Melatonina e sua relação com os componentes da síndrome metabólica em crianças, adolescentes e adultos jovens tratados por tumores primários da glândula pineal
Data
2024-08-09
Autores
Bustamante, Talita de Faria 
Orientadores
Siviero-Miachon, Adriana Aparecida
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
OBJETIVOS: Avaliar os componentes da síndrome metabólica, composição corporal, distribuição de gordura e adipocinas, antes e após o tratamento de suplementação com melatonina, em pacientes com tumores primários na glândula pineal, que possuem diminuição ou perda do ritmo de secreção deste hormônio. Correlacionar estas variáveis com a ausência de melatonina e seu comportamento após a sua reposição. CASUÍSTICA E MÉTODO: Pacientes tratados por tumores primários da pineal, com menos de 30 anos e fora de terapia há pelo menos 4 meses, avaliados de acordo com variáveis relacionadas ao paciente, doença e tratamento, medidas antropométricas, composição corporal, distribuição de gordura, perfil metabólico e adipocinas, antes (T1), 3 meses (T2), 6 meses (T3) e 12 meses (T4) após a suplementação com melatonina na dose de 0,315 mg. A análise estatística foi realizada por meio de técnicas de reamostragem: bootstrapping e teste de Monte Carlo. As comparações foram realizadas através do teste de Friedman. RESULTADOS: Onze pacientes, idade de 16,3 (DP=5,7) anos no T1, sendo 8/11 (72,7%) do sexo masculino e 8/11 (72,7%) púberes. O tumor células germinativas não-germinomatoso foi o mais prevalente em 5/11 (45,5%). Todos realizaram quimioterapia e 10/11 (90,9%) receberam radioterapia (RT) cranial. Três de 11 (27,3%) eram deficientes de hormônio do crescimento (GH), estando apenas dois em reposição de rhGH, e 1/11 (9,1%) em tratamento para hipogonadismo. O índice de massa magra apresentou um aumento significativo ao longo das consultas, sem alterações na massa gorda. Os tecidos adiposos subcutâneo e visceral aumentaram, apesar da melatonina. O índice de resistência à insulina (HOMA1-IR), HDL-colesterol e os triglicérides não apresentaram alterações significativas, mas a pressão arterial mostrou uma tendência à queda, apesar de nenhum paciente ser considerado hipertenso ou diabético. A leptina apresentou redução e a adiponectina marcada elevação, não significativa, no decorrer das visitas. A única variável que sofreu efeito do tempo sem melatonina foi a pressão arterial diastólica. A RT cranial aumentou o tecido adiposo visceral e a leptina. A reposição com rhGH diminuiu a massa gorda, tecido adiposo visceral, pressão arterial diastólica, glicose pós-sobrecarga e aumentou a adiponectina. CONCLUSÃO: Pacientes tratados por tumores da pineal e insuficientes em melatonina se beneficiam de sua suplementação, apesar dos efeitos da RT cranial. Ainda são necessários mais estudos para determinar a dose de melatonina suficiente para superar o efeito deletério da RT nestes pacientes.
