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class="fc1 sc0">A</span><span class="blank _0"> </span><span class="fc1 sc0">V</span><span class="blank _0"> </span><span class="fc1 sc0">O</span><span class="blank _0"> </span><span class="fc1 sc0"> </span><span class="blank _0"> </span><span class="fc1 sc0">U</span><span class="blank _0"> </span><span class="fc1 sc0">R</span><span class="blank _0"> </span><span class="fc1 sc0">Z</span><span class="blank _0"> </span><span class="fc1 sc0">Ê</span><span class="blank _0"> </span><span class="fc1 sc0">D</span><span class="blank _0"> </span><span class="fc1 sc0">A</span><span class="blank _0"> </span><span class="fc1 sc0"> </span><span class="blank _0"> </span><span class="fc1 sc0">V</span><span class="blank _0"> </span><span class="fc1 sc0">I</span><span class="blank _0"> </span><span class="fc1 sc0">T</span><span class="blank _0"> </span><span class="fc1 sc0">Ó</span><span class="blank _0"> </span><span class="fc1 sc0">R</span><span class="blank _0"> </span><span class="fc1 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</span><span class="fc1 sc0">U</span><span class="blank _0"> </span><span class="fc1 sc0">S</span><span class="blank _0"> </span><span class="fc1 sc0">T</span><span class="blank _0"> </span><span class="fc1 sc0">A</span><span class="blank _0"> </span><span class="fc1 sc0">V</span><span class="blank _0"> </span><span class="fc1 sc0">O</span><span class="blank _0"> </span><span class="fc1 sc0"> </span><span class="blank _0"> </span><span class="fc1 sc0">U</span><span class="blank _0"> </span><span class="fc1 sc0">R</span><span class="blank _0"> </span><span class="fc1 sc0">Z</span><span class="blank _0"> </span><span class="fc1 sc0">Ê</span><span class="blank _0"> </span><span class="fc1 sc0">D</span><span class="blank _0"> </span><span class="fc1 sc0">A</span><span class="blank _0"> </span><span class="fc1 sc0"> </span><span class="blank _0"> </span><span class="fc1 sc0">V</span><span class="blank _0"> </span><span class="fc1 sc0">I</span><span class="blank _0"> </span><span class="fc1 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class="blank _1"> </span> <span class="blank _1"> </span>O<span class="blank _1"> </span>B<span class="blank _1"> </span>E<span class="blank _1"> </span>S<span class="blank _1"> </span>I<span class="blank _1"> </span>D<span class="blank _1"> </span>A<span class="blank _1"> </span>D<span class="blank _1"> </span>E</div><div class="t m0 x5 h7 y14 ff6 fs5 fc4 sc0 ls0 ws0">6<span class="blank _1"> </span>2<span class="blank _1"> </span> <span class="blank _1"> </span>-<span class="blank _1"> </span> <span class="blank _1"> </span>O<span class="blank _1"> </span>R<span class="blank _1"> </span>I<span class="blank _1"> </span>E<span class="blank _1"> </span>N<span class="blank _1"> </span>T<span class="blank _1"> </span>A<span class="blank _1"> </span>Ç<span class="blank _1"> </span>Õ<span class="blank _1"> </span>E<span class="blank _1"> </span>S<span class="blank _1"> </span> <span class="blank _1"> </span>D<span class="blank _1"> </span>I<span class="blank _1"> </span>E<span class="blank 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</span>-<span class="blank _1"> </span> <span class="blank _1"> </span>D<span class="blank _1"> </span>I<span class="blank _1"> </span>S<span class="blank _1"> </span>L<span class="blank _1"> </span>I<span class="blank _1"> </span>P<span class="blank _1"> </span>I<span class="blank _1"> </span>D<span class="blank _1"> </span>E<span class="blank _1"> </span>M<span class="blank _1"> </span>I<span class="blank _1"> </span>A<span class="blank _1"> </span>S</div><div class="t m0 x6 h6 y16 ff5 fs3 fc3 sc0 ls0 ws4">74<span class="blank"> </span><span class="ff6 fs4 fc4 ws5 v1">F<span class="blank"> </span>A<span class="blank"> </span>R<span class="blank"> </span>M<span class="blank"> </span>A<span class="blank"> </span>C<span class="blank"> </span>O<span class="blank"> </span>L<span class="blank"> </span>O<span class="blank"> </span>G<span class="blank"> </span>I<span class="blank"> </span>A</span></div><div class="t m0 x5 h7 y17 ff6 fs5 fc4 sc0 ls0 ws0">7<span class="blank _1"> </span>4<span class="blank _1"> </span> <span class="blank _1"> </span>-<span class="blank _1"> </span> <span class="blank _1"> </span>A<span class="blank _1"> </span>N<span class="blank _1"> </span>T<span class="blank _1"> </span>I<span class="blank _1"> </span>D<span class="blank _1"> </span>I<span class="blank _1"> </span>A<span class="blank _1"> </span>B<span class="blank _1"> </span>É<span class="blank _1"> </span>T<span class="blank _1"> </span>I<span class="blank _1"> </span>C<span class="blank _1"> </span>O<span class="blank _1"> </span>S</div><div class="t m0 x5 h7 y18 ff6 fs5 fc4 sc0 ls0 ws0">8<span class="blank _1"> </span>1<span class="blank _1"> </span> <span class="blank _1"> </span>-<span class="blank _1"> </span> <span class="blank _1"> </span>M<span class="blank _1"> </span>E<span class="blank _1"> </span>D<span class="blank _1"> </span>I<span class="blank _1"> </span>C<span class="blank _1"> </span>A<span class="blank _1"> </span>M<span class="blank _1"> </span>E<span class="blank _1"> </span>N<span class="blank _1"> </span>T<span class="blank _1"> </span>O<span class="blank _1"> </span>S<span class="blank _1"> </span> <span class="blank _1"> </span>P<span class="blank _1"> </span>A<span class="blank _1"> </span>R<span class="blank _1"> </span>A<span class="blank _1"> </span> <span class="blank _1"> </span>T<span class="blank _1"> </span>R<span class="blank _1"> </span>A<span class="blank _1"> </span>T<span class="blank _1"> </span>A<span class="blank _1"> </span>M<span class="blank _1"> </span>E<span class="blank _1"> </span>N<span class="blank _1"> </span>T<span class="blank _1"> </span>O<span class="blank _1"> </span> <span class="blank _1"> </span>D<span class="blank _1"> </span>A<span class="blank _1"> </span> <span class="blank _1"> </span>D<span class="blank _1"> </span>I<span class="blank _1"> </span>S<span class="blank _1"> </span>L<span class="blank _1"> </span>I<span class="blank _1"> </span>P<span class="blank _1"> </span>I<span class="blank _1"> </span>D<span class="blank _1"> </span>E<span class="blank _1"> </span>M<span class="blank _1"> </span>I<span class="blank _1"> </span>A</div><div class="t m0 x5 h7 y19 ff6 fs5 fc4 sc0 ls0 ws0">8<span class="blank _1"> </span>6<span class="blank _1"> </span> <span class="blank _1"> </span>-<span class="blank _1"> </span> <span class="blank _1"> </span>T<span class="blank _1"> </span>A<span class="blank _1"> </span>B<span class="blank _1"> </span>E<span class="blank _1"> </span>L<span class="blank _1"> </span>A<span class="blank _1"> </span>S</div><div class="t m0 x6 h6 y1a ff5 fs3 fc3 sc0 ls0 ws6">96<span class="blank"> </span><span class="ff6 fs4 fc4 ws7 v1">R<span