Banca de DEFESA: ODIL GARRIDO CAMPOS DE ANDRADE

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : ODIL GARRIDO CAMPOS DE ANDRADE
DATE: 02/05/2024
TIME: 14:00
LOCAL: Auditório da Pós Graduação da Faculdade de Medicina
TITLE:

THYROIDAL, GLYCEMIC, AND OSTEOMETABOLIC FUNCTION DISORDERS ASSESSMENT IN ADULT INDIVIDUALS WITH PULMONARY ARTERIAL HYPERTENSION.

KEY WORDS:

Pulmonary arterial hypertension; thyroid disorders; dyslipidemia; bone metabolic disorders; insulin resistance.

PAGES: 59
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Introduction: Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary arterial pressure associated with increased pulmonary vascular resistance, right ventricular overload, and, in advanced stages, right heart failure. Several metabolic disorders have been reported in association with PAH, such as disorders of glucose, thyroid, lipid, mineral and bone metabolism, which may influence the prognosis of these patients. Methods: Observational clinical study, cross-sectional analytical, with a group of adult individuals with PAH and a control group without PAH, matched by sex and age group. Anamnesis, laboratory tests regarding glucose, lipid, thyroid, mineral and bone metabolism, thyroid ultrasound with Doppler and bone mass evaluation through bone densitometry (DXA) were performed on all patients. The values of the biomarkers related to PAH, such as B-type natriuretic peptide (BNP) and its pro-molecule (NT-ProBNP), and the hemodynamic tests for classifying PAH were retrieved from the patients' medical records. Results: The PAH group included 35 subjects (34 women, mean age 46 ± 15.5 years) and the control group, 40 (39 women, mean age 41.8 ± 13.1 years). There was no difference in the prevalence of insulin resistance between the PAH group (51.4%) and the control group (47.5%), p=0.74; however, patients with PAH had higher glycated hemoglobin (A1c) than the control group (6.1% and 5.57%, respectively, p=0.006). The PAH group had lower mean levels of total cholesterol than the control group (170.46 ± 35.51 mg/dL and 192.1 ± 34.44 mg/dL, p = 0.009), as well as the median (interquartile interval) LDL cholesterol levels [105 (46) mg/dL and 121.6 (35.02) mg/dL, respectively, p=0.012]. A higher prevalence of hypothyroidism (22.9%) was found among patients of the PAH than of the control group (2.5%), p = 0.007. Eight patients in the PAH group (23%) had elevated parathyroid hormone (PTH) values, with a mean value of 104.8 ± 23.3 pg/mL, compared to a mean value of 47.3 ± 13.8 pg/mL, p = 0.0003. None of the individuals in the control group had high PTH levels. Considering BMD disorders, 12 patients in the PAH group had low bone mass, osteopenia, or osteoporosis (34%), and 8 individuals in the control group (20%), p =0.032, representing a 2.13 times higher relative risk for these conditions in patients with PAH. Compared to the control group, the HAP group presented lower BMD Z-scores for total femur (0.50 ± 1.13 vs -0.15 ± 1.25, respectively, p = 0.021) and for femoral neck (0.35 ± 0.94 vs -0.14 ± 1.07, respectively, p = 0.038). HAP and HPT patients presented higher levels of creatinine and NT-proBNP than patients with HAP and normal parathyroid hormone (0.98 ± 0.12 mg/dL and 0.76 ± 0.14 mg/dL p = 0.0004) and (2062.8 ± 1723.3 pg/mL and 280.2 ± 292.2 pg/mL, p = 0.02), respectively. Conclusion: In this cohort, the findings of higher A1c levels, higher prevalence of hypothyroidism, lower levels of LDL and total
cholesterol, higher prevalence of hyperparathyroidism, as well as lower BMD Z-scores for total femur and femoral neck in the PAH group, implies in the systemic character of PAH and underscores the relevance of establishing a long-term care protocol for the assessment of glycemic, lipid, thyroid, and bone metabolism for these group of patients.

COMMITTEE MEMBERS:
Externo à Instituição - MÁRCIO GARRISON DYTZ - ESCS
Interno - ***.787.884-** - LEOPOLDO LUIZ DOS SANTOS NETO - UnB
Presidente - 1189371 - VERONICA MOREIRA AMADO