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Graves’ Disease and Down Syndrome: Case Report

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Open Journal of Endocrine and Metabolic Diseases 2016年第1期6卷 20-27页

作者： Fábio Ferreira do Espírito Santo denise rosso tenório wanderley rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School Salvador Brazil Visiting Scientist of the Harvard T. H. Chan School of Public Health Harvard University Boston USA

Down syndrome (DS) is the most common chromosomal abnormality in humans, and the most frequent cause of mental retardation. Patients affected by this syndrome show an increased prevalence of autoimmune diseases. The most common of those is Hypothyroidism. We present a case report describing the association of Down syndrome with Hyperthyroidism. An 18-year-old patient presented with a history of recurrent throat infections and intermittent diarrhea, having developed a total alopecia areata within one month from the first visit to the physician. After consultations with general practitioners, he was directed to an Endocrinology Ambulatory and diagnosed with a clear case of Graves’ disease associated with Down syndrome. Treatment was started with methimazole 20 mg/day, and after two months, was adjusted to 40 mg/day. The patient reached adequate clinical and laboratory balance after five months of treatment. Thus, the association between Down syndrome and Graves’ Disease is relevant in medical practice, due to its specific characteristics on diagnosis, and the need of an adequate treatment regarding this disease association.

关键词： Down Syndrome Graves’ Disease Alopecia Areata Methimazole Thyroid Gland

Polycystic Ovary Syndrome (PCOS) and Fertility

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Open Journal of Endocrine and Metabolic Diseases 2016年第1期6卷 58-65页

作者： Guilherme Barbosa Larissa Bianca Paiva Cunha de Sá denise rosso tenório wanderley rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School Sao Paulo Brazil Harvard T. H. Chan School of Public Health Harvard University Boston USA

The polycystic ovary syndrome (PCOS) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence of polycystic ovaries on ultrasound. It represents the main endocrine disorder in the reproductive age, affecting 6% - 15% of women in menacme. It is the most common cause of infertility due to anovulation, and the main source of female infertility. When in the presence of a menstrual disorder, the diagnosis of PCOS is reached in 30% - 40% of patients with primary or secondary amenorrhoea and in 80% of patients with oligomenorrhea. PCOS should be diagnosed and treated early in adolescence due to reproductive, metabolic and oncological complications which may be associated with it. Treatment options include drugs, diet and lifestyle improvement.

关键词： Polycystic Ovary Syndrome Infertility Anovulation Hyperandrogenism Insulin Resistance

Pathophysiology of Graves’ Ophthalmopathy: A Literature Review

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Open Journal of Endocrine and Metabolic Diseases 2017年第1期7卷 77-87页

作者： Mariela Carolina Santos Carballo Bianca Paiva Cunha de Sá denise rosso tenório wanderley rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School S&atilde o Paulo Brazil Diabetology Department Malteser Krankenhaus St. Franziskus-Hospital Flensburg Germany

Graves’ ophthalmopathy (GO), an autoimmune condition associated with Graves’ disease (GD), occurs at a prevalence of nearly 40% in patients diagnosed with GD. Ocular involvement is probably due to the presence of autoantibodies in the orbital tissues, regardless of the control state of thyroid hormones in individuals with GD, even during euthyroid or hypothyroid states, which are associated with thyroid hormone treatment. In addition to the immunological role present in the pathophysiology of GO, the genetic component, proteins and cytokines, minerals (e.g., selenium), and environmental factors (e.g., smoking) also contribute to its development and occurrence of clinical manifestations in varying degrees. Until now, the interaction of causal, intermediary, and triggering factors of GO is still unclear, so the purpose of this article is to review literature on the theme.

关键词： Ophthalmopathy Graves Disease Pathophysiology

Vitamin D and Diabetes Mellitus: A Review

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Open Journal of Endocrine and Metabolic Diseases 2016年第1期6卷 1-7页

作者： Cintia Linhares e Souza Larissa Bianca Paiva Cunha de Sá denise rosso tenório wanderley rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School Sao Paulo Brazil Visiting Scientist of the Harvard T. H. Chan School of Public Health Harvard University Boston USA

Vitamin D deficiency and Diabetes are both disorders of high prevalence in the world. Currently, evidences suggest a possible correlation of low levels of vitamin D with the diagnosis of Diabetes Mellitus. Hypovitaminosis D could be associated with insulin resistance and Diabetes Mellitus, which would in part explain mechanisms involved in the pathogenesis of Diabetes. The aim of this work is to discuss the association between Vitamin D and Diabetes, questioning if vitamin D can prevent the settlement of diabetes or slow down its clinical evolution, and improve the pancreatic function, thus providing a better glycaemic control.