class="blank"> </span>E<span class="blank"> </span>F<span class="blank"> </span>E<span class="blank"> </span>R<span class="blank"> </span>Ê<span class="blank"> </span>N<span class="blank"> </span>C<span class="blank"> </span>I<span class="blank"> </span>A<span class="blank"> </span>S</span></div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,-7.829980]}"></div></div> <div id="pf4" class="pf w1 h8" data-page-no="4"><div class="pc pc4 w1 h8"><img fetchpriority="low" loading="lazy" class="bi x0 y1b w0 h9" alt="" src="https://files.passeidireto.com/27f1c739-45df-4c63-94e7-e612c3f1223d/bg4.png"><div class="c x0 y0 w2 h8"><div class="t m0 x7 ha y1c ff7 fs6 fc2 sc0 ls0 ws0"><span class="fc1 sc0"> </span></div><div class="t m0 x7 ha y1d ff7 fs6 fc2 sc0 ls0 ws0"> </div></div><div class="c x8 y1e w3 hb"><div class="t m0 x9 ha y1f ff7 fs6 fc2 sc0 ls0 ws0"><span class="fc1 sc0">1</span><span class="fc1 sc0"> </span></div></div><div class="c x7 y20 w4 hc"><div class="t m0 xa hd y21 ff8 fs7 fc2 sc0 ls0 ws0"><span class="fc1 sc0">Gus</span><span class="fc1 sc0">tav</span><span class="fc1 sc0">o Urzê</span><span class="fc1 sc0">d</span><span class="fc1 sc0">a</span><span class="fc1 sc0"> V</span><span class="fc1 sc0">itór</span><span class="fc1 sc0">ia</span><span class="fc1 sc0"> </span></div></div><div class="c x0 y0 w2 h8"><div class="t m0 x2 he y22 ff9 fs8 fc2 sc1 ls0 ws8">ENDOCRINO<span class="blank _2"></span>LOGIA<span class="sc0 ws0"> </span></div><div class="t m0 xb hf y23 ff9 fs9 fc2 sc1 ls0 ws0">PATOLOGIAS </div><div class="t m0 xc hf y24 ff9 fs9 fc2 sc1 ls0 ws0"> </div><div class="t m0 x7 h10 y25 ff8 fsa fc2 sc0 ls0 ws0">- Hiperprola<span class="blank _3"></span>ctinemi<span class="ls2 ws9">a:</span> </div><div class="t m0 xd h10 y26 ff8 fsa fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 h11 y27 ffa fs7 fc2 sc0 ls0 ws0">Conceito: </div><div class="t m0 xe h11 y28 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>O mais comum dos adenomas </span><span class="ffc">\u2192<span class="ffa ws0"> mais de 99% são benignos. </span></span></div><div class="t m0 x7 h11 y29 ffa fs7 fc2 sc0 ls0 ws0">Sinais e sintomas: </div><div class="t m0 xe h11 y2a ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Galactorreia, <span class="blank _5"> </span>amenorreia, <span class="blank _5"> </span>infertilidade, <span class="blank _6"> </span>ginecomastia, <span class="blank _5"> </span>impotência,<span class="blank _3"></span> </span></div><div class="t m0 xf h11 y2b ffa fs7 fc2 sc0 ls0 ws0">osteoporose, mastodínia <span class="ffc fs6 wsb">\u2192</span> hipogonadismo hipogonadotrófico. </div><div class="t m0 xe h11 y2c ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Cefaleia e alterações visuais <span class="ffc fs6 wsb">\u2192</span> efeito de massa. </span></div><div class="t m0 x7 h11 y2d ffa fs7 fc2 sc0 ls0 ws0">Formas: </div><div class="t m0 xe h11 y2e ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Monomérica (forma ativa), dimérica e multimérica (macroprolactina). </span></div><div class="t m0 x7 h11 y2f ffa fs7 fc2 sc0 ls0 ws0">Diagnóstico: </div><div class="t m0 xe h11 y30 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Dosar <span class="blank _7"> </span>PRL <span class="blank _7"> </span>(excluir <span class="blank _7"> </span>outras <span class="blank _7"> </span>causas, <span class="blank _7"> </span>como <span class="blank _7"> </span>gravidez, <span class="blank _7"> </span>amamentação,<span class="blank _3"></span> </span></div><div class="t m0 xf h11 y31 ffa fs7 fc2 sc0 ls0 ws0">estresse, <span class="blank _1"> </span>fármacos <span class="blank _1"> </span>(a<span class="blank _3"></span>ntidepressivos, <span class="blank _1"> </span>opióides, <span class="blank _2"> </span>etc.<span class="blank _2"> </span>), <span class="blank _2"> </span>doença<span class="blank _2"> </span>s <span class="blank _2"> </span>ge<span class="blank _2"> </span>rais <span class="blank _2"> </span>(IR, </div><div class="t m0 xf h11 y32 ffa fs7 fc2 sc0 ls0 ws0">IH, <span class="blank _1"> </span>crises <span class="blank _1"> </span>epilépticas), <span class="blank _2"> </span>endocrinopatias <span class="blank _1"> </span>(hipotireoidismo <span class="blank _1"> </span>e <span class="blank _1"> </span>IS), <span class="blank _2"> </span>ca<span class="blank _2"> </span>rci<span class="blank _3"></span>noma </div><div class="t m0 xf h11 y33 ffa fs7 fc2 sc0 ls0 ws0">e adenocarcinoma). </div><div class="t m0 xe h11 y34 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Se <span class="blank _2"> </span>tem sintomas <span class="blank _2"> </span>relacionados <span class="blank _2"> </span></span><span class="ffc">\u2192<span class="ffa ws0"> fa<span class="blank _2"> </span>z RM <span class="blank _2"> </span></span><span class="ls1">\u2192</span><span class="ffa ws0"> <span class="blank _2"> </span>< 10 <span class="blank _2"> </span>mm é <span class="blank _2"> </span>micro <span class="blank _2"> </span>e > <span class="blank _2"> </span>10 mm </span></span></div><div class="t m0 xf h11 y35 ffa fs7 fc2 sc0 ls0 ws0">é <span class="blank _1"> </span>macro <span class="blank _1"> </span>(macro <span class="blank _1"> </span>tem <span class="blank _1"> </span>mais <span class="blank _1"> </span>chance <span class="blank _1"> </span>se <span class="blank _1"> </span>PRL <span class="blank _1"> </span>> <span class="blank _1"> </span>100, <span class="blank _1"> </span>se <span class="blank _1"> </span>for <span class="blank _1"> </span>< <span class="blank _1"> </span>100 <span class="blank _1"> </span>tem <span class="blank _1"> </span>mais </div><div class="t m0 xf h11 y36 ffa fs7 fc2 sc0 ls0 ws0">chance de ser micro). </div><div class="t m0 xe h11 y37 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Se não tem sintomas relacionados <span class="blank _2"> </span></span><span class="ffc">\u2192<span class="ffa ws0"> pesquisa macro. </span></span></div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf5" class="pf w1 h8" data-page-no="5"><div class="pc pc5 w1 h8"><img fetchpriority="low" loading="lazy" class="bi x7 y38 w5 h12" alt="" src="https://files.passeidireto.com/27f1c739-45df-4c63-94e7-e612c3f1223d/bg5.png"><div class="c x0 y0 w2 h8"><div class="t m0 x7 ha y1c ff7 fs6 fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 ha y1d ff7 fs6 fc2 sc0 ls0 ws0"> </div></div><div class="c x8 y1e w3 hb"><div class="t m0 x9 ha y1f ff7 fs6 fc2 sc0 ls0 ws0">2 </div></div><div class="c x7 y20 w4 hc"><div class="t m0 xa hd y21 ff8 fs7 fc2 sc0 ls0 ws0">Gustavo Urzêda Vitória </div></div><div class="c x0 y0 w2 h8"><div class="t m0 xe h11 y39 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Investigar neoplasia endócrina múltipla antes de tratar. </span></div><div class="t m0 xe h11 y3a ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Densitometria óssea