RESUMO
INTRODUCCIÓN: La forma clínica de presentación más común del neuroblastoma es el de una masa abdominal, pero puede presentarse con sintomatología menos habitual, como es la crisis adrenérgica por liberación de catecolaminas. OBJETIVO: Describir una forma de presentación inusual de neuroblastoma y el amplio diagnóstico diferencial que existe en un lactante con síntomas adrenérgicos. CASO CLÍNICO: Lactante femenina de 7 semanas de vida, consultó por historia de tres semanas de sudoración e irritabilidad a lo que se asoció fiebre de 24 h de evolución y dificultad respiratoria. Al ingreso presentaba mal esta do general, irritabilidad, sudoración, enrojecimiento facial, taquipnea y palidez cutánea, taquicardia sinusal extrema e hipertensión arterial (HTA), interpretadas como sintomatología adrenérgica. Se completó el estudio con una ecografía abdominal y resonancia magnética que mostraron una gran masa retroperitoneal compatible con neuroblastoma. Las catecolaminas en sangre y en orina mostraron altos niveles de dopamina, adrenalina y noradrenalina, probablemente de origen tumoral. Se inició tratamiento antihipertensivo con fármacos alfa bloqueantes con buen control de la tensión arterial. Se resecó quirúrgicamente el tumor sin incidencias y con una adecuada recuperación posterior. La paciente presentó evolución favorable a tres años de seguimiento. CONCLUSIONES: en un lactante con sintomatología adrenérgica como irritabilidad, enrojecimiento, sudoración asociada a HTA, se debe descartar patología cardiaca, metabólica (hipoglucemia), intoxicaciones y/o patología suprarrenal. Dentro de esta última, el neuroblastoma es la primera posibilidad diagnóstica, por ser uno de los principales tumores en la infancia y aunque esta presentación no es habitual puede producir estos síntomas.
INTRODUCTION: The most common clinical presentation of neuroblastoma is an abdominal mass, but it can present with uncommon symptoms, such as adrenergic storm due to catecholamine release. OBJECTIVE: To describe an unusual presentation of neuroblastoma and the wide differential diagnosis that exists in an infant with adrenergic symptoms. CLINICAL CASE: A 7-week old female infant was evaluated due to a 3-week history of sweating and irritability associated with a 24-hour fever and respiratory distress. At admission, she presented poor general condition, irritability, sweating, facial redness, tachypnea and skin paleness, extreme sinus tachycardia, and high blood pressure (HBP), interpreted as adrenergic symptoms. The study was completed with abdominal ultrasound and magnetic reso nance imaging that showed a large retroperitoneal mass compatible with neuroblastoma. Plasma and urinary catecholamines tests showed high levels of dopamine, adrenaline, and noradrenaline, probably of tumor origin. We started antihypertensive treatment with alpha-blocker drugs, showing a good blood pressure control. The tumor was surgically resected without incidents and adequate subsequent recovery. The patient presented a favorable evolution after three years of follow-up. CONCLUSIONS: In an infant with adrenergic symptoms such as irritability, redness, sweating associated with HBP, it should be ruled out pathology heart or metabolic (hypoglycemia) pathology, intoxications, and/or adrenal pathology. Within this last one, neuroblastoma is the first diagnostic possibility, since it is one of the main tumors in childhood and, although this presentation is not usual, it can produce these symptoms.
Assuntos
Humanos , Feminino , Lactente , Neoplasias Retroperitoneais/diagnóstico , Sudorese , Taquicardia/etiologia , Catecolaminas/urina , Rubor/etiologia , Hipertensão/etiologia , Neuroblastoma/diagnóstico , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/urina , Taquicardia/diagnóstico , Humor Irritável , Biomarcadores Tumorais/urina , Diagnóstico Diferencial , Hipertensão/diagnóstico , Neuroblastoma/complicações , Neuroblastoma/urinaRESUMO
INTRODUCTION: The most common clinical presentation of neuroblastoma is an abdominal mass, but it can present with uncommon symptoms, such as adrenergic storm due to catecholamine release. OBJECTIVE: To describe an unusual presentation of neuroblastoma and the wide differential diagnosis that exists in an infant with adrenergic symptoms. CLINICAL CASE: A 7-week old female infant was evaluated due to a 3-week history of sweating and irritability associated with a 24-hour fever and respiratory distress. At admission, she presented poor general condition, irritability, sweating, facial redness, tachypnea and skin paleness, extreme sinus tachycardia, and high blood pressure (HBP), interpreted as adrenergic symptoms. The study was completed with abdominal ultrasound and magnetic reso nance imaging that showed a large retroperitoneal mass compatible with neuroblastoma. Plasma and urinary catecholamines tests showed high levels of dopamine, adrenaline, and noradrenaline, probably of tumor origin. We started antihypertensive treatment with alpha-blocker drugs, showing a good blood pressure control. The tumor was surgically resected without incidents and adequate subsequent recovery. The patient presented a favorable evolution after three years of follow-up. Con clusions: In an infant with adrenergic symptoms such as irritability, redness, sweating associated with HBP, it should be ruled out pathology heart or metabolic (hypoglycemia) pathology, intoxications, and/or adrenal pathology. Within this last one, neuroblastoma is the first diagnostic possibility, since it is one of the main tumors in childhood and, although this presentation is not usual, it can produce these symptoms.
