Upload
katerinemari
View
62
Download
0
Embed Size (px)
Citation preview
5/13/2018 Farmaci endocrinologia - slidepdf.com
http://slidepdf.com/reader/full/farmaci-endocrinologia 1/6
Terapia ormonale
2UPRQLGHOOLSRILVLHORURIDUPDFL
2UPRQLVRPDWRWURSL
2UPRQHGHOODFUHVFLWD*+3URODWWLQD2UPRQLJOLFRSURWHLFL7LUHRWURSLQD76+2UPRQH/XWHLQL]]DQWH/+2UPRQHIROOLFRORVWLPRODQWH)6+'HULYDWLGHOODSURRSLRPHODQRFRUWLQD&RUWLFRWURSLQD$&7+RUPRQL0HODQRFLWLVWLPRODQWLE06+H F06+/LSRWURSLQH)DWWRULGLULODVFLRLSRWDODPLFL RUPRQHGLULODVFLRGHOORUPRQHGHOODFUHVFLWD*+5+ RUPRQHGL ULODVFLRGHO OHJRQDGRWURSLQH*Q5+ RUPRQHGL ULODVFLRGHO ODW LUHRWURSLQD75+ RUPRQHGL ULODVFLRGHO ODFRUWLFRWURSLQD&5+)DWWRULQHJDWLYL VRPDWRVWDWLQDULGXFHULODVFLR*+5+HWLUHRWURSLQD GRSDPLQDLQLELVFHODVHFUH]LRQHGHOODSURODWWLQD*+©VHFUHWRGDOOHFHOOXOHVRPDWRWURSHLQPLVXUDYDULDELOHLQIXQ]LRQHGHOOHW¡(PDVVLPDGXUDQWHODQRWWH6RQQRVWUHVVLSRJOLFHPLDHVHUFL]LRILVLFRHHVWURJHQLLQGXFRQRLOULODVFLR*+DJLVFHVXOODOLSROLVLH JOXFRQHRJHQHVLPDJOLHIIHWWLDQDEROLFLH SURPRWRULGHOODFUHVFLWDVRQRPHGLDWLGDOOLQGX]LRQHGHLIDWWRULGLFUHVFLWDLQVXOLQRVLPLOH,*)H,*)©LPSRUWDQWHQHOSHULRGRSRVWQDWDOHHG©VLQWHWL]]DWRQHOIHJDWRHLQPROWLWHVVXWL*OLHIIHWWLGL*+VRQRGRYXWLVRSUDWWXWWRDG,*))DUPDFR25021('(//$&5(6&,7$VRPDWRWURSLQHVHUPRUHOLQDDFHWDWR0HFFDQLVPRGD]LRQHWXWWHOHVRPDWRWURSLQHVRQRIRUPXOD]LRQLGL*+ULFRPELQDQWHOHVWUD]LRQHGDFDGDYHUHXPDQRQRQ©SLºSUDWLFDWDDFDXVDGHOODOWRULVFKLRGLPDODWWLDGL&UHXW]IHOGW-DNREPDODWWLDSULRQLFDPHQWUHVHUPRUHOLQDDFHWDWR©XQDQDORJRGL*+5+XPDQRvJNJDOGLH,OVRPDWUHPVRQRTXHLGHULYDWLGHO*+FKHSRVVLHGRQRXQDPHWLRQLQDLQSLºQHOODSRU]LRQHDPLQRWHUPLQDOH1HLVRJJHWWLFRQGHILFLWGL*+©XWLOHYDOXWDUHODIXQ]LRQHWLURLGHDLOLYHOOLGL*+OH,JIHGHIIHWWXDUHXQ5;GHOSROVRTXHOORFKHQRQXVD
)DUPDFRFLQHWLFD*+H*+5+YDQQRVRPPLQLVWUDWLXQDYROWDDOJLRUQRVRWWRFXWHODVHUDSHUPLPDUHLULWPLFLUFDGLDQL8VLLQWHUDSLDXWLOL]]DWLSHUWUDWWDUHOHVLQGURPLGDFDUHQ]DGL*+QDQLVPRDUPRQLFRQHOEDPELQRVLQGURPHGL7XUQHUEDVVDVWDWXUD LGLRSDWLFD H WHUDSLD VRVWLWXWLYD LQ FDVR GL DVSRUWD]LRQH GHOOLSRILVL 6HUPROLQD DFHWDWR ©PHQR HIILFDFLH GHO*+ HVRSUDWWXWWRQRQSX³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