e ECG: afastar cardiopatias e osteoporose. </span></div><div class="t m0 x7 h11 y3b ffa fs7 fc2 sc0 ls0 ws0">Tratamento: </div><div class="t m0 xe h11 y3c ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>1ª <span class="blank _8"></span>opção: <span class="blank _8"></span>medicamentoso <span class="blank _8"></span><span class="ffc ls1">\u2192<span class="ffa ls0"> <span class="blank _8"></span>agonista <span class="blank _8"></span>dopaminérgico <span class="blank _8"></span><span class="ffc ls1">\u2192<span class="ffa ls0"> <span class="blank _8"></span>br<span class="blank _3"></span>omocriptina <span class="blank _8"></span>(1ª </span></span></span></span></span></div><div class="t m0 xf h11 y3d ffa fs7 fc2 sc0 ls0 ws0">escolha <span class="blank _1"> </span>pa<span class="blank _2"> </span>ra <span class="blank _1"> </span>quem <span class="blank _1"> </span>quer <span class="blank _9"> </span>engravidar <span class="blank _1"> </span>ou<span class="blank _2"> </span> <span class="blank _1"> </span>está <span class="blank _1"> </span>grávida) <span class="blank _9"> </span>ou <span class="blank _9"> </span>caberdolina <span class="blank _1"> </span>(1ª </div><div class="t m0 xf h11 y3e ffa fs7 fc2 sc0 ls0 ws0">escolha, poucos efeitos colaterais, menos resistência). </div><div class="t m0 xe h11 y3f ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Controle com PRL sérica, RM e campimetria ocular. </span></div><div class="t m0 xe h11 y40 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Trata até remissão tumoral ou dos sintomas: + ou <span class="ffd ls3">\u2013</span> 2 anos. </span></div><div class="t m0 xe h11 y41 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Não <span class="blank _a"> </span>deu <span class="blank _a"> </span>certo: <span class="blank _7"> </span>cirurgia<span class="blank _2"> </span> <span class="blank _a"> </span><span class="ffc ls1">\u2192</span> <span class="blank _7"> </span>resistência/intolerân<span class="blank _2"> </span>cia <span class="blank _7"> </span>medicamentosa, </span></div><div class="t m0 xf h11 y42 ffa fs7 fc2 sc0 ls0 ws0">sintomas visuais. </div><div class="t m0 x10 h11 y43 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Prolactina <span class="blank _7"> </span>diferente <span class="blank _7"> </span>de <span class="blank _a"> </span>zero <span class="blank _7"> </span>no <span class="blank _7"> </span>pós<span class="blank _2"> </span>-operatório <span class="blank _7"> </span>pode <span class="blank _7"> </span>indicar </span></div><div class="t m0 x11 h11 y44 ffa fs7 fc2 sc0 ls0 ws0">recorrência. </div><div class="t m0 xe h11 y45 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Radioterapia: <span class="blank _a"> </span>raro <span class="blank _7"> </span>e <span class="blank _a"> </span>com <span class="blank _a"> </span>baixa <span class="blank _a"> </span>r<span class="blank _3"></span>esposta; <span class="blank _7"> </span>m<span class="blank _2"> </span>ais <span class="blank _7"> </span>para <span class="blank _a"> </span>controle <span class="blank _a"> </span>do </span></div><div class="t m0 xf h11 y46 ffa fs7 fc2 sc0 ls0 ws0">crescimento. </div><div class="t m0 xe h11 y47 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Quer <span class="blank _c"> </span>engravidar: <span class="blank _c"> </span>pode <span class="blank _c"> </span>tentar <span class="blank _c"> </span>controlar <span class="blank _c"> </span>com <span class="blank _c"> </span>ACO, <span class="blank _d"> </span>se <span class="blank _c"> </span>não <span class="blank _c"> </span>der <span class="blank _c"> </span></span><span class="ffc">\u2192<span class="ffa ws0"> </span></span></div><div class="t m0 xf h11 y48 ffa fs7 fc2 sc0 ls0 ws0">bromocriptina. </div><div class="t m0 x7 h10 y49 ff8 fsa fc2 sc0 ls0 ws0">- Acromegalia: </div><div class="t m0 x12 h10 y4a ff8 fsa fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 h11 y4b ffa fs7 fc2 sc0 ls0 ws0">Fisiopatologia: </div><div class="t m0 xe h11 y4c ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Desregulação <span class="blank _e"> </span>do <span class="blank _e"> </span>sistema <span class="blank _e"> </span>de <span class="blank _e"> </span>indução <span class="blank _e"> </span>e <span class="blank _e"> </span>inibição <span class="blank _e"> </span>do <span class="blank _e"> </span>GH <span class="blank _f"> </span><span class="ffc fs6 wsb">\u2192</span> <span class="blank _e"> </span>estando </span></div><div class="t m0 xf h11 y4d ffa fs7 fc2 sc0 ls0 ws0">aumentado <span class="blank _e"> </span>na <span class="blank _e"> </span>id<span class="blank _3"></span>ade <span class="blank _e"> </span>ad<span class="blank _3"></span>ulta <span class="blank _e"> </span>(acromegalia) <span class="blank _10"> </span>ou <span class="blank _10"> </span>na <span class="blank _e"> </span>infância <span class="blank _10"> </span>(de <span class="blank _e"> </span>forma </div><div class="t m0 xf h11 y4e ffa fs7 fc2 sc0 ls0 ws0">patológica; gigantismo). </div><div class="t m0 x10 h11 y4f ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Grelina <span class="blank _8"></span>e GHRH<span class="blank _3"></span> <span class="blank _8"></span>estimulam GH, <span class="blank _8"></span>já <span class="blank _8"></span>SSTR2 <span class="blank _8"></span>e <span class="blank _8"></span>SSTR5 <span class="blank _8"></span>(recep<span class="blank _2"> </span>tores <span class="blank _8"></span>de </span></div><div class="t m0 x11 h11 y50 ffa fs7 fc2 sc0 ls0 ws0">somatostatina) inibem. </div><div class="t m0 xe h11 y51 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Tem <span class="blank _9"> </span>alta <span class="blank _9"> </span>mo<span class="blank _2"> </span>rtalidade <span class="blank _1"> </span>e <span class="blank _11"> </span>reincidência, <span class="blank _1"> </span>e<span class="blank _2"> </span>stando <span class="blank _9"> </span>também <span class="blank _9"> </span>associado <span class="blank _1"> </span>a<span class="blank _2"> </span> <span class="blank _9"> </span>DM, </span></div><div class="t m0 xf h11 y52 ffa fs7 fc2 sc0 ls0 ws0">HA e cardiopatias. </div><div class="t m0 xe h11 y53 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>É associado a DM, HAS e cardiopatias. </span></div><div class="t m0 x7 h11 y54 ffa fs7 fc2 sc0 ls0 ws0">Sinais e sintomas: </div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf6" class="pf w1 h8" data-page-no="6"><div class="pc pc6 w1 h8"><img fetchpriority="low" loading="lazy" class="bi x7 y1b w5 h13" alt="" src="https://files.passeidireto.com/27f1c739-45df-4c63-94e7-e612c3f1223d/bg6.png"><div class="c x0 y0 w2 h8"><div class="t m0 x7 ha y1c ff7 fs6 fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 ha y1d ff7 fs6 fc2 sc0 ls0 ws0"> </div></div><div class="c x8 