关键词： Vitamin D Vitamin D Deficiency Autoimmune Disease Diabetes Mellitus Insulin Resistance

The Benefits of SGLT2 Inhibitors in Cardiovascular Prevention, Glycemic Control and Weight Loss, in the Treatment of Diabetes

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Open Journal of Endocrine and Metabolic Diseases 2016年第1期6卷 87-94页

作者： Bruna de Souza Faustino Alberto dos Reis Costa Junior Letícia Nascimento Medeiros Bortolon Larissa Bianca Paiva Cunha de Sá denise rosso tenório wanderley rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School Rio de Janeiro Brazil Visiting Scientist of the Harvard School of Public Health Harvard University Boston USA

The sodium and glucose co-transporter inhibitors type 2 (SGLT2) comprises a new class of hypoglycemic drugs to control type 2 diabetes mellitus, in an attempt to add new non-existing benefits to the so far arising classes. Regarding this new class of drugs, represented by dapaglifozin, canaglifozin and empaglifozin, it is important to highlight the benefits brought by these medications to combat hyperglycemia with insulin-independent mechanisms that are beyond glucose reduction, such as cardiovascular events prevention, reduction in HbA1c, weight loss and blood pressure lowering. Recently, a relevant study (Empa-Reg) brought hope and set the spotlight on the prevention of cardiac events among diabetic patients, which is the main cause of mortality within this group. However, despite coming out as a good treatment option, SGLT2 inhibitors are under constant clinical research and, as a new drug, it should be carefully carried out regarding the long-term effects of glycosuria and other possible side effects, such as the observed increase in the incidence of bladder, breast cancer and bone fractures, which require further studies. Therefore, these compounds might represent a landmark approach for the treatment of diabetes.

关键词： Diabetes SGLT-2 Inhibitor Glycemic Control Cardiovascular Risk Empa-Reg Side Effects Weight Loss

Understanding Growth Hormone Secretion and Short Stature

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Open Journal of Endocrine and Metabolic Diseases 2016年第1期6卷 78-86页

作者： Milton Rodrigo Lafuente Covarrubias Luis Fernando de Azevedo Piovezani Frederico Martins Cordeiro William Cabrera Viana Mirella Hansen de Almeida denise rosso tenório wanderley rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School (IPEMED) Sao Paulo Brazil Fellow at the Joslin Medical Center Boston USA Visiting Scientist Harvard T. H. Chan School of Public Health Harvard University Boston USA

Short stature is a clinical challenge in the daily practice of pediatric endocrinology, regarding the several technical, cultural and economic factors associated with its approach. This article intends to review the physiology of growth hormone secretion, the endocrine regulation of human growth and the clinical aspects of the diagnosis and treatment of short stature. It specifically analyses the treatment of short stature with growth hormone, along with its side effects, cost/benefit analysis and possible risks. A clinical case from a medical school is also described, intending a better understanding of this frequent ambulatory situation in endocrinology and pediatrics.

关键词： Growth Hormone GH Treatment Short Stature Abnormal Growth Children

Gestational Diabetes Mellitus: New Diagnostic Criteria

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Open Journal of Endocrine and Metabolic Diseases 2016年第1期6卷 13-19页

作者： Letícia Nascimento Medeiros Bortolon Luciana de Paula Leão Triz Bruna de Souza Faustino Larissa Bianca Cunha de Sá denise rosso tenório wanderley rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School Sao Paulo Brazil Visiting Scholar Harvard T. H. Chan School of Public Health Harvard University Boston USA

Gestational mellitus diabetes (GDM) is a highly prevalent metabolic disorder among pregnant women nowadays. It is defined as any level of glucose intolerance, appearing or first being recognized during pregnancy. It is essential to diagnose and treat GDM early, in order to reduce or avoid complications for mother and fetus. Recently, new guidelines have changed the diagnosis criteria, and it is expected that the prevalence of GDM will increase by approximately 18%. A relevant goal of these new definitions is to provide a better care for pregnant women, in an attempt to reduce fetal and maternal complications. These new criteria will also increase the impact on costs of the health care system. Treatment must be individualized for best results, including a specific diet, physical activity and the use of medications. Metformin and Insulin use are analyzed in detail, in face of new evidences regarding their safety and efficacy during pregnancy.

