Câncer diferenciado da tiróide de baixo risco: revisão do estado atual da literatura e proposta de conduta

A incidência do câncer diferenciado da tiróide vem aumentando há várias décadas no Brasil, assim como em todo o mundo. A popularização de métodos diagnósticos sensíveis e de uso relativamente simples tem contribuído para o diagnóstico cada vez mais freqüente de carcinomas de pequeno tamanho. Uma parte destes tumores ocorre em pacientes denominados de baixo risco, que poderiam se beneficiar de estratégias de conduta menos agressivas. Entretanto, a definição de baixo risco ainda é confusa e não existem meios seguros para distinguir os pacientes que evoluirão de forma pior dos demais. Por outro lado, o uso de novos métodos de acompanhamento vem mudando a maneira de conduzir estes casos. Um grupo multidisciplinar que inclui pesquisadores básicos, endocrinologistas, médicos nucleares, cirurgiões e patologistas endócrinos reviu a literatura pertinente e, com base em sua experiência, propõe algumas normas de conduta no carcinoma diferenciado da tiróide chamado de baixo risco em nosso meio.

Leptina, ghrelina e exercício físico

A obesidade é atualmente um problema de saúde pública que provoca sérias conseqüências sociais, físicas e psicológicas. A etiologia da obesidade não é de fácil identificação, uma vez que a mesma é caracterizada como doença multifatorial de complexa interação entre fatores comportamentais, culturais, genéticos, fisiológicos e psicológicos. Recentes avanços na área de endocrinologia e metabolismo mostram que, diferentemente do que se acreditava há alguns anos, o adipócito sintetiza e libera diversas substâncias, não sendo apenas uma célula armazenadora de energia. Entre as substâncias liberadas pelo adipócito incluem-se a adiponectina, o fator de necrose tumoral-alfa, a interleucina-6 e a leptina. Especificamente, a leptina desempenha importante papel no controle da ingestão alimentar e no controle do peso corporal em mamíferos. Além disso, o hormônio ghrelina, recentemente descoberto, também parece influenciar o metabolismo energético e a obesidade. As alterações que o exercício físico provoca na fisiologia endócrino-metabólica podem contribuir sobremaneira para a prática clínica. Assim, essa revisão abordará os conhecimentos mais recentes sobre a leptina, a ghrelina e o papel dos diferentes tipos de exercício físico sobre estes hormônios. Os trabalhos mostram que a relação entre o exercício físico e a concentração plasmática desses peptídeos ainda não está clara. As razões para isso poderiam ser devidas aos diferentes protocolos de treinamento físico empregados nos estudos. Além disso, diferenças genéticas também podem explicar as discrepâncias entre os resultados obtidos em seres humanos, pois a existência de polimorfismo em alguns genes pode acarretar respostas celulares diferentes frente ao exercício físico.

Post partum reproductive assessment in lowland Tapir (Tapirus terrestris): a case report

O tapir ou anta, descrito como o maior mamífero terrestre brasileiro, pertence à ordem Perissodactila, subordem Hippomorfa, superfamília Tapiroidea e família Tapiridae. Na floresta úmida está envolvido com a dispersão de sementes em função das características do tubo digestivo. O acompanhamento do ciclo estral permite avaliar e compreender a atividade reprodutiva nas espécies animais. Nos animais silvestres, o estresse da contenção pode interferir na própria ciclicidade gonadal, uma das alternativas é o acompanhamento dos hormônios gonadais nas excretas. Buscamos neste trabalho o acompanhamento periódico da atividade gonadal através da quantificação de progesterona no leite. Utilizamos uma fêmea recém-parida no Zoológico de Araçatuba, da qual colhemos leite, esfregaço vaginal e temperatura retal. A progesterona foi quantificada por radioimunoensaio de fase sólida (Coat-a-Count, DPC®) com curva padrão fornecida pela F.A.O. O ensaio mostrou sensibilidade de 1,25 nmol/l com coeficiente de variação intra-ensaio de 15,36%. Durante a fase de lactação, a fêmea não apresentou níveis detectáveis de progesterona por 158 dias (de novembro a abril). O primeiro pico de produção foi de 2,3 nmol/l e apresentou duração de 5 dias. O segundo pico de 3,54 nmol/l teve uma duração de 23 dias. Setenta e quatro dias após o aparecimento da progesterona no leite a lactação cessou. Podemos concluir que a fêmea de tapir apresentou um período de anestro lactacional de aproximadamente 5 meses e voltou a ciclar no outono (abril) sugerindo pouca influência do fotoperíodo. A quantificação da progesterona no leite mostrou-se útil para o acompanhamento do ciclo estral na espécie, porém a variação da citologia vaginal e temperatura retal não apresentaram correlação com os níveis hormonais.

