Tumor necrosis factor-alpha (TNF-alpha) is a proinfl ammatory cytokine, and its excess can lead to severe consequences. Those effects are known to be antagonized by TNF-alpha inhibitors. Etanercept is a fusion protein that inhibits TNF-alpha action. As TNF-alpha regulation is related to cellular differentiation of various cellular types involved in immune response through expression of several other cytokines, it is possible that the use of its inhibitors may cause cytopenia. We report two cases of bicytopenia induced by etanercept. Both cases recovered after drug withdrawal. We discuss the need of introduction of routine laboratorial tests in patients using anti-TNF therapy, in order to identify possible hematological changes.

Sheehan's Syndrome (SS) occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. We report a 41-year-old woman with a history of severe postpartum hemorrhage 18 years prior to presentation. During this period of time, she experienced severe fatigue. Three months prior to being admitted to our hospital, the patient started to notice alopecia, generalized edema and cognitive impairment. After proper investigation, laboratory tests and clinical findings indicated panhypopituitarism. In addition to neuroimaging and past medical history, SS was diagnosed and treatment started. We emphasize the importance of thorough investigation, further diagnosis and management of this condition (especially in third world countries), since SS is a neurological and endocrinological emergency and potentially life threatening.

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RESUMOExistem duas formas de vitamina D: vitamina D2 (ergocalciferol) e vitamina D3 (colecalciferol). A suplementação de vitamina D melhora condições ósseas como raquitismo, diminui a incidência de fraturas e quedas. Postula-se que essa reposição de vitamina D poderia também reduzir os riscos de desenvolvimento de várias doenças, como esclerose múltipla, doenças autoimunes e infecções. Apesar do grande número de estudos, os benefícios do uso da vitamina D na população em geral permanecem controversos. Propõe-se a discussão de um artigo de revisão e metanálise que contempla a relação dos níveis séricos de vitamina D e sua suplementação com associação de risco de morte Palavras-Chave:

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