FDULFRRUDOHGLJOXFRVLRQHOODFURPHJDOLFRLO*+QRQVFHQGH VSRQWDQHDGL*+SHURUH GRVDJJLRGHOOHELQGLQJSURWHLQ FRQWUROORDOSKDVXEXQLW¡ 501
)DUPDFR$1$/2*+,'(//$620$7267$7,1$RFWUHRWLGHODQUHRWLGH0HFFDQLVPRGD]LRQHXQWHPSR VL XWLOL]]DYD ODVRPDWRVWDWLQDPDYLVWRFKHHVVD SRWHYDLQLELUH ODVLQWHVL GLJOXFDJRQHHLQVXOLQD QRQFKª OD VHFUH]LRQH GL RUPRQL *, JDVWULQD 9,3 HFF VL VRQR VLQWHWL]]DWL TXHVWL DQDORJKL FKH LQLELVFRQRHVFOXVLYDPHQWHODVHFUH]LRQHGL*+DJHQGRVXOOHFHOOXOHVRPDWRWURSHHQRQVXOSDQFUHDV)DUPDFRFLQHWLFD LQLH]LRQH VRWWRFXWH GL RFWUHRWLGH GLH vJ SHUFKª KD HPLYLWD EDVVD GL RUH PD VRQR VWDWH IDWWHIRUPXOD]LRQLDOHQWRULODVFLRPLFURVIHUHFKHSHUPHWWRQRXQDVLQJRODLQLH]LRQHRJQLVHWWLPDQHLGHPSHUODQUHRWLGH8VLLQWHUDSLDVLQGURPLGDHFFHVVLYDSURGX]LRQHGL*+DFURPHJDOLDHJLJDQWLVPR$YROWHULHVFRQRDGGLULWWXUDDIDUULGXUUHODPDVVD GHOODGHQRPD 9HQJRQR XVDWL TXLQGL SULPD GL LQWHUYHQWR FKLUXUJLFR SHU ULGXUUH OD PDVVD LSRILVDULD H DQFKH SRVWLQWHUYHQWRVHFLVRQRGHLUHVLGXL(IIHWWL FROODWHUDOL GLDUUHD QDXVHD H GRORUH DGGRPLQDOH QHO GHL SD]LHQWL FKH SHU³ UHJUHGLVFRQR FRQ LO WHPSR H QRQULFKLHGRQRODVRVSHQVLRQHGHOODWHUDSLDIRUVHOHJDWRDOORURHIIHWWRVXOODVHFUH]LRQHRUPRQDOHLQWHVWLQDOH
5/13/2018 Farmaci endocrinologia - slidepdf.com
http://slidepdf.com/reader/full/farmaci-endocrinologia 2/6
)DUPDFR3(*9,620$170HFFDQLVPRGD]LRQHDQWDJRQLVWDGHO*+FKHVLOHJDDOUHFHWWRUHPDQRQDWWLYDODWUDGX]LRQHGHOVHJQDOH)DUPDFRFLQHWLFDLQLH]LRQHVRWWRFXWDQHDYROWDDOJLRUQR8VLLQWHUDSLDXWLOL]]DWRVRORLQS]DFURPHJDOLFLRJLJDQWLLQFXLODFKLUXUJLDODUDGLRWHUDSLDQRQKDDYXWRHIIHWWRHSHULTXDOLXQDWHUDSLDFRQDQDORJKLGHOODVRPDWRVWDWLQDQRQVL©ULYHODWDXWLOHDGDEEDVVDUHLOLYHOOLGL,*)(IIHWWLFROODWHUDOLUHD]LRQLQHOVLWRGLLQRFXORHULWHPDGRORUHFKHVL