13.943+03:00Sindromul testiculului feminizant (sindromul de rezistenta la androgeni)<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCw3gEd_XWaT7_6k8ayrfwf371MvGyM4Y76vYqfSvFfjSRhNtXVV1frLUU6MXkWCvPvn8zLD0rZY_MagAyV-Bez6ACnBaUIppSZl_w_n-ASlfojMTSUWiI-SzVzEXw9cpyOHz-qxYeS8A/s1600/maxresdefault.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="rezistenta la androgeni" border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCw3gEd_XWaT7_6k8ayrfwf371MvGyM4Y76vYqfSvFfjSRhNtXVV1frLUU6MXkWCvPvn8zLD0rZY_MagAyV-Bez6ACnBaUIppSZl_w_n-ASlfojMTSUWiI-SzVzEXw9cpyOHz-qxYeS8A/s320/maxresdefault.jpg" title="testicul feminizant" width="320" /></a></div>
Sindromul testiculului feminizant, cunoscut si sub denumirea de sindrom de insensibilitate la androgeni, este o forma de pseudohermafroditism masculin, caracterizata prin discordanta dintre sexul genetic si gonadal (care sunt masculine) si restul sexualizarii (care este feminina).<br />
<br />
Afectiunea se datoreaza deficitului complet sau partial al receptorilor hormonilor androgeni (testosteron si dihidrotestosteron), fiind o boala genetica, cu transmitere X-linkata recesiva.<br />
<br />
In mod fiziologic, testosteronul este implicat in dezvoltarea organelor genitale interne, in viata intrauterina, si dihidrotestosteronul determina virilizarea organelor genitale externe. In cazul deficitului receptorilor hormonilor androgeni, virilizarea organelor genitale interne si externe nu se mai produce.<br />
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhstwx9tmCzKrY4tiVtS9XtdPNopOP8iVicAEUmrl7FqBOEHK0OEizU5Rb-cZU9cSdcI3a8etmq0fapzGjWW4ivfYQ8qCmkoH_OxBqnMrSm0lIAGSHwu9WyVU5oqjNqJbO7Z6OpYaPQEBM/s1600/Androgen%252BInsensitivity%252BSyndrome.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="sindrom reifenstein" border="0" data-original-height="720" data-original-width="960" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhstwx9tmCzKrY4tiVtS9XtdPNopOP8iVicAEUmrl7FqBOEHK0OEizU5Rb-cZU9cSdcI3a8etmq0fapzGjWW4ivfYQ8qCmkoH_OxBqnMrSm0lIAGSHwu9WyVU5oqjNqJbO7Z6OpYaPQEBM/s400/Androgen%252BInsensitivity%252BSyndrome.jpg" title="insensibilitatea la androgeni" width="400" /></a></div>
Exista doua tipuri de rezistenta la hormonii androgeni:<br />
<ul>
<li>Deficitul complet de receptori androgeni sau sindromul Morris:</li>
<ul>
<li>Fenotipul este franc feminin (umeri ingusti, bazin lat, panicul adipos cu distributie feminina);</li>
<li>Talia esta inalta, cu aspect macroschel;</li>
<li>Organele genitale externe sunt de tip feminin, insa incomplet dezvoltate, vaginul fiind scurt, terminat in deget de manusa;</li>
<li>Organele genitale interne lipsesc: cele feminin nu se dezvolta, din cauza prezentei hormonului anti-mullerian secretat de testiculele localizate intraabdominal; organele genitale masculine nu se dezvolta din cauza deficitului receptorilor pentru testosteron;</li>
<li>Pilozitatea axilo-pubiana este absenta, iar cea tronculara este slab dezvoltata;</li>
<li>Glandele mamare se dezvolta datorita conversiei testosteronului in estrogeni, insa au aspect pubertar;</li>
<li>Sexualizarea pubertara lipseste, absenta menstrelor determina, in marea majoritate a cazurilor, prezentarea la medic si stabilirea diagnosticului.</li>
<li>Dezvoltarea psiho-comportamentala este normala, comportamentul fiind feminin.</li>
</ul>
<li>Deficitul partial de receptori androgeni sau sindromul Reifenstein:</li>
<ul>
<li>virilizarea organelor genitale este partiala, asociata sau nu cu <a href="http://www.endocrinopedia.info/2015/07/ce-este-ginecomastia.html">ginecomastia</a>.</li>
</ul>
</ul>
Diagnosticul de testicul feminizant se stabileste pe baza:<br />
<div>
<ul>
<li>aspectului clinic;</li>
<li>profilului hormonal care deceleaza un nivel crescut al testosteronului plasmatic, al estradiolului si al hormonului luteinizant (ca expresie a insensibilitatii hipotalamo-hipofizare la testosteron);</li>
<li>examenului citogenetic care pune in evidenta absenta cromatinei sexuale si prezenta cariotipului 46,XY;</li>
<li>examenului histopatologic al gonadei care deceleaza testiculi cu leziuni disgenetice;</li>
<li>analizei mutatiilor genei receptorului androgenilor.</li>
</ul>
Tratamentul sindromului de rezistenta la androgeni consta in indepartarea chirurgicala a testiculilor intraabdominali, continuarea sexualizarii farmacologice cu preparate estrogenice si consiliere psihologica.<br />
<br />
<span style="font-size: x-small;">sursa foto http://slideplayer.com/slide/9525893</span>/</div>
Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-57472869791702859862017-09-03T11:40:00.001+03:002019-05-18T00:24:00.969+03:00Hermafroditismul adevarat<br />
<div style="text-align: justify;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-gkcA5VrXetUzFAYbNDeV9O9QPAeH61V0_rVm5OeBLEUVtmLPqeSKUR-5SVObV6jzZ0yH_OQZyIeVEewgAiX-7yqp8jM1RDckSsa4DirRY9N5dObzzN_O3lmFrjB_mRg3z2WE10KwAEk/s1600/Ribera-La+mujer+barbuda.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="ovotestis" border="0" data-original-height="400" data-original-width="400" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-gkcA5VrXetUzFAYbNDeV9O9QPAeH61V0_rVm5OeBLEUVtmLPqeSKUR-5SVObV6jzZ0yH_OQZyIeVEewgAiX-7yqp8jM1RDckSsa4DirRY9N5dObzzN_O3lmFrjB_mRg3z2WE10KwAEk/s320/Ribera-La+mujer+barbuda.jpg" title="hermafroditism adevarat" width="320" /></a>Hermafroditismul adevarat reprezinta o forma rara de intersexualitate, reprezentand aproximativ 5% din totalul tulburarilor de diferentiere sexuala, avand o etiologie necunoscuta. Afectiunea este caracterizata prin coexistenta tesutului ovarian si testicular la acelasi individ, in urmatoarele variante:</div>
<ul>
<li style="text-align: justify;"><a href="http://festyy.com/wM1UHH">ovar</a> intr-o parte si testicul in partea opusa;</li>
<li style="text-align: justify;">ovotestis (gonada mixta ce contine tesut ovarian si testicular) intr-o parte si ovar sau testicul in partea opusa;</li>
<li style="text-align: justify;">ovotestis bilateral. </li>
</ul>
<div style="text-align: justify;">
Marea majoritate a indivizilor cu hermafroditism adevarat au cariotip 46,XX (peste 70% din cazuri), in timp de 10% din cazuri prezinta cariotip 46,XY. Mozaicismul 46,XX/46,XY apare in aproximativ 20% din cazuri si are un fenotip variabil.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Pacientii afectati prezinta ambiguitate a organelor genitale externe, variind de la un aspect tipic feminin, la clitoromegalie, micropenis, hipospadias, pana la aspect tipic masculin a organelor genitale externe. Desi liniile germinale sunt prezente, acestea nu reusesc sa ajunga la maturitate, sterilitatea fiind, in acest caz, compromisa.</div>