OBJECTIVES: To evaluate the components of metabolic syndrome, body composition, fat distribution and adipokines, before and after melatonin supplementation treatment, in patients with primary tumors in the pineal gland, who have a decrease or loss of the secretion rhythm of this hormone. To correlate these variables with the absence of melatonin and its behavior after its replacement. MATERIAL AND METHOD: Patients treated for primary pineal tumors, under 30 years of age and off therapy for at least 4 months, evaluated according to variables related to the patient, disease and treatment, anthropometric measurements, body composition, fat distribution, metabolic profile and adipokines, before (T1), 3 months (T2), 6 months (T3) and 12 months (T4) after supplementation with melatonin at a dose of 0.315 mg. Statistical analysis was performed using resampling techniques: bootstrapping and Monte Carlo test. Comparisons were made using the Friedman test. RESULTS: Eleven patients aged 16.3 (SD=5.7) years at T1, 8/11 (72.7%) male and 8/11 (72.7%) pubescent. Nongerminomatous germ cell tumor was the most prevalent in 5/11 (45.5%). All underwent chemotherapy and 10/11 (90.9%) received cranial radiotherapy (RT). Three of 11 (27.3%) were growth hormone (GH) deficient, with only two on rhGH replacement, and 1/11 (9.1%) on treatment for hypogonadism. The lean mass index showed a significant increase throughout the consultations, without changes in fat mass. Subcutaneous and visceral adipose tissue increased despite melatonin. The insulin resistance index (HOMA1-IR), HDL-cholesterol and triglycerides did not show significant changes, but blood pressure showed a tendency to fall, despite no patient being considered hypertensive or diabetic. Leptin showed a reduction and adiponectin showed a marked increase, not significant, during the visits. The only variable that was affected by time without melatonin was diastolic blood pressure. Cranial RT increased visceral adipose tissue and leptin. Replacement with rhGH decreased fat mass, visceral adipose tissue, diastolic blood pressure, post-overload glucose and increased adiponectin. CONCLUSION: Patients treated for pineal tumors and melatonin insufficient benefit from melatonin supplementation, despite the effects of cranial RT. More studies are still needed to determine the dose of melatonin sufficient to overcome the deleterious effect of RT in these patients.
OBJECTIVES: To evaluate the components of metabolic syndrome, body composition, fat distribution and adipokines, before and after melatonin supplementation treatment, in patients with primary tumors in the pineal gland, who have a decrease or loss of the secretion rhythm of this hormone. To correlate these variables with the absence of melatonin and its behavior after its replacement. MATERIAL AND METHOD: Patients treated for primary pineal tumors, under 30 years of age and off therapy for at least 4 months, evaluated according to variables related to the patient, disease and treatment, anthropometric measurements, body composition, fat distribution, metabolic profile and adipokines, before (T1), 3 months (T2), 6 months (T3) and 12 months (T4) after supplementation with melatonin at a dose of 0.315 mg. Statistical analysis was performed using resampling techniques: bootstrapping and Monte Carlo test. Comparisons were made using the Friedman test. RESULTS: Eleven patients aged 16.3 (SD=5.7) years at T1, 8/11 (72.7%) male and 8/11 (72.7%) pubescent. Nongerminomatous germ cell tumor was the most prevalent in 5/11 (45.5%). All underwent chemotherapy and 10/11 (90.9%) received cranial radiotherapy (RT). Three of 11 (27.3%) were growth hormone (GH) deficient, with only two on rhGH replacement, and 1/11 (9.1%) on treatment for hypogonadism. The lean mass index showed a significant increase throughout the consultations, without changes in fat mass. Subcutaneous and visceral adipose tissue increased despite melatonin. The insulin resistance index (HOMA1-IR), HDL-cholesterol and triglycerides did not show significant changes, but blood pressure showed a tendency to fall, despite no patient being considered hypertensive or diabetic. Leptin showed a reduction and adiponectin showed a marked increase, not significant, during the visits. The only variable that was affected by time without melatonin was diastolic blood pressure. Cranial RT increased visceral adipose tissue and leptin. Replacement with rhGH decreased fat mass, visceral adipose tissue, diastolic blood pressure, post-overload glucose and increased adiponectin. CONCLUSION: Patients treated for pineal tumors and melatonin insufficient benefit from melatonin supplementation, despite the effects of cranial RT. More studies are still needed to determine the dose of melatonin sufficient to overcome the deleterious effect of RT in these patients.
Descrição
Citação
BUSTAMANTE, Talita de Faria. Melatonina e sua relação com os componentes da síndrome metabólica em crianças, adolescentes e adultos jovens tratados por tumores primários da glândula pineal. 2024. 167 f. Dissertação (Mestrado em Pediatria e Ciências Aplicadas à Pediatria) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.