ULVROYRQRVSRQWDQHDPHQWHTXHVWRIDUPDFRDGLIIHUHQ]DGHLSUHFHGHQWLQRQIDGLPLQXLUHODPDVVDWXPRUDOH/LSHUSURODWWLQHPLD©XQDQRPDOLDHQGRFULQDSLXWWRVWRFRPXQHFKHSLºVSHVVR©FDXVDWDGDDGHQRPLLSRILVDULSURODWWLQDVHFHUQHQWL3X³DQFKHHVVHUHGRYXWDDXQDSDWRORJLDLSRWDODPLFDRLSRILVDULDFKHFDXVDODSHUGLWDGHOFRQWUROORGRSDPLQHUJLFRDLQVXIILFLHQ]DUHQDOHDLSRWLURLGLVPRSULPDULR DVVRFLDWRDG XQDXPHQWRGHL OLYHOOL GL75+ R D XQWUDWWDPHQWRFRQ XQ DQWDJRQLVWD GHOUHFHWWRUHGRSDPLQHUJLFR %URPRFULSWLQDHFDEHUJROLQDVRQRLIDUPDFLSLºXWLOL]]DWL)DUPDFR$*21,67,'(,5(&(7725,'23$0,1(5*,&,'EURPRFULSWLQDFDEHUJROLQD0HFFDQLVPRGD]LRQHLQLELVFRQROD VHFUH]LRQHGLSURODWWLQDSRLFKªVL FRPSRUWDQRILVLRORJLFDPHQWHFRPH ODGRSDPLQDFKHFRLQFLGHFRQLO3,)3RVVRQRULGXUUHOHGLPHQVLRQLGHLSURODWWLQRPL)DUPDFRFLQHWLFDSHU26PDDOWRPHWDEROLVPRGLSULPRSDVVDJJLRSHUODEURPRFULSWLQDWGDRUHEURPRFULSWLQDDRUH FDUEHJROLQD PHWDEROLVPR HSDWLFR FRQ VHFUH]LRQH ELOLDUH H QHOOH IHFLSHU HQWUDPEL 'RVL PJGLH EURPRFULSWLQDFDUEHJROLQDPJGLH8VLLQWHUDSLDLSHUSURODWWLQHPLDGDPLFURRPDFURDGHQRPDLSRILVDULRFKHFDXVDJDODWWRUUHDDPHQRUUHDLQIHUWLOLW¡HQHOOXRPRSHUGLWDGHOODOLELGRLPSRWHQ]D$YROWHXWLOLQHOODFURPHJDOLDIRUVHSHUFKªOHFHOOXOHWXPRUDOLGHOODGHQRPD*+VHFHUQHQWHHVSULPRQRUHFHWWRUL'DGLIIHUHQ]DGHOOHFHOOXOHVRPDWRWURSHQRUPDOL(IIHWWLFROODWHUDOL WLSLFLGHL GHULYDWLGHOOHUJRW QDXVHD YRPLWR HPLFUDQLD LSRWHQVLRQHSRVWXUDOH DOOLQL]LRGHOOD WHUDSLD /DFDEHUJROLQDKDPHQRHIIHWWLFROODWHUDOL
*Q5+)6+/+*Q5+KDXQULODVFLRLQWHUPLWWHQWHODFXLIUHTXHQ]DHGLQWHQVLW¡DXPHQWDFRQOHW¡/D VRPPLQLVWUD]LRQH FRQWLQXD GL *Q5+ SURGXFH XQDGHVHQVLELOL]]D]LRQH HG XQD GLPLQX]LRQH GHLUHFHWWRULVXOOHFHOOXOHJRQDGRWURSHLSRILVDULHHGXQLQLEL]LRQHGHOULODVFLRGL/+H)6+*Q5+VLQWHWLFRVRPPLQLVWUDWRSXOVDQWH)DUPDFR$*21,67,'(/*Q5+OHXSUROLGHJRVHUHOLQD0HFFDQLVPRGD]LRQHQRUPDOPHQWHLO*Q5+©VHFUHWRLQPDQLHUDSXOVDWLOHGDOOLSRWDODPRTXHVWDSXOVDWLOLW¡© LQGLVSHQVDELOH SHUXQDDGHJXDWD VHFUH]LRQH GL /+)6+ ,QIDWWL XQDVRPPLQLVWUD]LRQH FRQWLQXD GL *Q5+ FDXVD XQD GHVHQVLWL]]D]LRQH GHL UHFHWWRUL VXOOHFHOOXOHJRQDGRWURSHOHTXDOLQRQSURGXFRQRSLº)6+H/+4XLQGL UHFHQWHPHQWH VL XWLOL]]D LO *Q5+ LQIXVR SHU HY FRQ PHFFDQLVPR SXOVDWLOHDWWUDYHUVRXQDSRPSDSHUFXUDUHSD]LHQWLFRQGHILFLWGL*K5+PDFRQLSRILVL LQWHJUD,QYHFHJOLDQDORJKLVLQWHWLFLGHO*Q5+OHXSUROLGHJRVHUHOLQDSRLFKªKDQQRXQHPLYLWDSLºOXQJDH QRQYHQJRQRVRPPLQLVWUDWL LQPRGR SXOVDWLOHVRPPLQLVWUDWLVFR LPVRQR