O papel dos hormônios leptina e grelina na gênese da obesidade

A prevalência da obesidade está aumentando e estudos prospectivos mostram que, em 2025, o Brasil será o quinto país do mundo a apresentar problemas de obesidade em sua população. A etiologia da obesidade não é de fácil identificação, uma vez que a mesma é caracterizada como uma doença multifatorial, ou seja, diversos fatores estão envolvidos em sua gênese, incluindo fatores genéticos, psicológicos, metabólicos e ambientais. Pesquisas recentes na área de metabolismo mostram que o adipócito é capaz de sintetizar várias substâncias e, diferentemente do que se supunha anteriormente, o tecido adiposo não é apenas um sítio de armazenamento de triglicérides, é hoje considerado um órgão endócrino. Dentre as diversas substâncias sintetizadas pelo adipócito, destacam-se a adiponectina, a angiotensina e a leptina. A leptina é um petídeo que desempenha importante papel na regulação da ingestão alimentar e no gasto energético, gerando um aumento na queima de energia e diminuindo a ingestão alimentar. Além dos avanços no estudo da célula adiposa, um novo hormôrnio relacionado ao metabolismo foi descoberto recentemente, a grelina. A grelina é um peptídeo produzido nas células do estômago, e está diretamente envolvida na regulação do balanço energético a curto prazo. Assim, este artigo abordará o papel da leptina e da grelina no controle do peso corporal e as limitações que ainda existem para tratar a obesidade em humanos.

Time-dependent effects of lead on rat reproductive functions

The effects of exposure to lead on endocrine function and the reproductive parameters were studied in pubertal rats treated with 1.0 g l(-1) lead acetate in drinking water for 20 days (subacute group) or 9 months (chronic group) in addition to i.v. injections of lead acetate (0.1 mg 100 g(-1) body wt.) every 10 (subacute group) or 15 days (chronic group). Although basal levels of testosterone were higher both in plasma and in testes of acutely intoxicated animals, the circulating levels of luteinizing hormone (LH) were not affected in either group, nor was the LH-releasing hormone content of the median eminence. The density of [I-125]LH/human chorionic gonadotrophin (hCG) binding sites in testicular homogenates was reduced by saturnism in both groups, concomitant with a significantly increased apparent affinity constant of the hormone-receptor complex. These data can be viewed as the result of a mixture of specific lead toxicity (e.g. at the enzyme level) with other more general actions (e.g. at the level of the hypothalamus-pituitary-testicular axis).

Extinction of a conditioned response in rainbow trout selected for high or low responsiveness to stress

Two lines of rainbow trout (Oncorhynchus mykiss) that exhibit divergent endocrine responsiveness to stressors also display disparate behavioral traits. To investigate whether the high-responding (HR) and low-responding (LR) fish also differ in cognitive function, the rate of extinction of a conditioned response was compared between the two lines. Groups of HR and LR fish were exposed to a paired conditioned stimulus (CS- water off) and unconditioned stimulus (US; confinement stressor). After exposure to 18 CS-US pairings, at least 70% of individuals of both lines acquired a conditioned response (CR) manifested as an elevation of blood cortisol levels on presentation of the CS only. Post-conditioning, the fish were tested by presentation of the CS at weekly intervals, for 4 weeks, with no further reinforcement, and the extinction of the CR in the two lines was compared. The decline in mean plasma cortisol levels after exposure to the CS over successive tests suggested that the CR was retained for a shorter period among the HR (<14 days) than LR fish (<21 days). The frequency of individuals within each line whose plasma cortisol levels indicated a stress response when exposed to the CS was significantly greater among the LR than HR fish at 14 and 21 days with no HR fish falling into this category at 21 days. At 28 days post-conditioning, there were no HR fish and only three LR fish were categorized as stressed. These results suggest that there are differences in cognitive function between the two lines. Possible mechanisms underlying these differences are discussed. (C) 2004 Elsevier B.V. All rights reserved.