Assuntos
Catecolaminas/urina , Rubor/etiologia , Hipertensão/etiologia , Neuroblastoma/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Sudorese , Taquicardia/etiologia , Biomarcadores Tumorais/urina , Diagnóstico Diferencial , Feminino , Humanos , Hipertensão/diagnóstico , Lactente , Humor Irritável , Neuroblastoma/complicações , Neuroblastoma/urina , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/urina , Taquicardia/diagnósticoRESUMO
The metabolic and hormonal consequences of high-intensity functional training regimens such as CrossFit® (CF) are unclear. Little is known about the triggers and clinical and biochemical features of CF-related overtraining syndrome (OTS). The EROS study compared endocrine and metabolic responses, and eating, social, psychological and body characteristics of OTS-affected (OTS) and healthy athletes (ATL), and non-physically active controls (NPAC). The current study is a post-hoc analysis of the CF subgroups of the EROS study, to evaluate specific characteristics of CF in ATL and OTS. Parameters were overall and pairwise compared among OTS-affected (CF-OTS) and healthy (CF-ATL) athletes that exclusively practiced CF, and NPAC. CF-ATL yielded earlier and enhanced cortisol, GH, and prolactin responses to an insulin tolerance test (ITT), increased neutrophils, lower lactate, increased testosterone, improved sleep quality, better psychological performance, increased measured-to-predicted basal metabolic rate (BMR) ratio and fat oxidation, and better hydration, when compared to NPAC. Conversely, more than 90% of the adaptive changes in CF were lost under OTS, including an attenuation of the hormonal responses to an ITT, increased estradiol, decreased testosterone, and decreased BMR and fat oxidation; the most remarkable trigger of OTS among "HIFT athletes" was the long-term low carbohydrate and calorie intake.
Assuntos
Transtornos Traumáticos Cumulativos/etiologia , Transtornos Traumáticos Cumulativos/metabolismo , Condicionamento Físico Humano/efeitos adversos , Condicionamento Físico Humano/métodos , Adolescente , Adulto , Afeto/fisiologia , Biomarcadores/metabolismo , Fenômenos Biomecânicos , Catecolaminas/urina , Transtornos Traumáticos Cumulativos/fisiopatologia , Técnicas de Diagnóstico Endócrino , Estradiol/sangue , Hormônio do Crescimento Humano/sangue , Humanos , Hidrocortisona/análise , Hidrocortisona/sangue , Sistema Hipotálamo-Hipofisário/fisiologia , Insulina/sangue , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Sistema Hipófise-Suprarrenal/fisiologia , Prolactina/sangue , Saliva/química , Sono/fisiologia , Testosterona/sangue , Adulto JovemRESUMO
Pheochromocytoma and Ganglioneuroblastoma are separate diseases and a rare combination in which the diagnosis can only be confirmed by pathological examination after tumor excision. We reported here a case of ganglioneuroblastoma encapsulated in pheochromocytoma. The patient is a woman, 73 years old, hypertensive, with hypothyroidism, associated for 15 years with hypercholesterolemia and hypertriglyceridemia, which had frequent complaints of low back pain. She underwent magnetic resonance and the findings were consistent with the diagnosis of pheochromocytoma. After surgery, anatomic, pathologic and immunohistochemistry analysis confirmed the diagnosis of pheochromocytoma composed by small ganglioneuroblastoma representation with the identification of small focus of infiltration of the adrenal capsule and adipose tissue by pheochromocytoma. This rare association can instigate the discussion of methods of diagnosis, more effective and more appropriate treatments for each patient.