XWLOL]]DWL SHUVRSSULPHUH OD VHFUH]LRQH GL )6+ H /+ FRPH LQ FDVR GL EDPELQL FRQSXEHUW¡ SUHFRFH RUPRQH GLSHQGHQWHFDVWUD]LRQHPHGLFDDGGLULWWXUDQHOODWHUDSLDGHO.SURVWDWLFRDYDQ]DWRRUPRQHVHQVLELOH(IIHWWLFROODWHUDOLEHQWROOHUDWLIOHELWL LQIH]LRQL LQFDVR GLSRPSHGLVRPPLQLVWUD]LRQH*OL HIIHWWL FROODWHUDOLGHJOL DJRQLVWL DOXQJD GXUDWDVRQR LQ JHQHUHTXHOOLSUHYLVWL TXDQGR VL UHDOL]]D XQEORFFRGHOODVWHUHR JHQHVLJRQDGLFD YDPSDWH GLFDORUHVHFFKH]]DHVWURILDYDJLQDOHULGX]LRQHGHOODGHQVLW¡RVVHD)DUPDFR$17$*21,67,'(/*Q5+JDQLUHOL[8VLLQWHUDSLDSHSWLGHGRWDWRGLDOWDDIILQLW¡SHULOUHFHWWRUHGHO*Q5+XWLOL]]DWRSHUVRSSULPHUHUDSLGDPHQWHODVHFUH]LRQHGL/+XWLOHQHLSURWRFROOLGLVWLPROD]LRQHRYDULFDSHURWWHQHUHRYXOLSHUODIHFRQGD]LRQHLQYLWUR,QIDWWLODQWDJRQLVWDGHO*Q5+YLHQHVRPPLQLVWUDWR FRQ )6+ SHU LQGXUUH ODPDWXUD]LRQHGHOIROOLFROR VLLPSHGLVFHOD VHFUH]LRQH GL/+SHU QRQ VWLPRODUHWURSSRORYDLRJL¡VWLPRODWRGDO)6+ULFRPELQDQWHSRLVLVRPPLQLVWUDK&*R/+SHULQGXUUHORYXOD]LRQH266,72&,1$6\QWRFLQRQ(XQRUPRQHSHSWLGLFRSURGRWWRGDOOLSRWDODPR(LPPDJD]]LQDWRHVHFUHWRGDOOLSRILVLSRVWHULRUH(DWWLYRVXOOHFHOOXOHPXVFRODULOLVFHGHOOXWHURVXOOHPLRFHOOXOHPDPPDULHHGKDXQDPRGHVWDDWWLYLW¡DQWLGLXUHWLFDWLSR$'+/DVXDIXQ]LRQH©TXHOODGLVWLPRODUHODIUHTXHQ]DHODIRU]DGHOOHFRQWUD]LRQLXWHULQH/D VHQVLELOLW¡ GHOOXWHUR DOORVVLWRFLQD DXPHQWD JUDGXDOPHQWH GXUDQWH OD JUDYLGDQ]D ILQR D GLYHQWDUH HOHYDWLVVLPD DOOLQL]LR GHO WUDYDJOLR
DXPHQWRGHLUHFHWWRUL/RVVLWRFLQDYLHQHLPSLHJDWDSHULQGXUUHLOWUDYDJOLRGLSDUWRDWHUPLQHHSHUFRQWUROODUHOHHPRUUDJLHQHOSHULRGRGHOSRVWSDUWXP3X³HVVHUHXWLOL]]DWDSHUDXPHQWDUHODIXRULXVFLWDGLODWWHGDOFDSH]]RORFHOOXOHPLRHSLWHOLDOLFKHFLUFRQGDQRODOYHRORPDPPDULR$VVRUELWD GDOOHPXFRVHRUDOH HQDVDOH/HPLYLW¡ © GLPLQXWLH ODPHWDEROL]]D]LRQH© HSDWLFD H UHQDOH$JLVFHGLUHWWDPHQWH VXOOD