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<br /></div>
<div style="text-align: justify;">
<span style="font-size: x-small;">sursa foto: http://www.fundacionmedinaceli.org/coleccion/fichaobra.aspx?id=378</span></div>
Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-17813169736953349222017-08-23T12:33:00.000+03:002017-10-07T19:13:35.880+03:00Tiroidita acuta supurata (abcesul tiroidian)<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0iE53RDCMF52Y0BDS5fUt1aOBszil7TRBjHcTc_cQhJXkFu64ZY4aSQPOlI4xS93BoIDiUw70KlDM9slFHzuRXly46gJRmxYZvpnHwqwSlreaF6Gq7fKBuCTjfd_m-2mCT2_Vv4zLVbo/s1600/kak-izbavitsya-ot-boli-v-gorle-pri-glotanii-bez-temperatury-sovety-specialistov.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="abces tiroidian" border="0" data-original-height="333" data-original-width="580" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0iE53RDCMF52Y0BDS5fUt1aOBszil7TRBjHcTc_cQhJXkFu64ZY4aSQPOlI4xS93BoIDiUw70KlDM9slFHzuRXly46gJRmxYZvpnHwqwSlreaF6Gq7fKBuCTjfd_m-2mCT2_Vv4zLVbo/s320/kak-izbavitsya-ot-boli-v-gorle-pri-glotanii-bez-temperatury-sovety-specialistov.jpg" title="tiroidita acuta" width="320" /></a></div>
Tiroidita acuta este un proces inflamator al glandei tiroide, favorizat de persistenta ductului tiroglos sau de existenta unor procese infectioase localizate in apropierea tiroidei (infectii respiratorii, infectii din sfera ORL).
Germenii cei mai frecvent implicati in producerea bolii sunt reprezentati de stafilococul aureu, pneumococul, streptococul piogen, escherichia coli, salmonella tiphi, haemophilus influenzae. Mai rar, abcesul tiroidian poate fi generat de bacterii anaerobe sau de fungi.<br />
<br />
Manifestarile clinice are tiroiditei acute sunt reprezentate de:<br />
<ul>
<li>febra, frison;</li>
<li>durere in regiunea cervicala anterioara, cu caracter iradiant, care se accentueaza la palpare, deglutitie, tuse sau la miscarile capului;</li>
<li>tegumente rosii si fierbinti la nivelul regiunii cervicale anterioare;</li>
<li>disfagie (dificultate la inghitire) si disfonie (raguseala); </li>
<li>aparitia adenopatiilor satelite, cu caracter inflamator;</li>
<li>posibilitatea de extindere mediastinala si fistulizare a abcesului tiroidian.</li>
</ul>
<div>
Diagnosticul se stabileste pe baza tabloului clinic si a analizelor biochimice care releva un sindrom inflamator, cu o valoare crescuta a VSH-ului (viteza de sedimentare a hematiilor), proteinei C reactive si fibrinogenului. In plus, hemoleucograma evidentiaza cresterea nivelului leucocitelor (leucozitoza), pe baza neutrofilelor (neutrofilie). Profilul hormonal tiroidian nu este afectat. </div>
<div>
Ecografia tiroidiana evidentiaza un volum tiroidian marit, cu obiectivarea unei arii hipoecogene, avasculare, flu delimitata. Sunt evidentiate, de asemenea, adenopatiile latero-cervicale inflamatorii.</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXV7jwckXUCEqeNOegwDueqUPboy5yx_55QGXthdcdLBZG7OlMdOrAoaztYGId3tk2oFURgn1f7XujcZB_5XGtOCOMiav34GKd9eb0FsjLwEl6-epgsPE-o1PrSCwvBdmwkyRTLw04VsI/s1600/lbox_1516.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="398" data-original-width="406" height="313" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXV7jwckXUCEqeNOegwDueqUPboy5yx_55QGXthdcdLBZG7OlMdOrAoaztYGId3tk2oFURgn1f7XujcZB_5XGtOCOMiav34GKd9eb0FsjLwEl6-epgsPE-o1PrSCwvBdmwkyRTLw04VsI/s320/lbox_1516.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Aspect ecografic in tiroidita acuta</td></tr>
</tbody></table>
<div>
Scintigrafia tiroidiana deceleaza absenta captarii trasorului la nivelul zonelor inflamatorii.</div>
<div>
Examenul citologic, efectuat in urma punctionarii leziunii tiroidiene, evidentiaza detritusuri celulare si numeroase granulocite.</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgprifWXZwLHHfbGfOcH4Jh3CNbm3ipDe3aQLhCXlWUvjEbnpiw6NPn3QPFeWgUVJiOfeg66bD82mGJm_V5FcWmbMdav-7rJBMiR-CPmVTVWGhjG9nOv78jUoi7Qoc6kgkQPZjYNOOPmc4/s1600/jkspe-16-128-g005-l.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="tiroidita acuta supurata" border="0" data-original-height="328" data-original-width="458" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgprifWXZwLHHfbGfOcH4Jh3CNbm3ipDe3aQLhCXlWUvjEbnpiw6NPn3QPFeWgUVJiOfeg66bD82mGJm_V5FcWmbMdav-7rJBMiR-CPmVTVWGhjG9nOv78jUoi7Qoc6kgkQPZjYNOOPmc4/s320/jkspe-16-128-g005-l.jpg" title="abces tiroidian histopatologie" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Aspect citologic in tiroidita acuta</td></tr>
</tbody></table>
<div>
Tratamentul tiroiditei acute consta in:</div>
<div>
<ul>
<li>antibioterapie (conform antibiogramei), instituita precoce;</li>
<li>drenaj chirurgical, in caz de abces colectat;</li>
<li>amfotericina B asociata sau nu cu tratamentul chirurgical, atunci cand se suspicioneaza o etiologie fungica.</li>
</ul>
</div>
<span style="font-size: x-small;">sursa foto: </span><br />
<span style="font-size: x-small;">http://prostudnet.ru/kak-lechit/kak-izbavitsya-ot-boli-v-gorle-pri-glotanii-bez-temperatury-sovety-specialistov.html</span><br />
<span style="font-size: x-small;">http://ultrasoundcases.info/Slide-View.aspx?cat=278&case=280</span><br />
<span style="font-size: x-small;">https://synapse.koreamed.org/DOIx.php?id=10.6065/jkspe.2011.16.2.128&vmode=PUBREADER</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-20740344294504926142017-07-30T14:09:00.000+03:002019-08-25T09:20:02.893+03:00Tumorile pineale (epifizare)<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqRXbTXqRXAVF2gC11GcTLpzUhdFqHGj2cm8IGetvWAmV6V3-1l7Jrgz0Yd4rroMAccZcsq3MKJgxjQ1opLkBU1rzxJxyzUmrMIqilrRSRnbov7wo8zyX1B8JQQjLCNjp9mSVPP3SsQZw/s1600/pineal.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: inherit;"></span></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqRXbTXqRXAVF2gC11GcTLpzUhdFqHGj2cm8IGetvWAmV6V3-1l7Jrgz0Yd4rroMAccZcsq3MKJgxjQ1opLkBU1rzxJxyzUmrMIqilrRSRnbov7wo8zyX1B8JQQjLCNjp9mSVPP3SsQZw/s1600/pineal.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="tumora glanda epifiza" border="0" data-original-height="432" data-original-width="768" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqRXbTXqRXAVF2gC11GcTLpzUhdFqHGj2cm8IGetvWAmV6V3-1l7Jrgz0Yd4rroMAccZcsq3MKJgxjQ1opLkBU1rzxJxyzUmrMIqilrRSRnbov7wo8zyX1B8JQQjLCNjp9mSVPP3SsQZw/s320/pineal.jpg" title="tumora pineala" width="320" /></a></div>