Urocortin in the central nervous system of a primate (Cebus apella): Sequencing, immunohistochemical, and hybridization histochemical characterization

The urocortin (UCN)-like immunoreactivity and UCN mRNA distribution in various regions of the nonprimate mammalian brain have been reported. However, the Edinger-Westphal nucleus (EW) appears to be the only brain site where UCN expression is conserved across species. Although UCN peptides are present throughout vertebrate phylogeny, the functional roles of both UCN and EW remain poorly understood. Therefore, a study focused on UCN system organization in the primate brain is warranted. By using immunohistochemistry (single and double labeling) and in situ hybridization, we have characterized the organization of UCN-expressing cells and fibers in the central nervous system and pituitary of the capuchin monkey (Cebus apella). In addition, the sequence of the prepro-UCN was determined to establish the level of structural conservation relative to the human sequence. To understand the relationship of acetylcholine cells in the EW, a colocalization study comparing choline acetyltransferase (ChAT) and UCN was also performed. The cloned monkey prepro-UCN is 95% identical to the human preprohormone across the matched sequences. By using an antiserum raised against rat UCN and a probe generated from human cDNA, we found that the EW is the dominant site for UCN expression, although UCN mRNA is also expressed in spinal cord lamina IX. Labeled axons and terminals were distributed diffusely throughout many brain regions and along the length of the spinal cord. of particular interest were UCN-immunoreactive inputs to the medial preoptic area, the paraventricular nucleus of the hypothalamus, the oral part of the spinal trigeminal nucleus, the flocculus of the cerebellum, and the spinal cord laminae VII and X. We found no UCN hybridization signal in the pituitary. In addition, we observed no colocalization between ChAT and UCN in EW neurons. Our results support the hypothesis that the UCN system might participate in the control of autonomic, endocrine, and sensorimotor functions in primates.

Effects of intra-PAG infusion of ovine CRF on defensive behaviors in Swiss-Webster mice

The midbrain dorsal periaqueductal gray (DPAG) is part of the brain defensive system involved in active defense reactions to threatening stimuli. Corticotrophin releasing factor (CRF) is a peptidergic neurotransmitter that has been strongly implicated in the control of both behavioral and endocrine responses to threat and stress. We investigated the effect of the nonspecific CRF receptor agonist, ovine CRF (oCRF), injected into the DPAG of mice, in two predator-stress situations, the mouse defense test battery (MDTB), and the rat exposure test (RET). In the MDTB, oCRF weakly modified defensive behaviors in mice confronted by the predator (rat); e.g. it increased avoidance distance when the rat was approached and escape attempts (jump escapes) in forced contact. In the RET, drug infusion enhanced duration in the chamber while reduced tunnel and surface time, and reduced contact with the screen which divides the subject and the predator. oCRF also reduced both frequency and duration of risk assessment (stretch attend posture: SAP) in the tunnel and tended to increase freezing. These findings suggest that patterns of defensiveness in response to low intensity threat (RET) are more sensitive to intra-DPAG oCRF than those triggered by high intensity threats (MDTB). Our data indicate that CRF systems may be functionally involved in unconditioned defenses to a predator, consonant with a role for DPAG CRF systems in the regulation of emotionality. (c) 2006 Elsevier B.V. All rights reserved.

Low triioothyronine (T-3) or reverse triioothyronine (rT(3)) syndrome modifies gene expression in rats with congestive heart failure

Heart failure (NF) is frequently associated with euthyroid sicksyndrome (low T-3 and elevated rT(3)). We investigated if altered thyroid hormone in HF could affect expression of the TH receptor (TR alpha 1), and alpha and beta myosin heavy chains (alpha-MHC beta-MHC). HF was provoked in rats by aortic stenosis. We showed that rT(3) generated front liver and kidney deiodination significantly increased and T-3 decreased in HE; there was significantly higher TR alpha 1 expression, no alpha-MHC expression, but beta-MHC expression. Changes in TR alpha 1 could be compensating for low T-3 from HF.