关键词： Gestational Diabetes Mellitus Pregnancy Glucose Intolerance Metformin Insulin Complications

Extra Glycemic Impacts of GLP-1 Receptor Agonists: Benefits of a Class Effect?

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Open Journal of Endocrine and Metabolic Diseases 2016年第1期6卷 43-57页

作者： Lis Marina de Mesquita Araújo Sumaya Feguri Thereza Lopes de Oliveira Fernanda Batista Pedrosa Rodrigo Garcez Guimarães Larissa Bianca Paiva Cunha de Sá denise rosso tenório wanderley rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School Belo Horizonte Brazil Harvard T. H. Chan School of Public Health Boston USA

GLP-1 receptor agonists are approved for the treatment of type 2 diabetes, and more recently for obesity treatment. The glucagon-like-peptide-1 (GLP-1) is a glucose dependent hormone produced by intestinal cells, which is involved in insulin secretion and glucagon suppression. This hormone controls glucose plasma levels and reduces food intake. Additional effects were reported in slowing gastric emptying and in inducing satiety. In clinical practice, theGLP-1 receptor agonists are associated with significant reductions in glycosylated hemoglobin (HbA1c) and weight loss, despite showing a low risk of hypoglycemia. Beneficial effects have also been observed on blood pressure and lipid profile. The most common side effects associated with GLP-1 receptor agonists are gastro-intestinal motility disorders, such as nausea, vomiting and diarrhea, which are not associated with long-term health risks. Therefore, GLP-1 receptor agonists represent a relevant medication for type 2 diabetes, whose benefits may go far beyond glycemic control.

关键词： Diabetes GLP-1 Receptor Agonists Glycemic Control Extra Glicemic Effects Weight Loss Cardiovascular Risk

The Impact of the Essential Fatty Acids (EFA) in Human Health

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Open Journal of Endocrine and Metabolic Diseases 2015年第7期5卷 98-104页

作者： Alberto Krayyem Arbex Vagner Rosa Bizarro Julio Cesar Salles Santos Lis Marina Mesquita Araújo Ana Luísa Conceicao de Jesus Minelli Salles Alves Fernandes Marcela Miranda Salles denise rosso tenório wanderley rocha Aline Marcadenti Division of Endocrinology Faculdade IPEMED de Ciências Médicas (IPEMED) Rio de Janeiro Brazil Visiting Scientist of the Harvard School of Public Health Harvard University Boston USA Postgraduate Studies Program in Cardiology Instituto de Cardiologia/Fundacao Universitária de Cardiologia do Rio Grande do Sul (IC/FUC) Porto Alegre Brazil Department of Nutrition Universidade Federal de Ciências da Saúde de Porto Alegre (UFSCPA) Porto AlegreBrazil

Linoleic (LA) and α-linolenic acids (ALA) are considered essential fatty acids (EFA) because they are not produced by the human body. This way, EFAs sources must come from the diet. The primary dietary source of n-3 fatty acids is ALA, found in seeds and seed oils. Other important sources are fish oils such as tuna, salmon and herring. Currently, numerous studies suggest possible benefits of essential fatty acids in human health, such as in cardiovascular, cognitive and eye health, and also during pregnancy and childhood. This paper also discusses the impact of fatty acids in human metabolism, and the available evidence regarding its risks. It addresses the relevant debate regarding a general ban of trans fatty acids (TFA) from the world food market, because of the cardiovascular risks associated with its consumption.

关键词： Fatty Acids Linoleic Acid Alpha-Linolenic Acid Cardiovascular Health Trans Fatty Acids