<span style="font-family: inherit;">Tumorile <a href="http://www.endocrinopedia.info/2015/07/ce-este-hipofiza-glanda-pituitara.html">glandei pineale</a> reprezinta 0.5-3% din totalul tumorilor intracraniene, afectand cu precadere sexul masculin. Aceste tumori pot aparea la orice varsta, insa cu o frecventa mai mare intre varstele de 10 si 20 ani.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;"><b>Manifestarile clinice </b>specifice tumorilor pineale sunt reprezentate de:</span><br />
<span style="font-family: inherit;">- dureri de cap, letargie, efect de masa la nivelul structurilor mediane;</span><br />
<span style="font-family: inherit;">- hidrocefalie, hipertensiune intracraniana;</span><br />
<div style="text-align: right;">
</div>
<span style="font-family: inherit;">- sindrom Parinaud (paralizia la privirea in sus, nistagmus convergent, pupile Argyll Robertso<span style="font-family: inherit;">n), <span style="font-size: 12pt;">afectarea
nervilor oculomotori;</span></span></span><br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; line-height: 115%;">-
vertij, sincopa, tremor intentional, ataxie, tulburari de mers;<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; line-height: 115%;">- <a href="http://www.endocrinopedia.info/2015/07/insuficienta-hipofizara-adultului.html">insuficienta hipofizara</a>, <a href="http://www.endocrinopedia.info/2015/07/sete-intensa-diabet-insipid.html">diabet insipid</a>, hiperfagie, somnolenta, obezitate, tulburari de
comportament;</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit;"><span style="line-height: 115%;">-
<a href="http://www.endocrinopedia.info/2019/04/pubertatea-precoce.html">pubertate precoce </a>la baieti (in cazul tumorilor secretante de </span><span style="line-height: 115%;">β</span><span style="line-height: 115%;">-HCG, care mimeaza actiunea
hormonului luteinizant);<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; line-height: 115%;">-
amenoree secundara la pacientele cu varsta de peste 12 ani;<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; line-height: 115%;">-
deficit de crestere la copii cu varsta sub 15 ani.<o:p></o:p></span></div>
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Tumorile glandei pineale se clasifica, in functie de celularitate, in:</span><br />
<span style="font-family: inherit;">- tumori cu celule germinale (germinom, teratom);</span><br />
<span style="font-family: inherit;">- tumori pineale parenchimatoase: pinealocite (pinealocitom, pinealoblastom, forme mixte) si celule gliale (ependimom, astrocitom, forme mixte);</span><br />
<span style="font-family: inherit;">- tumori pineale neparenchimatoase (chist degenerativ, chist arahnoid, hemangiom cavernos);</span><br />
<span style="font-family: inherit;">- tumori ale celulelor invecinate (meningiom).</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">In functie de maligniate, tumorile glandei epifize pot fi:</span><br />
<span style="font-family: inherit;">- benigne - 10%;</span><br />
<span style="font-family: inherit;">- relativ benigne (low grade) - 10%;</span><br />
<span style="font-family: inherit;">- maligne - 80%.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Examinarile care deceleaza prezenta tumorilor pineale sunt reprezentate de CT-ul sau RMN-ul cerebral, examinarea lichidului cefalorahidian, markerii tumorali (HCG, alfa fetoproteina), biopsia formatiunii tumorale (in cazul in care markerii tumorali sunt echivoci) si examenul citologic al tumorii.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Managementul terapeutic al tumorilor pineale consta in:</span><br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; line-height: 115%;">- supraveghere (abordarea "wait and see") avand în vedere abordul chirurgical dificil, din cauza localizarii glandei pineale;<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; line-height: 115%;">-
radioterapie externa (germinoamele sunt radiosensibile în 90% din cazuri – prognosticul fiind unul foarte bun);<o:p></o:p></span></div>
<span style="font-family: inherit;">-
chimioterapie: vincristina.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit; font-size: xx-small;">sursa foto: http://camminanelsole.com/la-ghiandola-pineale-ci-immunizza-dalla-predisposizione-ai-tumori/</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-72984052120479854412017-03-04T23:36:00.002+02:002019-08-25T09:22:12.588+03:00Sindromul Sotos (gigantismul cerebral)<div class="separator" style="clear: both; text-align: center;">
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</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicru21r-KxnPXwKJ26zC_VirOOdF4awG8mAAW4-VSBHxw7yZb7aTS6xyw2J2OUEXj9fq6Q1Zv3IkXRjdVph26NMZoOr2GxSyuhXgJYyskguk0955pRuRGiLvXYWryTu89nJraTmY_b7cI/s1600/kooper.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="gigantismul cerebral" border="0" height="317" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicru21r-KxnPXwKJ26zC_VirOOdF4awG8mAAW4-VSBHxw7yZb7aTS6xyw2J2OUEXj9fq6Q1Zv3IkXRjdVph26NMZoOr2GxSyuhXgJYyskguk0955pRuRGiLvXYWryTu89nJraTmY_b7cI/s320/kooper.png" title="sindromul sotos" width="320" /></a></div>
Sindromul Sotos, cunoscut si sub denumirea de gigantism cerebral este o boala genetica rara, cu transmitere autozomal dominanta, caracterizata printr-o crestere exagerata peri- si postnatala.<br />
<br />
Aparitia bolii este generata de prezenta unei mutatii la nivelul genei NSD 1, localizata la nivelul cromozomului 5 (5q35.2-q35.3), care apare in peste 80% din cazuri (<i>sindromul Sotos tip 1</i>). Recent, a fost descoperita mutatia genei NFIX (Nuclear Facotre I, X type), situata pe cromozomul 19 (19p13.3 ), responsabila de aparitia <i>sindromului Sotos tip 2</i>.<br />
<br />
Gigantismul cerebral afecteaza in egala masura ambele sexe, aparand la unul din 14000 de nou-nascuti.<br />
<br />
Manifestarile clinice ale sindromului Sotos sunt reprezentate de:<br />
- cresterea rapida in greutate (intre percentila 75 si 97) si in inaltime (peste percentila 97) imediat dupa nastere;<br />
- circumferinta craniana la nastere peste percetila 97;<br />
- macrocefalie;<br />
- exces de crestere in primii ani de viata;<br />