y1e w3 hb"><div class="t m0 x9 ha y1f ff7 fs6 fc2 sc0 ls0 ws0">3 </div></div><div class="c x7 y20 w4 hc"><div class="t m0 xa hd y21 ff8 fs7 fc2 sc0 ls0 ws0">Gustavo Urzêda Vitória </div></div><div class="c x0 y0 w2 h8"><div class="t m0 xe h11 y39 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Crescimento <span class="blank"> </span>de <span class="blank _0"> </span>extremidade<span class="blank _2"> </span>s, <span class="blank _12"> </span>fácie<span class="blank _2"> </span>s <span class="blank _12"> </span>típica, <span class="blank _12"> </span>crescimento <span class="blank"> </span>da <span class="blank _12"> </span>estatura, </span></div><div class="t m0 xf h11 y55 ffa fs7 fc2 sc0 ls0 ws0">artrose, <span class="blank _11"> </span>alterações <span class="blank _13"> </span>visuais <span class="blank _11"> </span>e <span class="blank _11"> </span>humorais, <span class="blank _11"> </span>sudorese, <span class="blank _11"> </span>e<span class="blank _2"> </span>scoliose, <span class="blank _11"> </span>resistência </div><div class="t m0 xf h11 y56 ffa fs7 fc2 sc0 ls0 ws0">insulínica, cardiomegalia, visceromegalia. </div><div class="t m0 xe h11 y57 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Alargamento <span class="blank _d"> </span>do <span class="blank _c"> </span>nariz, <span class="blank _c"> </span>sín<span class="blank _2"> </span>drome <span class="blank _c"> </span>do <span class="blank _d"> </span>Túnel <span class="blank _c"> </span>do <span class="blank _c"> </span>Carpo, <span class="blank _d"> </span>Acrocódons, </span></div><div class="t m0 xf h11 y58 ffa fs7 fc2 sc0 ls0 ws0">galactorreia. </div><div class="t m0 x7 h11 y59 ffa fs7 fc2 sc0 ls0 ws0">Diagnóstico: </div><div class="t m0 xe h11 y5a ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Dosa GH e IGF-1: </span></div><div class="t m0 x10 h11 y5b ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>GH <span class="blank _8"></span>< <span class="blank _8"></span>1,0 <span class="blank _8"></span>exclui, <span class="blank _8"></span>> <span class="blank _8"></span>1,0 <span class="blank _8"></span>suspeita <span class="blank _8"></span>e <span class="blank _8"></span>> <span class="blank _14"></span>1,0 <span class="blank _8"></span>com <span class="blank _8"></span>IGF-1 <span class="blank _8"></span>alterado<span class="blank _2"> </span> <span class="blank _14"></span>confirma </span></div><div class="t m0 x11 h11 y5c ffc fs7 fc2 sc0 ls1">\u2192<span class="ffa ls0 ws0"> se for > 1,0, mas o IGF-1 for nor<span class="blank _3"></span>mal, faz TTGO <span class="ffc ls1">\u2192</span> > 1 confirma, </span></div><div class="t m0 x11 h11 y5d ffa fs7 fc2 sc0 ls0 ws0">< 1 exclui. </div><div class="t m0 xe h11 y5e ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>RM <span class="blank _13"> </span>loca<span class="blank _2"> </span>liza; <span class="blank _13"> </span>TC <span class="blank _15"> </span>de <span class="blank _15"> </span>abdome <span class="blank _15"> </span>e <span class="blank _13"> </span>tórax <span class="blank _15"> </span>afasta <span class="blank _13"> </span>outras <span class="blank _15"> </span>causas; <span class="blank _15"> </span>cintilografi<span class="blank _8"></span>a </span></div><div class="t m0 xf h11 y5f ffa fs7 fc2 sc0 ls0 ws0">quando <span class="blank _0"> </span>não <span class="blank _15"> </span>dá <span class="blank _0"> </span>para <span class="blank _15"> </span>localizar; <span class="blank _0"> </span>campimetria <span class="blank _0"> </span>para <span class="blank _15"> </span>avaliar <span class="blank _0"> </span>as <span class="blank _15"> </span>alterações </div><div class="t m0 xf h11 y60 ffa fs7 fc2 sc0 ls0 ws0">visuais. </div><div class="t m0 xe h11 y61 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Pode <span class="blank _11"> </span>cursar <span class="blank _13"> </span>com <span class="blank _11"> </span>hiperprolactinemia: <span class="blank _11"> </span>dosar <span class="blank _13"> </span>PRL <span class="blank _11"> </span>(pode <span class="blank _13"> </span>ser <span class="blank _11"> </span>misto <span class="blank _11"> </span>ou <span class="blank _13"> </span>só </span></div><div class="t m0 xf h11 y62 ffa fs7 fc2 sc0 ls0 ws0">efeito de massa). </div><div class="t m0 xe h11 y63 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Avaliar <span class="blank _8"></span>e<span class="blank _2"> </span> <span class="blank _8"></span>acompanhar <span class="blank _8"></span>as <span class="blank _3"></span>consequências <span class="blank _8"></span>em <span class="blank _8"></span>o<span class="blank _2"> </span>utros <span class="blank _8"></span>sistemas, c<span class="blank _8"></span>omo o <span class="blank _8"></span>CV. </span></div><div class="t m0 x7 h11 y64 ffa fs7 fc2 sc0 ls0 ws0">Tratamento: </div><div class="t m0 xe h11 y65 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Cirurgia <span class="blank _16"> </span>transesfenoidal <span class="blank _e"> </span></span><span class="ffc">\u2192<span class="ffa ws0"> <span class="blank _10"> </span>complicações: <span class="blank _e"> </span>diabetes <span class="blank _10"> </span>insí<span class="blank _2"> </span>pido, <span class="blank _10"> </span><span class="ls3">pan</span>-</span></span></div><div class="t m0 xf h11 y66 ffa fs7 fc2 sc0 ls0 ws0">hipopituitarismo, sinusite, etc. </div><div class="t m0 xe h11 y67 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Se for misto, a caberdolina pode diminuir o t<span class="blank _3"></span>umor e facilitar a cirurgia.<span class="blank _2"> </span> </span></div><div class="t m0 xe h11 y68 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Dosa GH e IFG-1 de 4 em 4 meses. </span></div><div class="t m0 xe h11 y69 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Medicamentoso: <span class="blank _11"> </span>pré-operató<span class="blank _2"> </span>rio <span class="blank _11"> </span>(apneia <span class="blank _11"> </span>do <span class="blank _11"> </span>sono, <span class="blank _11"> </span>misto, <span class="blank _11"> </span>risco <span class="blank _11"> </span>CV), <span class="blank _11"> </span>pós<span class="blank _2"> </span>-</span></div><div class="t m0 xf h11 y6a ffa fs7 fc2 sc0 ls0 ws0">operatório <span class="blank _0"> </span>(agonista <span class="blank _15"> </span>dopaminé<span class="blank _2"> </span>rgico, <span class="blank _15"> </span>antagonista <span class="blank _0"> </span>do <span class="blank _0"> </span>rece<span class="blank _3"></span>ptor <span class="blank _0"> </span>de <span class="blank _15"> </span>GH <span class="blank _0"> </span>e </div><div class="t m0 xf h11 y6b ffa fs7 fc2 sc0 ls0 ws0">análogos de somatostatina (escolha)) ou tumor irr<span class="blank _3"></span>essecável.