Browsing by Author "FARDELLA, C"

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    ADRENAL MACROTUMORS DIAGNOSED BY COMPUTED-TOMOGRAPHY
    (1990) LOPEZ, JM; FARDELLA, C; ARTEAGA, E; MICHAUD, P; RODRIGUEZ, JA; CRUZ, F
    Adrenal tumors larger than 6 cm are unusual but show a greater incidence of malignant etiologies than smaller adrenal tumors. The scarce information about adrenal macrotumors (AMT) induced us to study prospectively all patients who were seen in our clinic during the period 1984-1988 and were diagnosed by computed tomography (CT) to have an adrenal mass .gtoreq.6 cm. The clinical characteristics, including the main complaint, tumoral secretory activity, CT findings and histologic diagnosis from 18 patients are described; they represented a 0.3% of the total amount of abdominal CT studies performed. Seventy-two % of AMT resulted to be non cortisol or catecholamines secreting masses, and from them, a 38% corresponded to malignant etiologies characterized by marked and rapid weight loss. Four out of five hormone secreting AMT corresponded to pheochromocytomas, while the fifth one resulted to be a bilateral macronodular hyperplasia secreting cortisol. In two cases AMT did not correspond to a genuine adrenal mass, resulting to be a malignant histocytoma in one case and a hydatidic cyst in other one. When performed in two occasions, a percutaneous needle biopsy was a valuable diagnostic tool, permitting to diagnose a lymphoma and a tuberculoma. In conclusion: 1) AMT correspond mainly to non cortisol or catecholamines secreting tumors, often malignant; 2) not all AMT diagnosed by CT correspond to true adrenal masses; 3) percutaneous needle biopsy can be a helpful procedure for diagnosing nonfunctioning solid AMT.
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    AUTOIMMUNE THYROID-DISEASE IN THE PUERPERIUM - PREDICTIVE VALUE OF THYROID ENLARGEMENT AND RELATED HORMONAL CHANGES OCCURRING DURING PREGNANCY
    (1990) FARDELLA, C; LOPEZ, JM; VALDES, ME; NUNEZ, M; MIRANDA, M
    The incidence of goiter detected during pregnancy and its significance as an indicator of autoimmune thyroid disease after delivery was investigated in a sample of 707 pregnant women (81% in their 2nd trimester of gestation). Goiter was detected in 106 subjects (15%). Blood T4, T3, TSH, free T4 index (FT4), antimicrosomal antibodies (AMA) and urinary iodine excretion were measured in these women and in a control group of gravidas without goiter. These measurements were repeated at 1 and 3 months after delivery. Compared with controls during pregnancy, subjects with goiter had lower FT4I values (11.0 .+-. 2.8 vs 9.0 .+-. 1.8; p < 0.01) and higher TSH values (2.9 .+-. 0.6 .mu.U/ml vs 4.2 .+-. 2.1 .mu.U/ml; p < 0.01). In contrast, T4, T3, AMA and urinary iodine excretion values were similar in both groups. In subjects with goiter FT4I values increased over pregnancy levels at 1 month (11.2 .+-. 2.0; p < 0.05) and 3 months (14.0 .+-. 3.0; p < 0.05) after delivery; in 29% a biochemical hyperthyroidism (FT4I > 13.5) was detected. During the same period TSH values decreased significantly (1 month: 1.9 .+-. 0.7 .mu.U/ml; p < 0.05; 3 months: 2.7 .+-. 3.0 .mu.U/ml; p < 0.05). Frequency of positive AMA increased from 8.6% during pregnancy up to 32.1% in the post-delivery period (p < 0.01). In the control groups no variation in the FT4I, TSH or AMA were observed after delivery. These results indicate that goiter during pregnancy is common in Chilean gravidas and that it has predictive value for the appearance of autoimmune thyroid disease after delivery.
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    EFFECT OF ORAL POTASSIUM SUPPLEMENTS ON URINARY KALLIKREIN EXCRETION IN SHEEHANS SYNDROME
    (1988) LOPEZ, JM; MAHANA, D; RODRIGUEZ, JA; MICHAUD, P; ARTEAGA, E; FARDELLA, C
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    PRIMARY HYPERPARATHYROIDISM AND HYPERTENSION - PERSISTENTLY ABNORMAL PRESSOR SENSITIVITY IN NORMOTENSIVE PATIENTS AFTER SURGICAL CURE
    (1994) RODRIGUEZPORTALES, JA; FARDELLA, C
    To examine the effects of primary hyperparathyroidism separately from those of hypertension per se on blood pressure regulation in patients with primary hyperparathyroidism, we studied the presser response to infused angiotensin II (All) and to norepinephrine (NE) in 7 normotensive patients with primary hyperparathyroidism before and after surgical cure, and compared it to that observed in 10 subjects with idiopathic hypertension and 10 normal controls. While the subjects were on an ad libitum diet, we measured urinary and plasma electrolytes, creatinine, and plasma renin activity. Except for calcium, these values were not significantly different among the three groups. The blood pressure was measured basally and in response to graded doses of All or of NE until a 20-mmHg increase in the diastolic blood pressure was reached (''pressor dose''). The presser doses of All and of NE were lower in the normotensive patients with primary hyperparathyroidism than in normal controls [4.6 +/- 2.0 vs. 7.3 +/- 3.5 ng/kg/min (p<0.05) and 164 +/- 114 vs. 302 +/- 176 ng/kg/min (p<0.05) respectively] and not significantly different from those found in idiopathic hypertension (3.1 +/- 1.2 and 137 +/- 95 ng/kg/min). When the patients with primary hyperparathyroidism were studied again between 2-6 months after surgical cure, their presser doses of All and of NE remained unchanged from their preoperative values (5.4 +/- 2.9 and 137 +/- 80 mg/kg/min). We conclude that the hyperparathyroid condition can disrupt the normal responsiveness to presser agents even if the blood pressure remains within normal limits, and that this abnormality may persist after surgical cure.