Immunolocalization of estrogen and progesterone receptors in neuroendocrine tumors of lung, skin, gastrointestinal and female genital tracts

Expression of estrogen (ER) and progesterone (PR) receptors has traditionally been associated with hormone-responsive organs, such as breast, ovary, and endometrium, and carcinomas arising therefrom. More recently, examples of ''unexpected'' ER or PR expression have been reported, particularly in tumors of endocrine tissues, such as thyroid and pancreatic islet cells. We tested the hypothesis that neuroendocrine tumors of various primary and metastatic sites might also express ER or PR or both by performing a retrospective immunohistochemical study in a series of 59 formalin- or mechacarn-fixed neuroendocrine carcinomas of various sites, including lung, skin, gastrointestinal and female genital tracts, and including carcinoid and atypical carcinoid tumors, small cell carcinomas, and Merkel cell carcinomas. We employed the anti-ER monoclonal antibody 1D5 and the anti-PR monoclonal antibody PgR1A6 using standard immunohistochemical techniques after microwave-based heat-induced epitope retrieval. Two of 28 carcinoid tumors demonstrated ER positivity; six of 30 cases were positive for progesterone receptor only. In addition, PR expression was found in one of two cases of atypical carcinoid, in five of 25 cases of small cell carcinoma, and in one of two cases of Merkel cell carcinoma. None of the atypical carcinoids, small cell carcinomas, or Merkel cell carcinomas were ER positive. In most cases, the fraction of tumor cell nuclei that were positive was <50%. These studies add the spectrum of neuroendocrine tumors that can express these hormone receptors. Similar to the pattern previously described in the subsets of meningiomas and islet cell tumors, PR but not ER is detectable in most cases. These results underscore the caution that should be exercised in determining tissue origin of metastatic carcinomas based only on detection of hormone receptors by immunohistochemistry.

Hypothalamic melanin-concentrating hormone is induced by cold exposure and participates in the control of energy expenditure in rats

Short-term cold exposure of homeothermic animals leads to higher thermogenesis and food consumption accompanied by weight loss. An analysis of cDNA-macroarray was employed to identify candidate mRNA species that encode proteins involved in thermogenic adaptation to cold. A cDNA-macroarray analysis, confirmed by RT-PCR, immunoblot, and RIA, revealed that the hypothalamic expression of melanin-concentrating hormone (MCH) is enhanced by exposure of rats to cold environment. The blockade of hypothalamic MCH expression by antisense MCH oligonucleotide in cold-exposed rats promoted no changes in feeding behavior and body temperature. However, MCH blockade led to a significant drop in body weight, which was accompanied by decreased liver glycogen, increased relative body fat, increased absolute and relative interscapular brown adipose tissue mass, increased uncoupling protein 1 expression in brown adipose tissue, and increased consumption of lean body mass. Thus, increased hypothalamic MCH expression in rats exposed to cold may participate in the process that allows for efficient use of energy for heat production during thermogenic adaptation to cold.

Vascular organization of the hystricomorph placenta: a comparative study in the Agouti, capybara, guinea pig, paca and rock cavy

The placental vasculature of five hystricomorph rodents was examined by latex injection of the blood vessels, immunohistochemistry and scanning electron microscopy of vessel casts. The pattern of branching of the vessels is described at the level of fine structure. The placenta is divided into lobes separated by interlobular trophoblast. Fetal arteries course through the interlobular areas and give rise to capillaries from which blood drains into veins at the centre of the lobes. Maternal blood reaches the placenta through spiral arteries that pass around the perimeter of the subplacenta. They supply large maternal blood sinuses, lined by trophoblast, which run through the interlobular areas and into the centre of the lobes. Here they supply fine channels that run parallel to the fetal capillaries, so that maternal blood flows from the centre of the lobe to the periphery. This arrangement provides the morphological basis for countercurrent exchange. The maternal channels of the labyrinth drain into spaces formed by the latticework of the interlobular trophoblast and thence through venous lacunae to a basal venous lacunar ring. The subplacenta is supplied by a single fetal artery. The vessels within the subplacenta pursue a tortuous course with dilatations and constrictions as in an endocrine gland. (C) 2003 Elsevier Ltd. All rights reserved.

Dietary macronutrients and performance and plasma hormone and metabolite levels of broiler chickens fat by carbohydrate substitution