<span class="blank _2"> </span> </div><div class="t m0 x10 h11 y6c ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Análogo 1º geração: octreotide ou lanreotide <span class="ffc ls1">\u2192</span> SSTR2. </span></div><div class="t m0 x10 h11 y6d ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Análogo 2º geração: pasireotide <span class="ffc ls1">\u2192</span> SSTR2 e SSTR5. </span></div><div class="t m0 x10 h11 y6e ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Antagonista do receptor de <span class="blank _2"> </span>GH: pegvisomanto <span class="blank _2"> </span><span class="ffc wsa">\u2192</span> associado ao de </span></div><div class="t m0 x11 h11 y6f ffa fs7 fc2 sc0 ls0 ws0">escolhe. </div><div class="t m0 xe h11 y70 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Radio: casos refratários e hipopituitarismo. </span></div><div class="t m0 x7 h10 y71 ff8 fsa fc2 sc0 ls0 ws0">- Hipotireoid<span class="blank _8"></span>ismo: </div><div class="t m0 xe h11 y72 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Principal <span class="blank _17"> </span>causa <span class="blank _f"> </span>é<span class="blank _2"> </span> <span class="blank _f"> </span>o <span class="blank _17"> </span>hipotireoidismo <span class="blank _17"> </span>de <span class="blank _f"> </span>Hash<span class="blank _2"> </span>imoto <span class="blank _17"> </span></span><span class="ffc">\u2192<span class="ffa ws0"> <span class="blank _17"> </span>autoimune <span class="blank _17"> </span>e </span></span></div><div class="t m0 xf h11 y73 ffa fs7 fc2 sc0 ls0 ws0">genético. </div><div class="t m0 xe h11 y2f ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Outras causas são: ag<span class="blank _3"></span>enesia, radioterapia, doenças infiltrativas, tir<span class="blank _3"></span>eoidite </span></div><div class="t m0 xf h11 y74 ffa fs7 fc2 sc0 ls0 ws0">subaguda, <span class="blank _2"> </span>de<span class="blank _2"> </span>ficiência <span class="blank _2"> </span>grave <span class="blank _2"> </span>de <span class="blank _1"> </span>iodo, <span class="blank _2"> </span>uso <span class="blank _1"> </span>de <span class="blank _2"> </span>amiodarona, <span class="blank _1"> </span>AV<span class="blank _3"></span>E, <span class="blank _1"> </span>ciru<span class="blank _3"></span>rgias </div><div class="t m0 xf h11 y75 ffa fs7 fc2 sc0 ls0 ws0">e traumas no SNC. </div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf7" class="pf w1 h8" data-page-no="7"><div class="pc pc7 w1 h8"><img fetchpriority="low" loading="lazy" class="bi x7 y38 w5 h12" alt="" src="https://files.passeidireto.com/27f1c739-45df-4c63-94e7-e612c3f1223d/bg7.png"><div class="c x0 y0 w2 h8"><div class="t m0 x7 ha y1c ff7 fs6 fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 ha y1d ff7 fs6 fc2 sc0 ls0 ws0"> </div></div><div class="c x8 y1e w3 hb"><div class="t m0 x9 ha y1f ff7 fs6 fc2 sc0 ls0 ws0">4 </div></div><div class="c x7 y20 w4 hc"><div class="t m0 xa hd y21 ff8 fs7 fc2 sc0 ls0 ws0">Gustavo Urzêda Vitória </div></div><div class="c x0 y0 w2 h8"><div class="t m0 x13 h11 y76 ffa fs7 fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 h11 y77 ffa fs7 fc2 sc0 ls0 ws0">Formas: </div><div class="t m0 xe h11 y78 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Primário (TSH alto e T4 baixo). </span></div><div class="t m0 xe h11 y79 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Central (TSH e T4 baixos). </span></div><div class="t m0 xe h11 y7a ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Subclínico (TSH alto e T4 normal). </span></div><div class="t m0 xe h11 y7b ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Resistência periférica (TSH e T4 altos). </span></div><div class="t m0 x7 h11 y7c ffa fs7 fc2 sc0 ls0 ws0">Sinais e sintomas: </div><div class="t m0 xe h11 y7d ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Pele <span class="blank _13"> </span>seca, <span class="blank _11"> </span>anasarca, <span class="blank _11"> </span>cabelo <span class="blank _13"> </span>quebradiço, <span class="blank _11"> </span>cansaço, <span class="blank _13"> </span>mixedema, <span class="blank _11"> </span>piora <span class="blank _11"> </span>da </span></div><div class="t m0 xf h11 y7e ffa fs7 fc2 sc0 ls0 ws0">memória, <span class="blank _18"> </span>sonolência, <span class="blank _18"> </span>raciocínio <span class="blank _18"> </span>lento, <span class="blank _19"> </span>depressão, <span class="blank _18"> </span>bradicardia, </div><div class="t m0 xf h11 y7f ffa fs7 fc2 sc0 ls0 ws0">contratilidade <span class="blank _0"> </span>miocárdi<span class="blank _8"></span>ca <span class="blank _0"> </span>e <span class="blank _0"> </span>volu<span class="blank _3"></span>me <span class="blank _0"> </span>sistólico<span class="blank _8"></span> <span class="blank _0"> </span>reduzidos, <span class="blank _0"> </span>permeabili<span class="blank _8"></span>d<span class="blank _2"> </span>ade </div><div class="t m0 xf h11 y80 ffa fs7 fc2 sc0 ls0 ws0">capiliar <span class="blank _13"> </span>aumentada, <span class="blank _13"> </span>maior <span class="blank _15"> </span>risco <span class="blank _13"> </span>para <span class="blank _13"> </span>aterogênese, <span class="blank _15"> </span>dis<span class="blank _3"></span>pneia, <span class="blank _13"> </span>apneia <span class="blank _13"> </span>do </div><div class="t m0 xf h11 y81 ffa fs7 fc2 sc0 ls0 ws0">sono, <span class="blank _c"> </span>constipação, <span class="blank _c"> </span>diminuição <span class="blank _c"> </span>da<span class="blank _2"> </span> <span class="blank _c"> </span>absorção <span class="blank _c"> </span>intestinal, <span class="blank _c"> </span>hipotonia <span class="blank _c"> </span>da </div><div class="t m0 xf h11 y82 ffa fs7 fc2 sc0 ls0 ws0">vesícula <span class="blank _0"> </span>biliar, <span class="blank _15"> </span>d<span class="blank _2"> </span>iminuição <span class="blank _15"> </span>d<span class="blank _2"> </span>o <span class="blank _15"> </span>débito <span class="blank _0"> </span>urinário, <span class="blank _15"> </span>irregu<span class="blank _2"> </span>laridade <span class="blank _15"> </span>menstrual, </div><div class="t m0 xf h11 y83 ffa fs7 fc2 sc0 ls0 ws0">queda da libido <span class="ffc fs6 wsb">\u2192</span> redução metabólica generalizada. </div><div class="t m0 x14 h11 y84 ffa fs7 fc2 sc0 ls0 ws0"> </div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf8" class="pf w1 h8" data-page-no="8"><div class="pc pc8 w1 h8"><img fetchpriority="low" loading="lazy" class="bi x7 y1b w5 h13" alt="" src="https://files.passeidireto.com/27f1c739-45df-4c63-94e7-e612c3f1223d/bg8.png"><div class="c x0 y0 w2 h8"><div class="t m0 x7 ha y1c ff7 fs6 fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 ha y1d ff7 fs6 fc2 sc0 ls0 ws0"> </div></div><div class="c x8 y1e w3 hb"><div class="t m0 x9 ha y1f ff7 fs6 fc2 sc0 ls0 