- dismorfism craniofacial, cu dolicocefalie (alungirea craniului antero-posterior), bose frontale proeminente, hipertelorism (marirea distantei dintre globii oculari), epicantus, bolta ogivala, eruptie dentara precoce, barbie ascutita, fata alungita (forma ovalara);<br />
- manifestari neurologice: intarziere in achizitia mersului si a limbajului, hipotonie, hiperlaxitate articulara, crize convulsive (in 30% din cazuri);<br />
- retard mintal - prezent in peste 80% din cazuri si tulburari de comportament;<br />
- diverse anomalii: cardiace, genito-urinare, ale organelor de simt (hipoacuzie, afectare oculara - strabism) si anomalii scheletale;<br />
- risc de dezvoltare a numeroase tumori: teratom sacrococcigian, neuroblastom, leucemie limfoblastica acuta.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5YsWXGqOZ4KtsEBMKezuWDk7eyjHwU1D-StK7kN_de3tIlPZOSozM1ve9cJ4L6vMekDzVghAFdfg5jf8rKGDmy2EGomHnnh3Wfal5WTzdY3hAhulwL08RfKQDVt9kO7cpez01APgPgNg/s1600/a09fig03.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="cavum velum interpositum" border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5YsWXGqOZ4KtsEBMKezuWDk7eyjHwU1D-StK7kN_de3tIlPZOSozM1ve9cJ4L6vMekDzVghAFdfg5jf8rKGDmy2EGomHnnh3Wfal5WTzdY3hAhulwL08RfKQDVt9kO7cpez01APgPgNg/s400/a09fig03.gif" title="hidrocefalie" width="226" /></a></div>
Diagnosticul se stabileste pe baza aspectului clinic, neexistand nici un marker biochimic specific bolii. Radiografia de pumn sau genunchi releva un avans de varsta osoasa in peste 75% din cazuri, insa acestea nu sunt considerate examinari specifice. Imagistica cerebrala poate evidentia prezenta anomaliilor ventriculilor cerebrali (ventriculomegalie, colpocefalie) si ale liniei mediane (disgenezie de corp calos, persistenta structurii <i>cavum velum interpositum</i>). Diagnosticul de certitudine se stabileste in urma identificarii mutatiilor de la nivelul genelor NSD 1 si NIFX, prin tehnica FISH.<br />
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Diagnosticul diferential se face cu urmatoarele afectiuni:<br />
- gigantismul (in perioada copilariei) si a <a href="http://www.endocrinopedia.info/2015/07/gigantismul-adenom-hipofizar-secretant.html">acromegaliei</a> (la varsta adulta) - in carul acestor afectiuni, se identifica un nivel crescut al hormonului de crestere si al IGF-1;<br />
- sindromul Weaver-Smith
- afectiune extrem de rara, caracterizata de un proces de accelerare a cresterii, insa manifestarile clinice difera de cele prezente in sindromul Sotos - forma fetei este rotunda, oasele maxilare sunt hipodezvoltate, pacientii prezinta hipertonie si afectare articulara;<br />
- sindromul Beckwith-Wiedemann;<br />
- sindromul Simpson-Golabi-Behmel;<br />
- sindromul Fragile X.<br />
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Tratamentul bolii este unul simptomatic. Se recomanda consiliere genetica in cazul familiilor afectate.<br />
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<span style="font-size: x-small;">sursa foto: https://www.gemssforschools.org/conditions/sotos/default</span><br />
<span style="font-size: x-small;">http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2002000200009</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-1339318589378762412016-10-07T23:16:00.001+03:002019-08-25T09:23:26.113+03:00Tiroidita postiradiere <div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgQ01XiXJ8Ac9chMhzTIiu04Uaet-VDrdZYBAxY3Y3ueAYKzfnBXmiLbXPZvKGM7HGIwooJdlijghmp_Zw8MCw1AP6Ok2ldJEb5JJUREOuPhZJB4PHE7eH3WQWdQCxRC_bYJPjFEa14dk/s1600/ThyroidRadiationBychkov5-24.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="tiroida dupa radiatii" border="0" data-original-height="1142" data-original-width="1600" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgQ01XiXJ8Ac9chMhzTIiu04Uaet-VDrdZYBAxY3Y3ueAYKzfnBXmiLbXPZvKGM7HGIwooJdlijghmp_Zw8MCw1AP6Ok2ldJEb5JJUREOuPhZJB4PHE7eH3WQWdQCxRC_bYJPjFEa14dk/s400/ThyroidRadiationBychkov5-24.jpg" title="tiroidita postiradiere" width="400" /></a></div>
<span style="font-family: inherit;">Tiroidita postiradiere este o forma de tiroidita acuta, dureroasa, secundara tratamentului cu iod radioactiv (utilizat in managementul hipertiroidismului) sau radioterapiei pentru cancerele de cap, gat sau limfom, determinand distructia tesutului tiroidian. </span><br />
<span style="font-family: inherit;">Boala afecteazã aproximativ 1% din pacientii tratati cu iod radioactiv pentru <a href="http://www.endocrinopedia.info/2015/07/boala-basedow-graves.html">boala Basedow Graves </a>(la 1-2 saptamani de la procedura terapeutica).</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Manifestarile clinice sunt reprezentate de </span><span style="font-family: inherit;"><a href="http://www.endocrinopedia.info/2015/07/ce-este-gusa.html">gusa</a> dureroasa sau sensibilitate in zona cervicala anterioara si e</span><span style="font-family: inherit;">xacerbarea hipertiroidiei.</span><br />
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<span style="font-family: inherit;">Managementul terapeutic consta in admnistrarea de antiinflamatorii nesteroidiene in asociere cu corticoterapia (in doza de 40-60 mg/zi, ulterior cu scaderea progresivã a dozelor) si cu betablocante.</span><br />
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<span style="font-family: inherit;">Afectiunea evolueaza, in general, cu fibrozarea tiroidei, intr-un interval de 6-18 saptamani.</span><br />
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<span style="font-size: x-small;"><span style="font-family: inherit;">sursa foto: </span>http://www.pathologyoutlines.com/imgau/thyroid/ThyroidRadiationBychkov5-24.jpg</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-34918567133649197272016-08-24T18:24:00.001+03:002019-08-25T09:26:39.181+03:00Tirotropinomul (adenomul hipofizar secretant de TSH)<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBR6ITVT02zspUERZ7AGCPvS5n-8VHMemGWe3fWmWeOgJP2pRconu2cf33agfzbT3C-pp_hXgQCb6x_30hon8IytcHb87Yl9dNepLdQYwJNem2jrP7pSbxGLllG7nvHF0Pg5uRL38dQH8/s1600/IndianJNuclMed_2016_31_2_141_178322_u1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="tirotropinom" border="0" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBR6ITVT02zspUERZ7AGCPvS5n-8VHMemGWe3fWmWeOgJP2pRconu2cf33agfzbT3C-pp_hXgQCb6x_30hon8IytcHb87Yl9dNepLdQYwJNem2jrP7pSbxGLllG7nvHF0Pg5uRL38dQH8/s400/IndianJNuclMed_2016_31_2_141_178322_u1.jpg" title="adenom hipofizar secretant de TSH" width="400" /></a></div>