Assuntos
Neoplasias das Glândulas Suprarrenais/patologia , Ganglioneuroblastoma/patologia , Imageamento por Ressonância Magnética , Neoplasias Primárias Múltiplas/patologia , Feocromocitoma/patologia , Doenças Raras , 3-Iodobenzilguanidina , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Idoso , Catecolaminas/urina , Diagnóstico Diferencial , Feminino , Ganglioneuroblastoma/diagnóstico por imagem , Ganglioneuroblastoma/cirurgia , Humanos , Invasividade Neoplásica , Feocromocitoma/diagnóstico por imagem , CintilografiaRESUMO
BACKGROUND: Lower socioeconomic status (SES) is associated with poorer health, possibly through activation of the sympathetic nervous system. PURPOSE: This study aimed to examine the association between SES and catecholamine levels, and variations by acculturation. METHODS: Three hundred one Mexican-American women underwent examination with a 12-h urine collection. Analyses tested associations of SES, acculturation (language and nativity), and their interaction with norepinephrine (NOREPI) and epinephrine (EPI). RESULTS: No main effects for SES or the acculturation indicators emerged. Fully adjusted models revealed a significant SES by language interaction for NOREPI (p< .01) and EPI (p< .05), and a SES by nativity interaction approached significance for NOREPI (p= .05). Simple slope analyses revealed that higher SES related to lower catecholamine levels in Spanish-speaking women, and higher NOREPI in English-speaking women. Although nonsignificant, similar patterns were observed for nativity. CONCLUSIONS: Associations between SES and catecholamines may vary by acculturation, and cultural factors should be considered when examining SES health effects in Hispanics.
Assuntos
Aculturação , Catecolaminas/urina , Americanos Mexicanos/etnologia , Classe Social , Adulto , Feminino , Nível de Saúde , Humanos , Pessoa de Meia-Idade , MulheresRESUMO
This article presents a study on the evaluation of the workload imposed to workers of two sectors of a flexible packaging manufacturer that operates in three shifts. The workers are allocated in one of the shifts (morning, evening and night shifts) without evaluation of their chronotype and/or social needs. The Imprint sector has a more dynamic work, which is done only by man due to the effort demanded by handling loads. The work in the Cutting/Welding sector is static, done mainly by women. The results showed that the overall workload was the same in the Imprint and Cutting/Welding sectors, because physical effort for load handling is higher in the former but the latter involves high static load. The levels of urinary catecholamines and salivary cortisol were consistent with the workers biological clock showing that none of the workers changed his/her biological cycle to accommodate to the time of the shift schedule.
Assuntos
Embalagem de Produtos , Soldagem , Tolerância ao Trabalho Programado , Carga de Trabalho , Adulto , Brasil , Catecolaminas/urina , Ritmo Circadiano , Feminino , Humanos , Hidrocortisona/análise , Masculino , Saliva/química , Inquéritos e QuestionáriosRESUMO
Sympathetic activation is detected by the tachycardic, hypertensive and hyperthermic responses during social conflicts in rodents and primates. Sympathetic nervous system activation promoting sodium retention has long been recognized to play a significant role in the development and maintenance of salt-sensitive hypertension. The objective was to investigate neuroendocrine activation and renal sodium excretion in response to chronic social stress. Male Wistar rats were subjected to social stress in accordance with the resident-intruder paradigm. Intruder rats were subjected to social confrontation once daily for 6 days. After the last confrontation, plasma corticosterone and urinary catecholamines were determined to assess the neuroendocrine activation. Plasma aldosterone, plasma and urinary creatinine, Na(+) , K(+) and urinary volume were also measured. Chronic social stress increased the urinary norepinephrine, dopamine and plasma corticosterone levels, with no changes in epinephrine levels. On the other hand, high plasma aldosterone levels and low urinary sodium excretion without differences in creatinine clearance were observed. In conclusion, social stress had a strong antinatriuretic effect, which is coincident with noradrenergic and corticoadrenal activation and an increase in plasma aldosterone levels. Activation of these factors may promote sodium retention, which has long been recognized to play a significant role in the development and maintenance of hypertension.
