RESUMO
CONTEXT: The loss of body weight and fat late in life is associated with premature death and increased risk of disability, even after excluding elderly subjects who have a preexisting disease. Although it is important to recognize that periods of substantially positive or negative energy balance and body weight fluctuation occur as a normal part of life, weight losses greater than 5% over 6 months should be investigated. We can divide the major causes of weight loss in the elderly into 4 categories: social, psychiatric, due to medical conditions, and age-related. The clinical evaluation should include a careful history and physical examination. If these fail to provide clues to the weight loss, simple diagnostic tests are indicated. A period of watchful waiting is preferable to blind pursuit of additional diagnostic testing that may yield few useful data, if the results of these initial tests are normal. The first step in managing patients with weight loss is to identify and treat any specific causative or contributing conditions and to provide nutritional support when indicated. Non-orexigenic drugs have found an established place in the management of protein-energy malnutrition. Early attention to nutrition and prevention of weight loss during periods of acute stress, particularly during hospitalization, may be extremely important, as efforts directed at re-feeding are often unsuccessful. DESIGN: Narrative review.
Assuntos
Emaciação/etiologia , Redução de Peso/fisiologia , Fatores Etários , Idoso , Envelhecimento/fisiologia , Causas de Morte , Diagnóstico Diferencial , Emaciação/fisiopatologia , Emaciação/terapia , Feminino , Humanos , MasculinoRESUMO
Säo apresentados dois pacients portadores de tumores diencefálicos (teratoma indiferenciado e glioma pilocistico) que vieron a desenvolver síndrome de Rossell. os diagnósticos histológicos foram confirmados por biópsia estereotomográfica
Assuntos
Humanos , Pré-Escolar , Criança , Masculino , Feminino , Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Diencéfalo , Emaciação/etiologia , Teratoma/complicações , Astrocitoma/patologia , Biópsia/métodos , Neoplasias Encefálicas/patologia , Diencéfalo/patologia , Técnicas Estereotáxicas , Síndrome , Teratoma/patologia , Tomografia Computadorizada por Raios XRESUMO
The case of a male child with Russel's syndrome due to a pilocytic astrocytoma located in the diencephalic region is presented. The diagnosis was made in the 16th month of age, but symptoms began in the 4th months of life, when he started losing weight. By the time he was admitted weight was 6150g and he was 74cm tall, with an emaciated aspect, no panniculus adiposus, irritated, and with symptoms of intracranial hypertension. There was convergent strabismus, vertical nystagmus of the left eye and bilateral papilledema. Tendinous reflexes were exacerbated and he had spastic tetraparesis. The endocrine evaluation showed a basal raise of GH (23ng/ml), TSH (6.2mUI/1) and prolactin (26ng/ml). The first two hormones did not respond to the acute test with TRH, while prolactin had a poor response. He was submitted to radiotherapy with linear acceleration (total dose of 4000 rads) and surgery, during which the tumor could not be completely removed due to its large size. After 9 months, the child is doing well, with a considerable weight gain (2500g).
Assuntos
Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Diencéfalo , Emaciação/etiologia , Astrocitoma/sangue , Astrocitoma/cirurgia , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/cirurgia , Humanos , Lactente , Masculino , Prolactina/sangue , Síndrome , Tireotropina/sangue , Hormônio Liberador de TireotropinaRESUMO
The Russel's syndrome is characterized by emaciation and hyperactivity in children and is caused by hypothalamic expansive process. This report presents the typical signs of the syndrome associated with growth hormone secretion disorders and precocious puberty pattern appearing at the age of four. The pathogenesis of the disorder is discussed and related to the hypothalamus-pituitary axis dysfunction caused by the tumor growth.
Assuntos
Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Diencéfalo , Emaciação/etiologia , Puberdade Precoce/etiologia , Astrocitoma/terapia , Neoplasias Encefálicas/terapia , Terapia Combinada , Feminino , Humanos , Lactente , Obesidade/etiologia , SíndromeRESUMO
A síndrome de Russel é caracterizada por emaciaçäo e hiperatividade da criança e é decorrente de processo expansivo hipotalâmico. O caso relatado apresenta os sinais típicos da síndrome associados a distúrbios na secreçäo do hormônio do crescimento e quadro de puberdade precoce desenvolvimento aos 4 anos de idade. A patogênese das alteraçöes é discutida e relacionada com a disfunçäo do eixo hipotálamo-hipofisário, produzida pela evoluçäo do crescimento tumoral
Assuntos
Lactente , Humanos , Feminino , Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Diencéfalo , Emaciação/etiologia , Puberdade Precoce/etiologia , SíndromeRESUMO
Apresenta-se um caso de síndrome de emaciaçäo diencefálica associada à presença de craniofaringioma. O paciente, de sete anos de idade, apresentava emagrecimento profundo, baixa estatura, palidez cutânea e papiledema bilateral. Pela revisäo efetuada da literatura, esta síndrome, também conhecida como de Russel, ainda näo havia sido relatada em criança em associaçäo com este tipo de tumor
Assuntos
Criança , Humanos , Masculino , Craniofaringioma/complicações , Emaciação/etiologia , Neoplasias Hipofisárias/complicaçõesRESUMO
A child who presented the typical features of the diencephalic syndrome of Russell is presented. The authors stress the importance of ruling out a diencephalic neoplasm in all infants who present failure to thrive. The appearance of symptoms related to diencephalic syndromes of older children such as obesity, sexual precocity in later stages of syndrome of Russell is discussed.