ILEUDPXVFRODUH XWHULQD PRGLILFDQGR LO SRWHQ]LDOH GL PHPEUDQD HG HVDOWDQGR OHFFLWDELOLW¡ H OD FRQGXFLELOLW¡ GHOOD PLRILEULOOD DWWUDYHUVR XQLQFUHPHQWRGHOODSHUPHDELOLW¡PLRPHWULDOHDJOLLRQLFDOFLR/HGRVLLQGLFDWLYHSHUOLQGX]LRQHGHOWUDYDJOLRVRQRGL8,LQOLWURGLVROX]LRQHJOXFRVDWDLQIXVLRQHFRQ'RVL)ORZRSRPSD9HORFLW¡GLVRPPLQLVWUD]LRQHLQL]LDOHP8PLOOLXQLW¡DOPLQXWRGDDXPHQWDUHILQRDFKHQRQFRPSDLDQRLPSRUWDQWLFRQWUD]LRQL%LVRJQDPRQLWRUDUHODIUHTXHQ]DFDUGLDFDIHWDOHHODSUHVVLRQHDUWHULRVDPDWHUQD6HLOGRVDJJLR©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
5/13/2018 Farmaci endocrinologia - slidepdf.com
http://slidepdf.com/reader/full/farmaci-endocrinologia 3/6
)DUPDFLWLURLGHLHGDQWLWLURLGHL
*OLRUPRQLWLURLGHLVRQRLPPDJD]]LQDWLFRPHDPLQRDFLGLLRGDWLGHOODWLURQLQDQHOODWLUHRJOREXOLQD/HWDSSHGHOODVLQWHVLHULODVFLRVRQR FDSWD]LRQHGHOORLRGXURGLHWD RVVLGD]LRQHGHOORLRGXURHLRGD]LRQHGHLUHVLGXLWLURVLQLFL SURWHROLVLGHOODWLUHRJOREXOLQDHULODVFLRGLWLUR[LQDHWULLRGRWLURQLQDQHOVDQJXHOHJDWDDJOREXOLQD7%* FRQYHUVLRQHGLWLUR[LQD7 LQWULLRGRWLURQLQD7QHLWHVVXWLSHULIHULFL,OSULFLSDOHVLWRQRQWLURLGHRGLFRQYHUVLRQH©LOIHJDWR'XH
GLVWLQWHGHLRGLQDVLFRQYHUWRQROD7LQ7/D'FKHHVSUHVVDQHOIHJDWRQHOUHQHHQHOODWLURLGHJHQHUDOD7FLUFRODQWHFKHYLHQHXWLOL]]DWDGDOODPDJJLRUSDUWHGHLWHVVXWLSHULIHULFLEHUVDJOLR/D'©LQLELWDGDPROWLIDUPDFLWUDFXLSURSDQRORORDPLRGDURQHHJOXFRFRUWLFRLGL /D ' © VRYUD UHJRODWD QHOOLSHUWLURLGLVPR H VRWWRUHJRODWD QHOOLSRWLURLGLVPR /D ' © GLVWULEXLWD QHO FHUYHOORQHOOLSRILVLQHOODPXVFRODWXUDFDUGLDFDH JDUDQWLVFHODSSRUWRGL7 LQTXHVWLWHVVXWL*OLRUPRQLWLURLGHLVRQRWUDVSRUWDWLLQFLUFRORGDOOD 7%3 H LQ TXRWD PLQRUH GDOOD WUDVWLUHWLQD ,O OHJDPH GHJOL RUPRQL WLURLGHL DOOH SURWHLQH SODVPDWLFKH GDO PHWDEROLVPR HGDOOHVFUH]LRQHHQHSUROXQJDOHPLYLWD
76+©ORUPRQHFKHFRQWUROODLOLYHOOLGLRUPRQL7H7/HIXQ]LRQLVRQRUHJRODWHGDUHFHWWRULQXFOHDUL+DQQRIXQ]LRQHGLDWWLYD]LRQHRUHSUHVVLRQHGHOODWUDVFUL]LRQH7SLºDIILQHGL7