Adenomul hipofizar secretant de TSH, cunoscut si sub denumirea de tirotropinom sau TSHom, este o tumora extrem de rar intalnita in cadrul patologiei hipofizare (< 1% din cazuri), fiind caracterizata prin <a href="http://www.endocrinopedia.info/2015/07/ce-este-gusa.html">gusa difuza</a>, semne de hipertiroidism si <a href="http://www.endocrinopedia.info/2015/07/sindromul-tumoral-hipofizar.html">sindrom tumoral hipofizar</a>.<br />
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In majoritatea cazurilor, tirotropinoamele au dimensiuni de peste 10 mm si secreta izolat TSH. In peste 50% din cazuri, pe langa secretia de TSH, s-au raportat secretii concomitente de hormon de crestere si, mai rar, de prolactina (5%). In cazuri rare, TSHom-ul se poate asocia cu <a href="http://www.endocrinopedia.info/2015/07/neoplazia-endocrina-multipla-tip-1.html">neoplazia endocrina multipla de tip 1</a>.<br />
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Profilul hormonal evidentiaza un nivel crescut al hormonilor tiroidieni (FT4, FT3), cu un TSH inadecvat crescut sau normal. In cazul tumorilor cu secretie mixta se asociaza un nivel crescut al prolactinei si al hormonului de crestere.<br />
Testarile hormonale dinamice evidentiaza absenta raspunsului TSH-ului la administrarea de TRH.<br />
Explorarile imagistice (<a href="http://www.endocrinopedia.info/2015/07/rmn-ul-hipofizar.html">RMN-ul hipofizar</a> sau Octreoscan-ul) evidentiaza tumora cu localizare hipofizara.<br />
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Afectiunea trebuie diferentiata de sindromul de rezistenta la hormonii tiroidieni, de tratamentul cu amiodarona si de unele anomalii ereditare ale proteinelor de legare ale hormonilor tiroidieni.<br />
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Managementul tirotropinomului consta in:<br />
- tratament medicamentos cu: agonisti de somatostatina (Octreotid, Lanreotid) - pentru scaderea TSH-ului si a volumului tumoral si antitiroidiene de sinteza (<a href="http://www.endocrinopedia.info/2015/07/thyrozol-prospect-indicatii.html">Thyrozol</a>, Carbimazol) - pentru contracararea efectelor hormonilor tiroidieni in exces;<br />
- tratament chirurgical (curativ in majoritarea microadenoamelor si in aproximativ 30% din cazurile de macroadenom hipofizar);<br />
- radioterapia - in cazul in care interventia chirurgicala nu a fost curativa.<br />
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<span style="font-size: x-small;">http://www.ijnm.in/article.asp?issn=0972-3919;year=2016;volume=31;issue=2;spage=141;epage=143;aulast=Okuyucu</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-911759586557497652016-08-15T14:31:00.004+03:002019-08-25T09:28:59.645+03:00Ce este tireotoxicoza factitia?<div class="MsoNormal">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZbkrVg57lF2OVYccoFfGckwaBFyHQZqyfEb4wKHvqXaYWQgwUlmgFDBB_NVbNfhPWwSqjx4NWCfCFscCN8HpSYX9Js4FuDktpDIz3Oc85jJjvjm0Do2HTtZC1AqAtdPeiCgTJAFH3XB8/s1600/landscape-1450186023-g-different-medicines-171626219.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="tireotoxicoza" border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZbkrVg57lF2OVYccoFfGckwaBFyHQZqyfEb4wKHvqXaYWQgwUlmgFDBB_NVbNfhPWwSqjx4NWCfCFscCN8HpSYX9Js4FuDktpDIz3Oc85jJjvjm0Do2HTtZC1AqAtdPeiCgTJAFH3XB8/s400/landscape-1450186023-g-different-medicines-171626219.jpg" title="tireotoxicoza factitia" width="400" /></a></div>
<span style="font-family: inherit;"><span style="font-size: 12pt; line-height: 115%;">Tireotoxicoza factitia este o afectiune</span><span style="font-size: 12pt; line-height: 115%;"> psihica intalnita mai frecvent in randul femeilor care
folosesc tratamentul cu hormoni tiroidieni pentru controlul greutatii corporale.</span></span><br />
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<span style="font-size: 12pt; line-height: 115%;">Manifestarile clinice ale acestei forme de tireotoxicoza cu hipofunctie tiroidiana sunt reprezentate de: scadere</span><span style="font-size: 12pt; line-height: 115%;"> ponderala, nervozitate, palpitatii,
tahicardie si tremor. Comparativ cu formele clasice de hipertiroidism (<a href="http://www.endocrinopedia.info/2015/07/boala-basedow-graves.html">boala Basedow Graves</a>, <a href="http://www.endocrinopedia.info/2015/07/adenomul-toxic-tiroidian-boala-plummer.html">adenomul toxic</a> sau gusa hipertiroidiazata), tireotoxicoza factitia nu prezinta <a href="http://www.endocrinopedia.info/2015/07/ce-este-gusa.html">gusa</a> sau <a href="http://www.endocrinopedia.info/2015/07/exoftalmia-din-boala-basedow-graves.html">oftalmopatie tiroidiana</a>.</span></span><br />
<span style="font-family: inherit;"><span style="font-size: 12pt; line-height: 115%;"><br /></span>
<span style="font-size: 12pt; line-height: 115%;">Profilul hormonal pe linie tiroidiana deceleaza un nivel crescut al hormonilor tiroidienei (T3 si T4) si cu un nivel scazut al TSH-ului, iar scintigrafia tiroidiana evidentiaza o captare scazuta sau absenta a iodului radioactiv. Pacientele afectate necesita tratament psihiatric de specialitate.</span></span><br />
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<span style="font-family: inherit; font-size: x-small; line-height: 115%;">sursa foto: http://www.netdoctor.co.uk/medicines/a4461/is-it-dangerous-to-take-different-medicines-at-the-same-time/</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-35463904131261316422016-07-28T16:14:00.001+03:002019-08-25T09:29:40.829+03:00Sindromul Cowden (sindromul hamartoamelor multiple)<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmxRgzd7VRIJzaNJKFlnnPtzOh0aa55-MGCgCM57YmGmskFptFrzwHm9SyHOYK0bLqf0eA1CPCPm0nQe07JBZTFXPHqkDybiggjAqvdeTUUlh4u1bUxrDv_7db9DT3od6q1XgrwIGaMPE/s1600/28599.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" border="0" height="252" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmxRgzd7VRIJzaNJKFlnnPtzOh0aa55-MGCgCM57YmGmskFptFrzwHm9SyHOYK0bLqf0eA1CPCPm0nQe07JBZTFXPHqkDybiggjAqvdeTUUlh4u1bUxrDv_7db9DT3od6q1XgrwIGaMPE/s320/28599.jpg" title="sindrom cowden" width="320" /></a></div>
