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
Autores
Morie A. Gertz, MD, MACP
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.
Revisores
Donna Reece, MD
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.
Jeffrey Zonder, MD
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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