,PSRUWDQWLQHOORVYLOXSSRGHOFHUYHOORFUHWLQLVPRHULWDUGRPHQWDOH 6YLOXSSRFRUUHWWRGLDUWLHGRUJDQL (IIHWWRQHOODUHJROD]LRQHWHUPLFD (IIHWWLFDUGLRYDVFRODUL (IIHWWLPHWDEROLFL
,SHUWLURLGLVPRWLUHRWRVVLFRVLFDXVHGLIIHUHQWLHGDXWRLPPXQLPRUERGL*UDYHVFKHDWWLYDLUHFHWWRULSHU76+DGHQRPLLSHUIXQ]LRQDQWLJR]]RWRVVLFRGLIIXVRSUHVHQ]DGLQRGXOLVHJQLWLSLFLVRQRJR]]RSUREOHPLPHWDEROLFLHRIWDOPRSDWLDLQILOWUDWLYDQRGXOL
,SRWLURLGLVPRRPL[HGHPDFDXVHVRQROLSRWLURLGLVPRHDXWRDQWLFRUSLDQWLWLUHRJOREXOLQD+DVKLPRWR,QWXWWRLOPRQGROLSRWLURLGLVPRSULPDULR©SLºVSHVVRFDXVDWRGDGHILFLWGLLRGLR1HLSDHVLLQFXLODTXDQWLW¡GLLRGLR©VXIILFLHQWHODWLURLGLWHFURQLFDDXWRLPPXQH+DVKLPRWRUHQGHFRQWRGHOODPDJJLRUSDUWHGHLFDVL$OWUH FDXVHVRQR UDSSUHVHQWDWHGDDVSRUWD]LRQHFKLUXUJLFDGHOOD WLURLGHDEOD]LRQHJKLDQGRODUHFRQLRGLR UDGLRDWWLYRWLURLGLWHSRVWSDUWXPVHJQLWLSLFLVRQRDWURILDJKLDQGRODUHHJR]]R)DUPDFR25021,7,52,'(,
/HYRWLUR[LQDVRGLFD/7SHURVRLYHXWLUR[/LRWLURQLQDVRGLFD/7SHURVRLY/LRWUL[PLVFHODGL/7H/7)DUPDFRFLQHWLFD26 OHYRWLUR[LQD GHYHHVVHUHDVVXQWDD VWRPDFRYXRWR WSHU OHYRWLUR[LQDJLRUQL OLRWLURQLQDJLRUQRPHWDEROLVPRHSDWLFROHGRVLVRQRDJJLXVWDWHLQEDVHDLYDORULGL76+YDQQRGDDvJGLH8VL LQ WHUDSLD OD OHYRWLUR[LQD© LO IDUPDFRSLºXWLOL]]DWRQHOODWHUDSLDVRVWLWXWLYD/D OLRWLURQLQDQRQ©XWLOL]]DWDQHOODWHUSDLDVRVWLWXWLYDPDVRORSHUDEEDVVDUHLOLYHOOLGL76+UDSLGDPHQWHFRPHLQFDVRGLPL[HGHPDHFFHVVLYRFRPDWRVR,OOLRWUL[©PROWRFRVWRVRHQRQYLHQHXWLOL]]DWRDOSRVWRGHOODOHYRWLUR[LQD4XHVWLIDUPDFLROWUHDGHVVHUHXVDWLQHOODWHUDSLDVRVWLWXWLYDVRQRDQFKHLPSLHJDWLQHOODWHUDSLDGHOFRPHPL[RPDWRVRDGRVLPROWRHOHYDWHQHOODWHUDSLDGHOFUHWLQLVPRHQHOODWHUDSLDGHOFDQFURGHOODWLURLGHSHUVRSSULPHUHOD]LRQHVWLPRODQWHGHO76+VXOODFUHVFLWDGHLFDUFLQRPLWLURLGHLGLIIHUHQ]LDWL(IIHWWLFROODWHUDOLIRQGDPHQWDOPHQWHOHJDWLDOOHFFHVVLYDGRVHFRQLSHUWLURLGLVPR1XPHURVL FRPSRVWL DJLVFRQR GLUHWWDPHQWHR LQGLUHWWDPHQWH FRQOD VLQWHVL LO ULODVFLR R OD]LRQHGHJOLRUPRQL WLURLGHL *OLLQLELRUL YHQJRQRFODVVLILFDWLLQFDWHJRULH
)DUPDFLDQWLWLURLGHLFKHLQWHUIHULVFRQRGLUHWWDPHQWHFRQODVLQWHVLGHJOLRUPRQLWLURLGHL ,QLELWRULLRQLFLFKHEORFFDQRLOPHFFDQLVPRGLWUDVSRUWRGHOORLRGXUR