<span style="font-family: inherit;"><span style="line-height: 115%;">Sindromul Cowden este o afectiune genetica rara (1 caz la 200000 de indivizi) cu transmitere autozomal dominanta, cauzata de prezenta mutatiei de inactivare a genei PTEN situata pe bratul lung al cromozomul 10 (cr 10q23) care</span><span style="line-height: 115%;"> asociaza hamartoame multiple cu crestere ponderala si diverse endocrinopatii (aproximativ 75% dintre acestea fiind reprezentate de patologia </span></span><span style="font-family: inherit; line-height: 115%;">tiroidiana)</span><span style="font-family: inherit; line-height: 115%;">. De asemenea, mutatii ale genelor SDHB, SDHD si KLLN au fost descrise ca fiind implicate in producerea bolii.</span></div>
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<span style="font-family: inherit; line-height: 115%;">Pacientii afectati prezinta un risc crescut de cancer mamar, tiroidian, renal, colorectal, de endometru si de piele (melanom), care, in general, se manifesta la varste tinere.</span></div>
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<b>Manifestarile clinice sindromului Cowden </b>sunt reprezenate de:</div>
<ul>
<li><span style="line-height: 18.4px;">hamartoame cutanate si mucoase multipe;</span></li>
<li><span style="line-height: 18.4px;">cancer mamar;</span></li>
<li><span style="line-height: 18.4px;">fibrochiste mamare;</span></li>
<li><span style="line-height: 18.4px;">crestere ponderala;</span></li>
<li><span style="line-height: 18.4px;">macrocefalie;</span></li>
<li><span style="line-height: 18.4px;">retard mintal;</span></li>
<li><span style="font-family: inherit; line-height: 18.4px;">gangliocitom displazic al cerebelului (boala Lhermitte-Duclos);</span></li>
<li><span style="font-family: inherit;">adenom tiroidian;</span></li>
<li><span style="line-height: 115%;"><span style="font-family: inherit;">gusa nodulara;</span></span></li>
<li><span style="font-family: inherit;">carcinom tiroidian nonmedular (cel mai frecvent folicular);</span></li>
<li><span style="line-height: 115%;"><span style="font-family: inherit;"><a href="http://www.endocrinopedia.info/2015/07/hiperparatiroidismul-primar.html">adenom paratiroidian</a> – foarte rar;<o:p></o:p></span></span></li>
<li><span style="font-family: inherit;"><span style="font-family: inherit; line-height: 115%;">alte afectiuni cutanate (lipoame, fibroame).</span></span></li>
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<span style="font-family: inherit;"><span style="line-height: 115%;"><b>Managementul</b> boli consta in administrare de retinoizi orali (care reusesc sa controleze, cel putin temporar leziunile cutanate) si tratament chirurgical. </span></span><br />
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Avand in vedere riscul oncologic extrem de crescut al pacientilor afectati, se recomanda o monitorizare stransa a acestora.</div>
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<span style="font-size: x-small;">sursa foto: http://emedicine.medscape.com/article/1093383-clinical#b4</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0tag:blogger.com,1999:blog-671585039839342502.post-23463900059161987092016-07-19T22:10:00.000+03:002019-08-25T09:31:12.855+03:00Disfunctia erectila<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOZS24jzwgVErSaB0J0aBKZWKhdn6YCeH9raVwobKy4VNSZDI70ka3bG3g-k8SqbFitQ780UPGsKqQXD8_4yDK2Q4-cdy2I6jPUedpBxE_vi37ME9PK5YMMt01sntbZC02qSta37aPJZw/s1600/dt_141028_depressed_senior_erectile_dysfunction_800x600.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="tulburari de dinamica sexuala" border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOZS24jzwgVErSaB0J0aBKZWKhdn6YCeH9raVwobKy4VNSZDI70ka3bG3g-k8SqbFitQ780UPGsKqQXD8_4yDK2Q4-cdy2I6jPUedpBxE_vi37ME9PK5YMMt01sntbZC02qSta37aPJZw/s400/dt_141028_depressed_senior_erectile_dysfunction_800x600.jpg" title="disfunctia erectila" width="400" /></a></div>
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<span style="font-family: inherit;"><span style="line-height: 18.4px;"><b>Disfunctia erectila </b>reprezinta<b> </b></span><span style="line-height: 115%;">imposibilitatea
barbatului de a obtine si mentine o erectie suficienta pentru a putea intretine un
raport sexual satisfacator. Afectiunea poate asocia scaderea libidoului si/sau tulburari de ejaculare.</span></span></div>
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<span style="font-family: inherit;">Disfunctia sexuala masculina afecteaza aproximativ <span style="line-height: 115%;">10% dintre barbati, peste </span><span style="line-height: 115%;">50% avand varsta peste 70 ani. Afectiunea se asociaza mai frecvent diabetetului zaharat, obezitatii, hipertensiunii arteriale, bolilor cardiovasculare si hipertrofiei benigne de prostata.</span></span></div>
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<span style="font-family: inherit;">Disfunctia erectila poate fi psihogena, organica sau mixta:</span><br />
<span style="font-family: inherit;"><b>1. Disfunctia erectila psihogena:</b></span><br />
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- este mai frecventa la tineri<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- sunt implicati factori individuali sau de cuplu: <o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- autodevalorizarea
prin experiente sexuale cu partenere nepotrivite;<o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- fobii si aversiuni
fata de partenera;<o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- istoric de dominanta familiala materna;<o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- abuz sexual in
copilarie;<o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- teama de sarcina sau
de boli cu transmitere sexuala;<o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- homosexualitatea sau
alte deviatii sexuale;<o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- complexe legate de
procesul de imbatranire;<o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- depresie;</span></span><br />
<span style="font-family: inherit; font-size: 12pt;">- stres
social sau profesional.</span></div>
<span style="font-family: inherit;"><span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;"><span style="font-weight: bold;">2. Disfunctia erectila organica</span> este determinata de:</span></span><br />
<span style="font-family: inherit;"><span style="font-family: inherit;">- </span></span><b><span style="font-size: 12pt;">factori locali: </span></b><span style="font-size: 16px;">malformatii congenitale, traumatisme, boala Peyronié (fibroza idiopatica a corpului cavernos), disfunctii veno-ocluzive congenitale;</span><br />