Assuntos
Natriurese/fisiologia , Sistemas Neurossecretores/metabolismo , Sódio na Dieta/metabolismo , Estresse Psicológico/metabolismo , Aldosterona/sangue , Análise de Variância , Animais , Comportamento Animal/fisiologia , Catecolaminas/urina , Doença Crônica , Corticosterona/sangue , Modelos Animais de Doenças , Feminino , Abrigo para Animais , Hipertensão/metabolismo , Rim/fisiopatologia , Masculino , Sistemas Neurossecretores/fisiopatologia , Primatas , Ratos , Ratos Wistar , Sódio na Dieta/administração & dosagem , Estresse Psicológico/sangue , Estresse Psicológico/urina , Sistema Nervoso Simpático/fisiopatologiaRESUMO
Pheochromocytoma resection is often complicated by intra-operative hypertension and post-resection hypotension. Factors associated with these hemodynamic alterations are not well defined. The aim of this study was to analyse the clinical-laboratory features associated with hemodynamic parameters during pheochromocytoma resection. Twenty-seven patients submitted to tumor resection - either open (no.=18) or video laparoscopic - between 1978-2007 were included. Nineteen received pre-operative alpha-blockers. Intra-operative hemodynamic data analysed were: maximum and minimum mean arterial blood pressure (MABP), no. of severe hypertensive (systolic BP >200 mmHg) and hypotensive episodes (MABP <60 mmHg), maximum and minimum heart rate (HR), no. of episodes of tachycardia and bradycardia, need to receive iv intra-operative treatment for hypertension and hypotension and the volume of fluids administered during surgery. Patients were 39.4+/-14.4-yr-old, 66% women. Intra-operative hemodynamic parameters were not different in patients submitted to open or video laparoscopic resection. Maximum intraoperative HR and the percentage of patients with HR>100 beats/min were higher in patients without pre-operative alpha- blocker treatment (no.=8). Pre-operative urinary vanylmandelic acid was positively associated with intra-operative maximum MABP (r=0.535, p=0.047) and with maximum transoperative systolic BP (r=0.805, p=0.016). Pre-operative urinary catecholamine (Pearson correlation r=0.575, p=0.03) and vanylmandelic acid (Pearson correlation r=0.605, p=0.04) levels were associated with maximum intra- operative MABP, adjusted for the presence of pheochromocytoma symptoms, surgical approach and pre-operative alpha-blockers. In conclusion, the degree of pre-operative catecholamine secretion was the most important aspect of transoperative BP control.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Catecolaminas/metabolismo , Hemodinâmica/fisiologia , Feocromocitoma/diagnóstico , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/metabolismo , Neoplasias das Glândulas Suprarrenais/fisiopatologia , Antagonistas Adrenérgicos alfa/uso terapêutico , Adulto , Biomarcadores/metabolismo , Biomarcadores/urina , Pressão Sanguínea/fisiologia , Catecolaminas/urina , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Feocromocitoma/metabolismo , Feocromocitoma/fisiopatologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Ectopic ACTH secretion represents 8-18% of the cases of endogenous hypercortisolism. Pheochromocytomas correspond to 2-25% of the cases and surgery is the indicated treatment. We describe a case of ACTH-secreting pheochromocytoma treated with percutaneous ethanol injection (PEI) guided by computed tomography (CT). A 71-yr-old man presented with diabetes, severe hypokalemia, weight loss, muscle weakness, and hypertension. Hormonal evaluation revealed elevated levels of urinary cortisol, ACTH, catecholamines, and urinary metanephrines. There was no cortisol or ACTH response to desmopressin stimulation test. Magnetic resonance revealed bilateral adrenal nodules, larger on the left side. The suspected diagnosis was ectopic ACTH syndrome caused by pheochromocytoma. Ketoconazole treatment resulted in reduction of urinary cortisol levels but was followed by severe cholestasis and hepatic dysfunction, preventing surgery; it was substituted by octreotide with reduction of ACTH and cortisol levels, but without improvement of cholestasis. The patient presented cachexia and developed multiple pulmonary abscesses that also prevented surgical treatment, thus he was treated with percutaneous ethanol injection guided by CT of the left adrenal tumor. During the procedure, the patient had an increase in blood pressure controlled by the infusion of sodium nitroprusside followed by hypotension that required infusion of dopamine and volume expansion. Afterwards, he presented hormonal normalization, normal catecholamines levels, and clinical improvement. Histological tissue analysis confirmed pheochromocytoma. We concluded that CT-guided PEI represents an efficient alternative therapy to ectopic ACTH-secreting pheochromocytomas in patients without clinical conditions for surgery.