ws0">5 </div></div><div class="c x7 y20 w4 hc"><div class="t m0 xa hd y21 ff8 fs7 fc2 sc0 ls0 ws0">Gustavo Urzêda Vitória </div></div><div class="c x0 y0 w2 h8"><div class="t m0 x7 h11 y85 ffa fs7 fc2 sc0 ls0 ws0">Diagnóstico: </div><div class="t m0 xe h11 y86 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Sinais <span class="blank _13"> </span>e <span class="blank _13"> </span>sintomas <span class="blank _13"> </span>+ <span class="blank _11"> </span>fatores <span class="blank _13"> </span>de <span class="blank _13"> </span>risco <span class="blank _13"> </span>(sexo <span class="blank _13"> </span>feminino, <span class="blank _13"> </span>> <span class="blank _13"> </span>60 <span class="blank _11"> </span>ano<span class="blank _2"> </span>s, <span class="blank _11"> </span>bócio, </span></div><div class="t m0 xf h11 y87 ffa fs7 fc2 sc0 ls0 ws0">doença <span class="blank _c"> </span>nodular <span class="blank _c"> </span>tireoidiana, <span class="blank _c"> </span>história <span class="blank _c"> </span>familiar, <span class="blank _c"> </span>sínd<span class="blank _2"> </span>romes <span class="blank _c"> </span>assoc<span class="blank _2"> </span>iadas,<span class="blank _3"></span> </div><div class="t m0 xf h11 y88 ffa fs7 fc2 sc0 ls0 ws0">doenças autoimunes, grávidas, IC, anemia). </div><div class="t m0 xe h11 y89 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>TSH: <span class="blank _1"> </span>1º <span class="blank _2"> </span>exame <span class="blank _1"> </span></span><span class="ffc">\u2192<span class="ffa ws0"> <span class="blank _2"> </span>alteração <span class="blank _1"> </span>l<span class="blank _3"></span>eve <span class="blank _2"> </span>a<span class="blank _2"> </span>guarda <span class="blank _2"> </span>2 <span class="blank _2"> </span>m<span class="blank _2"> </span>eses <span class="blank _2"> </span>e <span class="blank _1"> </span>solicita <span class="blank _2"> </span>novamente </span></span></div><div class="t m0 xf h11 y59 ffa fs7 fc2 sc0 ls0 ws0">junto com T4; caso mais característico, já pede outro junto com T4. </div><div class="t m0 x10 h11 y8a ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Normal: 0,45-4,5. </span></div><div class="t m0 xe h11 y8b ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Confirmado: solicitar ac para Hashimoto, anti-peroxida<span class="blank _2"> </span>se é o <span class="blank _3"></span>melhor. </span></div><div class="t m0 xe h11 y8c ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>USG: não é rotina, mas pode ajudar a escolher entre tratar ou não. </span></div><div class="t m0 x7 h11 y8d ffa fs7 fc2 sc0 ls0 ws0">Tratamento: </div><div class="t m0 xe h11 y8e ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Levotiroxina <span class="blank _d"> </span>sódica <span class="blank _d"> </span>(T4): <span class="blank _c"> </span>quase <span class="blank _d"> </span>sempre <span class="blank _d"> </span>(jejum, <span class="blank _d"> </span>dose <span class="blank _d"> </span>depende <span class="blank _c"> </span>do </span></div><div class="t m0 xf h11 y8f ffa fs7 fc2 sc0 ls0 ws0">paciente). </div><div class="t m0 xe h11 y90 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Triiodotironina <span class="blank _9"> </span>(T3): <span class="blank _9"> </span>casos <span class="blank _1"> </span>especí<span class="blank _2"> </span>ficos <span class="blank _9"> </span>que <span class="blank _1"> </span>envolvem <span class="blank _9"> </span>alterações <span class="blank _9"> </span>leves <span class="blank _9"> </span>e </span></div><div class="t m0 xf h11 y91 ffa fs7 fc2 sc0 ls0 ws0">em locais específicos de deiodinase. </div><div class="t m0 xe h11 y92 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Trata todos<span class="blank _3"></span> os <span class="blank _8"></span>clínicos, mas <span class="blank _8"></span>o subclínic<span class="blank _3"></span>o só <span class="blank _8"></span>se o <span class="blank _8"></span>TSH ><span class="blank _3"></span> 10, entre <span class="blank _8"></span>4,5 e <span class="blank _8"></span>10 </span></div><div class="t m0 xf h11 y93 ffa fs7 fc2 sc0 ls0 ws0">é individualizado. </div><div class="t m0 xe h11 y94 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Acompanhamento pelo TSH (2 a 3 meses do início do tratamento): </span></div><div class="t m0 x10 h11 y95 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>< 60 anos: 1 <span class="ffd wsd">\u2013</span> 2,5 mU/L. </span></div><div class="t m0 x10 h11 y96 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ls4 ws0"> <span class="ls3">60 </span></span><span class="ffd wsd">\u2013<span class="ffa ws0"> 70: 3 </span><span class="ls3">\u2013<span class="ffa ls5 ws0"> <span class="ls6 wse">4.</span><span class="ls0"> </span></span></span></span></div><div class="t m0 x10 h11 y97 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>> 70: 4 <span class="ffd ls3">\u2013</span> <span class="ls3 wsf">6.</span> </span></div><div class="t m0 x10 h11 y98 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Orienta mudança de dose. </span></div><div class="t m0 x7 h11 y99 ffa fs7 fc2 sc0 ls0 ws0">OBS: inspeção, palpação e ausculta da tireoi<span class="blank _3"></span>de.<span class="blank _2"> </span> </div><div class="t m0 x7 h10 y9a ff8 fsa fc2 sc0 ls0 ws0">- Diabetes <span class="fff ws10">Mellitus</span> <span class="blank _8"></span>(D<span class="blank _2"> </span>M): </div><div class="t m0 x15 h10 y9b ff8 fsa fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 h11 y9c ffa fs7 fc2 sc0 ls0 ws0">Conceito: </div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf9" class="pf w1 h8" data-page-no="9"><div class="pc pc9 w1 h8"><img fetchpriority="low" loading="lazy" class="bi x7 y38 w5 h12" alt="" src="https://files.passeidireto.com/27f1c739-45df-4c63-94e7-e612c3f1223d/bg9.png"><div class="c x0 y0 w2 h8"><div class="t m0 x7 ha y1c ff7 fs6 fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 ha y1d ff7 fs6 fc2 sc0 ls0 ws0"> </div></div><div class="c x8 y1e w3 hb"><div class="t m0 x9 ha y1f ff7 fs6 fc2 sc0 ls0 ws0">6 </div></div><div class="c x7 y20 w4 hc"><div class="t m0 xa hd y21 ff8 fs7 fc2 sc0 ls0 ws0">Gustavo Urzêda Vitória </div></div><div class="c x0 y0 w2 h8"><div class="t m0 xe h11 y39 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Grupo d<span class="blank _2"> </span>e doenças <span class="blank _2"> </span>metabólicas <span class="blank _2"> </span>caracterizado por <span class="blank _2"> </span>defeito na <span class="blank _2"> </span>secreção <span class="blank _2"> </span>de </span></div><div class="t m0 xf h11 y55 ffa fs7 fc2 sc0 ls0 ws0">insulina <span class="blank _18"> </span><span class="ffc ls1">\u2192</span> <span class="blank _18"> </span>hipe<span class="blank _2"> </span>rglicemia <span class="blank _19"> </span>crônica <span class="blank _1a"> </span><span class="ffc wsa">\u2192</span> <span class="blank _18"> </span>complicações <span class="blank _18"> </span>micro <span class="blank _19"> </span>e </div><div class="t m0 xf h11 y56 ffa fs7 fc2 sc0 ls0 ws0">macrovasculares <span class="ffc wsa">\u2192</span> disfunção e lesões em vários órgãos. </div><div class="t m0 xe h11 y57 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Muito associada a doenças CV, renais e metabólicas. </span></div><div class="t m0 x7 h11 y89 ffa fs7 fc2 sc0 ls0 ws0">Fisiopatologia: </div><div class="t m0 xe h11 y9d ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Complexa, envolve diversos sistemas </span><span class="ffc">\u2192<span class="ffa ws0"> resistência <span class="blank _2"> </span>insulínica: </span></span></div><div class="t m0 x10 h11 y5a ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Diminuição da produção insulínica pelo pâncreas. </span></div><div class="t m0 x10 h11 y5b ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Aumento da produção hepática de glicose. </span></div><div class="t m0 x10 h11 y5c ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Adiposopatia. </span></div><div class="t m0 x10 h11 y5d ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Disfunção de neurotransmissores. </span></div><div class="t m0 x10 h11 y9e ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Diminuição da captação muscular de glicose. </span></div><div class="t m0 x10 h11 y9f ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Aumento da secreção de glucagon. </span></div><div class="t m0 x10 h11 ya0 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Diminuição da secreção de incretina. </span></div><div class="t m0 x10 h11 ya1 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Aumento da reabsorção renal de glicose. </span></div><div class="t m0 x10 h11 ya2 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Alteração <span class="blank _1"> </span>do <span class="blank _2"> </span>ciclo <span class="blank _1"> </span>cicardiano <span class="blank _1"> </span><span class="ffc wsa">\u2192</span> <span class="blank _2"> </span>aumento <span class="blank _1"> </span>de <span class="blank _2"> </span>cortisol, <span class="blank _1"> </span>GH <span class="blank _2"> </span>e <span class="blank _1"> </span>outros<span class="blank _8"></span> </span></div><div class="t m0 x11 h11 ya3 ffa fs7 fc2 sc0 ls0 ws0">hormônios antagonistas da insulina. </div><div class="t m0 x7 h11 ya4 ffa fs7 fc2 sc0 ls0 ws0">Quadro clínico: </div><div class="t m0 xe h11 ya5 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>DM <span class="blank _c"> </span>tipo <span class="blank _c"> </span>2: <span class="blank _c"> </span>obesidade, <span class="blank _17"> </span>HA, <span class="blank _c"> </span>dislipidemia, <span class="blank _d"> </span>doença <span class="blank _c"> </span>macrovascular <span class="blank _17"> </span><span class="ffc ls1">\u2192</span> </span></div><div class="t m0 xf h11 ya6 ffa fs7 fc2 sc0 ls0 ws0">geralmente <span class="blank _9"> </span>oligossintomático. <span class="blank _11"> </span>Relacionado <span class="blank _9"> </span>ao <span class="blank _9"> </span>desenvolvimento <span class="blank _9"> </span>de <span class="blank _11"> </span>RI <span class="blank _9"> </span>e </div><div class="t m0 xf h11 ya7 ffa fs7 fc2 sc0 ls0 ws0">com idade mais avançada. </div><div class="t m0 x10 h11 ya8 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Mais relacionado a história familiar positiva. </span></div><div class="t m0 xe h11 ya9 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>DM <span class="blank _14"></span>tipo <span class="blank _14"></span>1: <span class="blank _14"></span>pe<span class="blank _2"> </span>rda<span class="blank _3"></span> <span class="blank _14"></span>de <span class="blank _14"></span>peso, <span class="blank _14"></span>poliuria, <span class="blank _14"></span>po<span class="blank _2"> </span>lidipsia,<span class="blank _3"></span> <span class="blank _14"></span>desidratação <span class="blank _14"></span>e <span class="blank _14"></span>ceto<span class="blank _2"> </span>-acidose. </span></div><div class="t m0 xf h11 y7d ffa fs7 fc2 sc0 ls0 ws0">Relacionado <span class="blank _2"> </span>a <span class="blank _2"> </span>idade m<span class="blank _2"> </span>ais p<span class="blank _2"> </span>recoce; <span class="blank _2"> </span>fundo genético <span class="blank _2"> </span>e <span class="blank _2"> </span>autoimune <span class="blank _2"> </span>(auto<span class="blank _2"> </span>-ac </div><div class="t m0 xf h11 y7e ffa fs7 fc2 sc0 ls0 ws0">contra a células beta pancreáticas). </div><div class="t m0 x10 h11 y7f ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Peptídeo-C: reserva de produção de insulina. </span></div><div class="t m0 x10 h11 y80 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Anti-GAD. </span></div><div class="t m0 xe h11 yaa ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Outras formas: LADA, Flatbush, Monogênicos, Gestacional, etc. </span></div><div class="t m0 x10 h11 yab ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>LADY: <span class="blank _15"> </span>mais <span class="blank _15"> </span>na <span class="blank _15"> </span>adolescência <span class="blank _0"> </span><span class="ffc ls1">\u2192</span> <span class="blank _15"> </span>fase <span class="blank _15"> </span>de <span class="blank _15"> </span>lua <span class="blank _15"> </span>de <span class="blank _15"> </span>mel <span class="blank _15"> </span>tem <span class="blank _15"> </span>pouca </span></div><div class="t m0 x11 h11 yac ffa fs7 fc2 sc0 ls0 ws0">insulina, depois apresenta os sintomas. </div><div class="t m0 x10 h11 yad ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>LADA: <span class="blank _e"> </span>autoimune <span class="blank _e"> </span>no <span class="blank _e"> </span>adulto <span class="blank _f"> </span><span class="ffc ls1">\u2192</span> <span class="blank _10"> </span>q<span class="blank _2"> </span>uadro <span class="blank _10"> </span>mais <span class="blank _e"> </span>brando, <span class="blank _f"> </span>raro <span class="blank _10"> </span>ter </span></div><div class="t m0 x11 h11 yae ffa fs7 fc2 sc0 ls0 ws0">cetoacidose. </div><div class="t m0 x10 h11 y2d ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Flatbush: <span class="blank _2"> </span>prop<span class="blank _2"> </span>enso <span class="blank _2"> </span>a <span class="blank _2"> </span>ceto<span class="blank _2"> </span>acidose, <span class="blank _2"> </span>mais <span class="blank _1"> </span>co<span class="blank _3"></span>mu<span class="blank _2"> </span>m <span class="blank _2"> </span>em <span class="blank _1"> </span>negros <span class="blank _2"> </span>e <span class="blank _1"> </span>não </span></div><div