<span style="font-size: 16px;">- </span><b><span style="font-size: 12pt;">factori vasculari: </span></b><span style="font-family: inherit; font-size: 12pt;">leziuni ateromatoase, </span><span style="font-family: inherit; font-size: 12pt;">arteriopatii periferice, </span><span style="font-family: inherit; font-size: 12pt;">anomalii congenitale ale arterelor pelviene/peniene si ale sistemului</span><span style="font-family: inherit; font-size: 12pt;"> </span><span style="font-family: inherit; font-size: 12pt;">veno-ocluziv al corpilor cavernosi - </span><span style="font-family: inherit; font-size: 12pt;">scad fluxul sangvin catre spatiile lacunare, ceea ce determina scaderea </span><span style="font-family: inherit; font-size: 12pt;">rigiditatii si cresterea</span><span style="font-family: inherit; font-size: 12pt;"> timpului pana la o erectie completa;</span><br />
<span style="font-family: inherit; font-size: 12pt;">- </span><b><span style="font-size: 12pt;">factori neurogeni: </span></b><span style="font-size: 16px;">leziuni traumatice, degenerative (sleroza multipla), inflamatorii ale sistemului nervos central sau ale maduvei spinarii, neuropatia periferica (cauzata de diabet zaharat, alcoolism) sau autonoma;</span><br />
<span style="font-size: 16px;">- </span><b><span style="font-size: 12pt;">factori endocrini: </span></b><span style="font-size: 12pt;">hipogonadism primar sau secundar,<a href="http://www.endocrinopedia.info/2015/07/prolactinomul-si-hiperprolactinemia.html"> hiperprolactinemie</a></span><span style="font-size: 12pt;">, hipotiroidism, hipertiroidism, tumori feminizante;</span><br />
<span style="font-size: 12pt;">- </span><b><span style="font-size: 12pt;">boli metabolice: </span></b><span style="font-size: 16px;">dislipidemii, diabet zaharat (prin complicatiile macrovasculare si neurologice asociate cu scaderea nivelului de NO-sintetaza in tesutul endotelial si neural);</span><br />
<span style="font-size: 16px;">- </span><b><span style="font-size: 12pt;">boli sistemice: </span></b><span style="font-size: 16px;">insuficienta cardiaca, insuficienta respiratorie, ciroza hepatica, <a href="http://www.endocrinopedia.info/2015/07/hemocromatoza-sau-diabetul-bronzat.html">hemocromatoza</a>;</span><br />
<span style="font-size: 16px;">- </span><b><span style="font-size: 12pt;">factori toxici: </span></b><span style="font-size: 16px;">etilism cronic, tabagism, consum de droguri (marijuana, heroina, metadona);</span><br />
<span style="font-size: 16px;">- </span><b><span style="font-size: 12pt;">factori iatrogeni: </span></b><span style="font-size: 12pt;">interventii chirurgicale in sfera pelvina (prostatectomie), iradiere, medicamente: acetat de ciproteron, agonisti de GnRH, estrogeni, glucocorticoizi, betablocante, blocante de calciu, diuretice (spironolactona), agonsti H2 (ranitidina, cimetidina), tranchilizante, benzodiazepine, antidepresive, interferon alfa, inhibitori de 5 alfa-reductaza -</span><span style="font-size: 12pt;"> actioneaza direct sau indirect la nivelul corpilor cavernosi, prin scaderea presiunii sangvine la nivel pelvin.</span><br />
<b><br /></b>
<span style="font-family: inherit;"><b>
</b><span style="font-family: inherit;"><b>3. Disfunctia erectila mixta:</b> asociaza factori psihogeni si organici.</span></span><br />
<span style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></span>
<span style="font-family: inherit;">
<span style="font-family: inherit;"><b>Manifestarile clinice</b> ale bolii sunt reprezentate de:</span></span><br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit;"><span style="font-size: 12.0pt; line-height: 115%;">-
incapacitatea de initiere si mentinere a erectiei</span><span style="font-size: 12pt; line-height: 115%;"> (turgescenta peniana scazuta, libidou scazut);</span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; font-size: 12.0pt; line-height: 115%;">- simptome de hipogonadism: libidou scazut, hipotrofie musculara, fara istoric de
erectie;<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; font-size: 12.0pt; line-height: 115%;">- atrofie testiculara;</span><br />
<span style="font-family: "times new roman" , serif;"><span style="line-height: 18.4px;"><span style="font-family: "times new roman" , serif;">- </span></span></span><span style="font-family: inherit; font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">boala Peyronié (fibroza idiopatica a corpului cavernos);</span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">- ginecomastie.</span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;"><b>Investigatii</b>:</span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: inherit;">Obligatorii:</span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit;"><span style="font-size: 12.0pt; line-height: 115%;">Analize biochimice:<b> </b></span><span style="font-size: 16px; line-height: 18.4px;">glicemia, profil lipidic, functia renala si hepatica, feritina (hemocromatoza)</span></span></div>
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<span style="font-family: inherit;"><span style="font-size: 12.0pt; line-height: 115%;">Profil hormonal: testosteron, prolactina, </span><span style="font-size: 12.0pt; line-height: 115%;">FSH, LH, evaluarea functiei</span><span style="font-size: 12pt; line-height: 115%;"> tiroidiene (TSH,
FT4)</span><span style="font-size: 12pt; line-height: 115%;"> </span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit;"><span style="font-size: 12pt; line-height: 115%;">Aditionale:</span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; font-size: 12.0pt; line-height: 115%;">-
studii de tumescenta si rigiditate peniana <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit;"><span style="font-size: 12.0pt; line-height: 115%;">-
injectare intracavernoasa cu vasodilatatoare: papaverina, sildenafil, alprostadil
E1 </span><span style="font-size: 12.0pt; line-height: 115%;">- </span><span style="font-size: 12.0pt; line-height: 115%;">o erectie sustinuta exclude o insuficienta vasculara semnificativa<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit;"><span style="font-size: 12.0pt; line-height: 115%;">- ecografia Doppler peniana/angiografia peniana/perfuzie dinamica in
cavernosografie sau cavernosometrie </span><span style="font-size: 12.0pt; line-height: 115%;">-</span><span style="font-size: 12.0pt; line-height: 115%;"> sunt evaluati
