Última revisão: 22 Mai 2021
Última atualização: 13 Abr 2021

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • estase jugular
  • edema nos membros inferiores
  • púrpura periorbital
  • petéquias palpebrais
  • macroglossia

Outros fatores diagnósticos

  • fadiga
  • perda de peso
  • dispneia ao esforço
  • neuropatia periférica
  • neuropatia autonômica
  • claudicação
  • náuseas ou vômitos
  • cólicas abdominais
  • hábito intestinal alternado
  • tontura/hipotensão ortostática
  • aumento da glândula salivar submandibular
  • hepatomegalia
  • ombros com aspecto de ombreira (sinal de "shoulder pad")
  • fraqueza muscular difusa
  • Síndrome do túnel do carpo

Fatores de risco

  • gamopatia monoclonal de significado indeterminado (MGUS)
  • poliartropatia inflamatória
  • infecções crônicas
  • doença inflamatória intestinal
  • síndromes febris periódicas hereditárias
  • doença de Castleman

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • imunofixação sérica
  • imunofixação da urina
  • técnica de detecção de cadeias leves livres de imunoglobulina
  • Hemograma completo
  • perfil metabólico abrangente
  • urina de 24 horas

Investigações a serem consideradas

  • biópsia tecidual
  • espectrometria de massa
  • microscopia imunoeletrônica
  • estudos imuno-histoquímicos
  • teste genético
  • cintilografia com amiloide sérico P (SAP)
  • nível de troponina sérica
  • fragmento N-terminal do peptídeo natriurético tipo B
  • beta-2-microglobulina
  • eletrocardiograma (ECG)
  • ecocardiografia (com Doppler tecidual e deformação longitudinal global)
  • ressonância nuclear magnética (RNM) cardíaca
  • cintilografia (óssea)

Algoritmo de tratamento

Colaboradores

Morie A. Gertz

Seidler Jr. Professor of Medicine

Consultant in Hematology

Chair Emeritus of the Department of Medicine

Mayo Distinguished Clinician

Mayo Clinic College of Medicine

Rochester

MN

Declarações

MAG has received personal fees from Ionis/Akcea, Alnylam, Prothena, Janssen, Annexon, Appellis, Amgen, Medscape, Physicians Education Resource, and Research to Practice; and grants and personal fees from Spectrum. MAG has received personal fees from AbbVie and Celgene for a Data Safety Monitoring board, and personal fees from Sanofi for workforce training. MAG has received speaker fees from Teva, Johnson & Johnson, Medscape, and DAVA Oncology; and advisory board fees from Pharmacyclics and Procalara. MAG has participated in the development of educational materials for the i3Health Educational Program development. MAG has received royalties from Springer Publishing. MAG has received grant funding from the Amyloidosis Foundation, International Waldenstrom's Macroglobulinemia Foundation, and National Cancer Institute (SPORE MM SPORE 5P50 CA186781-04). MAG has stock options in Aurora Bio. MAG is an author of references cited in this topic.

RevisoresVER TUDO

Associate Professor of Medicine

Director

Program for Multiple Myeloma and Related Diseases

Princess Margaret Hospital

Toronto

Ontario

Canada

Declarações

DR has been reimbursed by Millennium Pharmaceuticals, Inc and Johnson & Johnson, the manufacturers of bortezomib, for attending several conferences, for speaking at educational meetings, and for consulting work. She has also been reimbursed by Celgene, the manufacturer of lenalidomide and thalidomide, for attending several symposia and serving as a speaker.

Assistant Professor of Medicine and Oncology

Division of Hematology/Oncology

Wayne State University School of Medicine

Barbara Ann Karmanos Cancer Institute

Detroit

MI

Declarações

JZ declares that he has no competing interests.

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