/RLRGLRVWHVVRDFRQFHQWUD]LRQLHOHYDWH /RLRGLRUDGLRDWWLYRFKHGDQQHJJLDODJKLDQGRODFRQOHVXHUDGLD]LRQLLRQL]]DQWL
)DUPDFR)$50$&,$17,7,52,'(, R7,21$0,',SURSLOWLRXUDFLOHPHWLPD]RORFDUELPD]ROR0HFFDQLVPRGD]LRQH LQLELVFRQR OD IRUPD]LRQHGL RUPRQL WLURLGHL LQWHUIHUHQGR FRQ OLQFRUSRUD]LRQHGHOOR LRGLR QHL UHVLGXLWLURVLQLFLGHOODWLUHRJOREXOLQD,QROWUHSURSLOWLRXUDFLOHLQLELVFHSDU]LDOPHQWHODGHLRGDVLSHULIHULFDPDQRQFRVLOPHWLPD]RORHLOFDUELPD]ROR&RPHDJLVFDQRUHDOPHQWHQRQVLVD)DUPDFRFLQHWLFDSHU26HPLYLWDEUHYHSHUSURSLOWLRXUDFLOHRUDHPHGLDSHUDOWULRUHSHU³OHPLYLWDSODVPDWLFDQRQVLFRUUHODFRQ ODGXUDWDGHLORURHIIHWWL LQIDWWLSURSLOWLRXUDFLOH© GDWR RJQL RUH LOPHWLPD]RORGLHPHWDEROLVPRHSDWLFR HVXFFHVVLYDHOLPLQD]LRQHUHQDOH 3DVVDQRQHOODSODFHQWDTXLQGL QRQHOOD JUDYLGDQ]D VHVL GHYRQR SHUIRU]DXVDUHPHJOLRSUSLOWLRXUDFLOHSHUFKª©SLºOHJDWRDOOHSURWHSDVVDPHQRODSODFHQWD8VLLQWHUDSLDXVDWLLQLSHUWLURLGLVPRGD%DVHGRZLQDWWHVDGLHYHQWXDOHUHPLVVLRQH6HOLSHWLURLGLVPR©SLºJUDYHVLXVDQRLQDVVRFLD]LRQH FRQ OR LRGLR UDGLRDWWLYR LQ DWWHVD GHJOL HIIHWWL GHOOD WHUDSLD UDGLDQWH R SHU FRQWUROODUH OD PDODWWLD SULPDGHOOLQWHUYHQWRFKLUXUJLFR ,QFDVRGL WHPSHVWD WLURLGHD LOSURSLOWLRXUDFLOH ©SUHIHULWRLQ YLUWºGHOOD VXDFDSDFLW¡ GLLQLELUH OD
5/13/2018 Farmaci endocrinologia - slidepdf.com
http://slidepdf.com/reader/full/farmaci-endocrinologia 4/6
FRQYHUVLRQHSHULIHULFDGHOOD7D71HOOHIRUPHPHQRJUDYLGLLSHUWLURLGLVPRVLSX³XVDUHDQFKHLOPHWLPD]ROR8QDYROWDUDJJLXQWROHXWLURLGLVPRJHQHUDOPHQWHLQVHWWLPDQHLOIDUPDFRQRQGHYHHVVHUHVRVSHVRDFDXVDGHOODSRVVLELOLW¡FKHVLYHULILFKLXQDULFDGXWDGHOORVWDWRGLLSHUWLURLGLVPR(IIHWWLFROODWHUDOLODSLºIUHTXHQWH©XQHUX]LRQHFXWDQHDSUXULJLQRVDFKHUHJUHGLVFHVSRQWDQHDPHQWHVHQ]DGRYHULQWHUURPSHUHODWHUDSLDUDUDPHQWHYDVFXOLWLHDJUDQXORFLWRVL)DUPDFR,1,%,725,$1,21,&,WLRFLDQDWRSHUFORUDWR0HFFDQLVPRGD]LRQHEORFFDQRFRPSHWLWLYDPHQWHLOWUDVSRUWDWRUHGHOORLRGLRQHLWLUHRFLWL8VLLQWHUDSLDLOWLRFLDQDWRQRQ©XWLOL]]DWRORVLWURYDQHOODGLHWDULFFDGLFDYROLPHQWUHSHUFORUDWRSX³HVVHUHXWLOL]]DWRQHOWUDWWDPHQWRGHOPRUERGL%DVHGRZ*UDYHVHQHOODWLUHRWRVVLFRVLGDDPLRGDURQHIDUPDFRULFFRGLLRGLRPJGLH(IIHWWLFROODWHUDOLSHUFORUDWRLQDOWHGRVLJSX³SURYRFDUHDQHPLHDSODVWLFKHIDWDOL)DUPDFR,2'8520HFFDQLVPRGD]LRQHDOWHFRQFHQWUD]LRQLGLLRGLRLQLELVFRQRLQPRGRDFXWRDOSURGX]LRQHH