fluxul arterial cavernos si insuficienta venoasa<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; font-size: 12.0pt; line-height: 115%;">-
testare neurologica (perceptia vibratiei cu biotensiometru gradat, potentiale
evocate somatosenzitive)<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; font-size: 12.0pt; line-height: 115%;">-
testare psihologica<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: inherit; font-size: 12.0pt; line-height: 115%;"><b>Managementul disfunctiei erectile consta in:</b></span><br />
<span style="font-family: inherit; font-size: 12.0pt; line-height: 115%;">- psihoterapie si tratament cu anxiolitice si/sau antidepresive (in cazul disfunctiei erectile psihogene),</span><br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
tratamentul patologiei de fond (in cazul disfunctiei erectile organice) si <span style="font-family: inherit; font-size: 12pt;">sistarea medicamentelor implicate in producerea bolii.</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: inherit; font-size: 12pt;"></span><br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: inherit; font-size: 12pt;">Preparatele medicamentoase cu efecte benefice in tratarea disfunctiei erectile sun reprezentate de:<o:p></o:p></span><br />
<b><span style="font-size: 12pt;">Inhibitori de 5 fosfodiesteraza:</span></b><span style="font-size: 12pt;"> </span><i style="font-size: 12pt;">Sildenafil</i><span style="font-size: 12pt;"> (Viagra), V</span><i style="font-size: 12pt;">ardenafil</i><span style="font-size: 12pt;"> (Levitra), </span><i style="font-size: 12pt;">Tadalafil</i><span style="font-size: 12pt;"> (Cialis), care </span><span style="font-size: 16px;">se administreaza cu aproximativ 30-60 minute inaintea actului sexual</span><br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: inherit; font-size: 12pt;"><b>Androgeni </b>- cu indicatie in </span><span style="font-family: inherit; font-size: 12pt;">hipogonadism si hiperprolatctinemie </span><br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: inherit; font-size: 12pt;"><b>Alprosatid (Prostaglandina E)</b></span><span style="font-family: inherit; font-size: 12pt;">, cu administrare intrauretrala<b> - </b>se indica in cazul pacientilor </span><span style="font-family: inherit; font-size: 12pt;">nonresponder la tratamentul oral cu vasodilatatoare</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: inherit;"><b><span style="font-size: 12pt;">Injectare intracavernoasa </span></b><span style="font-size: 12pt;">cu papaverina sau alprostadil reuseste sa</span></span><span style="font-family: inherit; font-size: 12pt;"> antrene zeo erectie temporara</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: inherit; font-size: 12pt;"><b><br /></b></span>
<span style="font-family: inherit; font-size: 12pt;"><b>Dispozitive cu vacuum:</b></span><br />
<span style="font-family: inherit; font-size: 12pt;"><b>- </b>realizeaza </span><span style="font-family: inherit; font-size: 12pt;">constrictie prin vid;</span><br />
<span style="font-family: inherit; font-size: 12pt;">-</span><span style="font-family: inherit; font-size: 12pt;"> atrag sangele venos in penis cu ajutorul unui inel de constrictie si se redirectioneaza intoarcerea venoasa </span><span style="font-family: inherit; font-size: 12pt;">pentru</span><span style="font-family: inherit; font-size: 12pt;"> a se mentine erectia;</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: inherit; font-size: 12pt;">- reprezinta o alternativa pentru pacientii care au contraindicatii la inhibitorii de 5 fosfodiesteraza sau la alte proceduri terapeutice.</span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCiNVx6iygTyYFg0ul_sWGcBw4e8VFtLsQmY6vcfNF_C31bv4ezMRD62CIYlEbPwlg15RTM9V4mOtzN6O4_olsMxF8CaI5U5_fMOhRmC6iM6WehouSIpD8BaNFPNMpqFdPyTMmMdWyXlU/s1600/AB-Still-iM04-small.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img alt="" border="0" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCiNVx6iygTyYFg0ul_sWGcBw4e8VFtLsQmY6vcfNF_C31bv4ezMRD62CIYlEbPwlg15RTM9V4mOtzN6O4_olsMxF8CaI5U5_fMOhRmC6iM6WehouSIpD8BaNFPNMpqFdPyTMmMdWyXlU/s400/AB-Still-iM04-small.jpg" title="dispozitive cu vacuum disfunctie sexuala" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dispozitive cu vacuum</td></tr>
</tbody></table>
<span style="font-family: inherit; font-size: 12pt;"><b style="font-size: medium;"><span style="font-size: 12pt;">Revascularizatia chirurgicala este </span></b><span style="font-size: 12pt;">indicata in disfunctia erectila refractara la celelalte forme de tratament.</span></span><br />
<span style="font-family: inherit; font-size: 12pt;"><span style="font-size: 12pt;"><br /></span></span>
<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: inherit;"><b><span style="font-size: 12pt;">Proteze peniene (semirigide sau gonflabile)</span></b><span style="font-size: 12pt;"> determina o </span><span style="font-size: 12pt;">erectie artificiala </span></span><span style="font-family: inherit; font-size: 12pt;">si sunt indicate in disfunctia erectila refractara la celelalte forme de tratament</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: inherit; font-size: 12pt;"><br /></span>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh7i-iUw8HlbJGsfjdC89GIT_KNeq67ck1nLIUNxh230GtH0VQtnzNsoLxsn8H8tCmmLTf3BydyBytKeRd2sxe9jSxx9P5mCygFCrE4Mm8wBYEm8xF6Ko7sO1t3gBzgeBBGj98YQi95us/s1600/proteza-pracia.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="proteza penis" border="0" height="259" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh7i-iUw8HlbJGsfjdC89GIT_KNeq67ck1nLIUNxh230GtH0VQtnzNsoLxsn8H8tCmmLTf3BydyBytKeRd2sxe9jSxx9P5mCygFCrE4Mm8wBYEm8xF6Ko7sO1t3gBzgeBBGj98YQi95us/s400/proteza-pracia.jpg" title="proteza peniana" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Proteza peniana</td></tr>
</tbody></table>
<span style="font-family: inherit; font-size: x-small;">sursa foto: http://www.medscape.com/viewarticle/844181</span></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<span style="font-family: inherit; font-size: x-small;">http://hifu.pl/aktualnosci/hydrauliczna-proteza-pracia/</span><br />
<span style="font-family: inherit; font-size: x-small;">http://www.imedicare.co.uk/</span>Dr. Oana Stanoiu-Pinzariuhttp://www.blogger.com/profile/08621965283793001671noreply@blogger.com0