class="t m0 x11 h11 yaf ffa fs7 fc2 sc0 ls0 ws0">é autoimune. </div><div class="t m0 x10 h11 yb0 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>Monogênicos: <span class="blank _10"> </span>14 <span class="blank _10"> </span>subtipos <span class="blank _10"> </span><span class="ffc ls7">\u2192</span> <span class="blank _10"> </span>raro, <span class="blank _10"> </span>começa <span class="blank"> </span>com <span class="blank _10"> </span>hiperglicemia </span></div><div class="t m0 x11 h11 yb1 ffa fs7 fc2 sc0 ls0 ws0">precoce e tem transmissão autossômica dominante. </div><div class="t m0 x10 h11 yb2 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>DMG: geralmente a partir de 24 semanas <span class="ffc ls1">\u2192</span> GJ > 92. </span></div><div class="t m0 x7 h11 yb3 ffa fs7 fc2 sc0 ls0 ws0">Fatores de risco: </div><div class="t m0 xe h11 yb4 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Tabagismo, <span class="blank _12"> </span>medicações, <span class="blank _12"> </span>obesidade, <span class="blank _12"> </span>sedentarismo, <span class="blank _12"> </span>hormônios <span class="blank _12"> </span>contra<span class="blank _2"> </span>-</span></div><div class="t m0 xf h11 yb5 ffa fs7 fc2 sc0 ls0 ws0">regulatórios, <span class="blank _4"> </span>genética, <span class="blank _4"> </span>desnutrição <span class="blank _4"> </span>fetal, <span class="blank _4"> </span>dislipidemia, <span class="blank _4"> </span>infla<span class="blank _8"></span>m<span class="blank _2"> </span>ação </div><div class="t m0 xf h11 yb6 ffa fs7 fc2 sc0 ls0 ws0">sistêmica, HA, SOP, aterosclerose, DAC, apneia do sono. </div><div class="t m0 x7 h11 yb7 ffa fs7 fc2 sc0 ls0 ws0">Diagnóstico: </div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pfa" class="pf w1 h8" data-page-no="a"><div class="pc pca w1 h8"><img fetchpriority="low" loading="lazy" class="bi x16 y1b w6 h13" alt="" src="https://files.passeidireto.com/27f1c739-45df-4c63-94e7-e612c3f1223d/bga.png"><div class="c x0 y0 w2 h8"><div class="t m0 x7 ha y1c ff7 fs6 fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 ha y1d ff7 fs6 fc2 sc0 ls0 ws0"> </div></div><div class="c x8 y1e w3 hb"><div class="t m0 x9 ha y1f ff7 fs6 fc2 sc0 ls0 ws0">7 </div></div><div class="c x7 y20 w4 hc"><div class="t m0 xa hd y21 ff8 fs7 fc2 sc0 ls0 ws0">Gustavo Urzêda Vitória </div></div><div class="c x0 y0 w2 h8"><div class="t m0 xe h11 y39 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Glicemia <span class="blank _1"> </span>de <span class="blank _2"> </span>jejum<span class="blank _2"> </span> <span class="blank _2"> </span>> <span class="blank _1"> </span>ou <span class="blank _2"> </span>= <span class="blank _1"> </span>a <span class="blank _1"> </span>126 <span class="blank _2"> </span>(3 <span class="blank _1"> </span>dias <span class="blank _1"> </span>sem <span class="blank _2"> </span>restrições <span class="blank _1"> </span>e<span class="blank _2"> </span> <span class="blank _1"> </span>8h <span class="blank _2"> </span>de <span class="blank _1"> </span>jejum <span class="blank _2"> </span>na </span></div><div class="t m0 xf h11 y55 ffa fs7 fc2 sc0 ls0 ws0">véspera de colher amostra). </div><div class="t m0 xe h11 yb8 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>HbA1c > ou = a 6,5%. </span></div><div class="t m0 x10 h11 y57 ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>OBS: <span class="blank _15"> </span>não <span class="blank _15"> </span>se <span class="blank _0"> </span>b<span class="blank _3"></span>aseia <span class="blank _15"> </span>em <span class="blank _15"> </span>um <span class="blank _0"> </span>só <span class="blank _15"> </span>exame, <span class="blank _15"> </span>repete <span class="blank _15"> </span>aquele <span class="blank _15"> </span>que <span class="blank _15"> </span>deu </span></div><div class="t m0 x11 h11 y58 ffa fs7 fc2 sc0 ls0 ws0">alterado. </div><div class="t m0 xe h11 yb9 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>2h após sobrecarga > ou = a 200 + sintomas. </span></div><div class="t m0 xe h11 yba ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Ao acaso > ou = a 200 + sintomas. </span></div><div class="t m0 x10 h11 ybb ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>OBS: não precisa repetir. </span></div><div class="t m0 xe h11 ybc ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Jejum entre 100 e 125: alterada. </span></div><div class="t m0 xe h11 ybd ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>TTGO 75g entre 140 e 199: tolerância a glicose reduzida. </span></div><div class="t m0 x10 h11 ybe ffe fs7 fc2 sc0 ls0 wsc">o<span class="ffa ws0"> <span class="blank _b"> </span>OBS: Pré-DM. </span></div><div class="t m0 x17 h11 ybf ffa fs7 fc2 sc0 ls0 ws0"> </div><div class="t m0 x7 h11 yc0 ffa fs7 fc2 sc0 ls0 ws0">Metas: </div><div class="t m0 xe h11 yc1 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Pré-prandial: <100 (podendo de 80-130 no ADA). </span></div><div class="t m0 xe h11 yc2 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>Pós-prandial: < 160 (podendo ser < 180 no ADA). </span></div><div class="t m0 xe h11 yc3 ffb fs7 fc2 sc0 ls0 wsa">\u2022<span class="ffa ws0"> <span class="blank _4"> </span>HbA1c: <7,0% (7,5 a 8,5% em idosos). </span></div><div class="t m0 x7 h11 yc4 ffa fs7 fc2 sc0 ls0 ws0">Tratamento: </div><div class="t m0 xe h11 yc5 ffc fs7 fc2 sc0 ls0 wsa">\u27a2<span class="ffa ws0"> <span class="blank _c"> </span>HbA1c <span class="blank _4"> </span>< <span class="blank _1b"> </span>7,5%: <span class="blank _1b"> </span>geralmente<span class="blank _2"> </span> <span class="blank _1b"> </span>assintomático <span class="blank _1b"> </span><span class="ls3">ou</span> <span class="blank _1b"> </span>oligo<span class="blank _2"> </span>ssintomático; </span></div><div class="t m0 xf h11 yc6 ffa fs7 fc2 sc0 ls0 ws0">modificações do estilo de vida e pode ter metformina em monoterapia. </div><div class="t m0 xe h11 yc7 ffc fs7 fc2 sc0 ls0 wsa">\u27a2<span class="ffa ws0"> <span class="blank _c"> </span>HbA1c entre 7,5 e 9%: metformina + 2º agente. </span></div><div class="t m0 xe h11 yc8 ffc fs7 fc2 sc0 ls0 wsa">\u27a2<span class="ffa ws0"> <span class="blank _c"> </span>HbA1c > <span class="blank _8"></span>9%: muito sin<span class="blank _3"></span>tomático <span class="ffc ls1">\u2192</span> ins<span class="blank _8"></span>u<span class="blank _2"> </span>lina +<span class="blank _8"></span> VO; pouco <span class="blank _8"></span>sintomático <span class="ffc ls1">\u2192</span> s<span class="blank _3"></span>ó </span></div><div class="t m0 xf h11 yc9 ffa fs7 fc2 sc0 ls0 ws0">VO. </div><div class="t m0 x7 h11 yca ffa fs7 fc2 sc0 ls0 ws0">Modificação do estilo de vida (MEV): </div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div>
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