The present experiment was aimed to study the effects of an isocaloric substitution of fat by carbohydrate calories while maintaining the same CP content - on some endocrine parameters and key metabolites of the lipid (L), protein (CP) and carbohydrate (CHO) metabolism and muscle cell membrane integrity of broiler chickens. Ninety male broiler chicks (Cobb) were obtained at 1-day old and raised in an environmentally controlled room. Food and water was provided ad libitum. At day 7, the chicks were provided with the experimental diets: Control diet (CON: 20% CP; 9.1% L; 39.6% CHO), Low lipid diet (LowL: 22% CP; 3.36% L; 59.7% CHO), and low carbohydrate diet (LowCHO: 22% CP; 8.09% L; 46.7% CHO). T e chickens fed the CON manifested the best growth rate feed conversion compared to both other groups. The CO chickens showed the highest plasma T-3 Concentrations at 14 days of age as compared to both LowL and LowCHO chickens. At 35 days of age however, LowL chickens were characterized by the highest plasma T-3 levels. Overall, CON birds had the highest plasma T-4 levels (P < 0.0001) compared to LowL and LowCHO chickens. Plasma corticosterone levels were not affected by diet composition. Glucose levels increased towards the end of the experimental period, but there was no overall effect of diet composition on plasma glucose levels. Chickens fed the CON diet were consistently characterized by the highest plasma uric acid levels compared to LowL and LowCHO chickens. Irrespectively of diet, plasma triglyceride levels were high at 14 days of age, then decreased and finally increased again during the last week. This latter increase was most pronounced for the CON chickens and is congruous with their high fat deposition. At 28 days of age, a significant effect of diet was observed, as CON birds had lower plasma free fatty acid (FFA) levels compared to LowL but not to LowCHO chickens. However there was no overall effect of diet composition on plasma FFA levels. Creatine kinase (CK) activities increased significantly with age and were consistently higher in CON chickens. In conclusion, fast growth in broiler chickens is positively correlated with catabolism of protein from dietary or endogenous origin and (muscle) cell membrane disruption as reflected in high plasma uric acid levels and CK activity, respectively. The currently investigated substitution of fat by CHO had no marked effects on endocrine functioning and intermediary metabolism, but this does not exclude that larger substitutions between both nutrients can have an effect.

MOTILIN-IMMUNOREACTIVE CELLS IN THE DUODENUM, PYLORIC STOMACH AND PANCREAS OF CAIMANS (CAIMAN-LATIROSTRIS AND CAIMAN-CROCODILUS, ALLIGATORINAE) - A FURTHER COMPARISON USING REGION-SPECIFIC MOTILIN ANTISERA

Motilin-immunoreactive cells in the duodenum, pyloric stomach and pancreas of Caiman latirostris and Caiman crocodilus were investigated using region specific antisera for porcine and canine motilin molecules. Motilin-immunoreactive cells were found in the duodenum, pyloric stomach and pancreas of both caiman species. These cells were primarily open-type endocrine ones in the epithelium of the duodenum and pyloric stomach. Motilin-immunoreactive cells were observed in both the exocrine and endocrine portions of the pancreas, and frequently exhibited one or more cytoplasmic processes of variable length. Since motilin-immunoreactive cells do not cross-react with serotonin or any of the other pancreatic and gut hormones, they are considered to be cell type independent from any of the other known pancreatic or gut endocrine cells. The molecular similarity between caiman motilin and porcine and canine motilins and the heterogeneity of the motilin molecule in the caiman digestive system is discussed.

Secretion of metalloendopeptidase 24.15 (EC 3.4.24.15)

The metalloendopeptidase EP24.15 (EC3.4.24.15) is a neuropeptide-metabolizing enzyme present in neural and endocrine tissues, presumably functioning extracellularly, Because the majority of the EP24.15 activity is identified in the soluble fraction of cellular homogenates, suggesting that the enzyme is primarily an intracellular protein, we addressed the issue of how EP24.15 arrives in the extracellular environment, We utilized a model system of neuroendocrine secretion, the AtT20 cell, According to both enzymatic activity and immunologic assays, EP24.15 was synthesized in and released from AtT20 cells. Under basal conditions and after stimulation by corticotropin-releasing hormone or the calcium ionophore A23187, EP24.15 activity accumulated in the culture medium. This secretion was not attributable to cell damage, as judged by the absence of release of cytosolic enzyme markers and the ability to exclude trypan blue dye. Pulse-chase analysis and subcellular fractionation of AtT20 cell extracts suggested that the mechanism of EP24.15 secretion is not solely via classical secretory pathways, Additionally, drugs which disrupt the classical secretory pathway, such as Brefeldin A and nocodazole, blocked A23187-stimulated EP24.15 release yet had no effect on basal EP24.15 release, suggesting differences in the basal and stimulated pathways of secretion for EP24.15. In summary, EP24.15 appears to be secreted from AtT20 pituitary cells into the extracellular milieu, where the enzyme can participate in the physiologic metabolism of neuropeptides.