OLEHUD]LRQHGLRUPRQLWLURLGHLGDSDUWHGHLWLUHRFLWLHIIHWWR:ROII&KDLNRIIDQFKHVHWUDQVLWRULRJLRUQLPDVVLPR*OLHIIHWWLVRQRWUDQVLWRULSHUWDQWRORLRGXUR©VSHVVRXWLOL]]DWRQHOWUDWWDPHQWRSUHRSHUDWRULRGHOOLSHUWLURLGLVPRLQDWWHVDGHOOLQWHUYHQWRFKLUXUJLFRDQFKHSHUFKª©LQJUDGRGLLQGXUUHXQDEHQHILFDULGX]LRQHGHOODYDVFRODUL]]D]LRQHGHOODJKLDQGROD)DUPDFRFLQHWLFDXWLOL]]DWRFRPHVROX]LRQHFRQFHQWUDWDGLLRGLR6ROX]LRQHGL/XJRO8VLLQWHUDSLDSX³HVVHUHXWLOL]]DWRQHOWUDWWDUHDWWDFFKLDFXWLGLWLUHRWRVVLFRVLKDD]LRQHUDSLGDSRLFKªVL©YLVWRFKHULGXFHODIUDJLOLW¡GLXQDWLURLGHLSHUSODVWLFD©XWLOL]]DWRQHOODSUHSDUD]LRQHGHOOLQWHUYHQWRFKLUXUJLFR&RQODYYHQWRGHOOHWLRDPLGLQRQ©SLºXWLOL]]DWRQHOWUDWWDPHQWRFURQLFR
)DUPDFR,2',25$',2$77,92TXHOORSLºXWLOL]]DWR©OR, 0HFFDQLVPRGD]LRQHFDSWDWRGDOODWLURLGHYLHQHLQFRUSRUDWRQHOODFROORLGHHTXLGHFDGHOHQWDPHQWHSURGXFHQGRVLDSDUWLFHOOHFKHUDJJLFKHGLVWUXJJRQRLOSDUHQFKLPDWLURLGHRHVRORTXHOORYLVWDODVXDVHOHWWLYLW¡)DUPDFRFLQHWLFDFDSVXOHSHU26HPLYLWDGLJLRUQLGHOODUDGLRDWWLYLW¡VLHVDXULVFHLQJLRUQL8VLLQWHUDSLDWURYDLOVXRLPSLHJRSULQFLSDOHQHOOLSHUWLURLGLVPRFKHQRQULVSRQGHDOOHWLRDPLGLQHOODWHUDSLDSRVWFKLUXUJLFDGHOFDQFURDOODWLURLGHP&LHQHOODGLDJQRVLDWWUDYHUVRSURFHGLPHQWRVFLQWLJUDILFLP&L(IIHWWLFROODWHUDOLVLKDXQLSRWLURLGLVPRULWDUGDWRQHOOGHLS]WUDWWDWLDVVROXWDPHQWHYLHWDWRLQJUDYLGDQ]D,QXQRVWXGLR©VWDWRULOHYDWRXQDXPHQWRGHOOLQFLGHQ]DGLFDQFURFRORQUHWWDOH VRPPLQLVWUD]LRQHSURILODWWLFDGLODVVDWLYL
,QVXOLQDHIDUPDFLLSRJOLFHPL]]DQWLRUDOL
&HOOXOH EHWDSDQFUHDWLFKHGHOOH LVROH GL /DQJHUKDQV VHFHUQRQR ,168/,1$FHOOXOH DOIDSDQFUHDWLFKH VHFHUQRQR
JOXFDJRQH 6HFUH]LRQHGLLQVXOLQD©VWLPRODWDGDVWLPROD]LRQHQHUYLSDUDVLPSDWLFLUHFHWWRULPXVFDULQLFLDOFRQWUDULRQVLPSDWLFL
HDGUHQDOLQD DJHQGR VXLUHFHWWRULDOIDDGUHQHUJLFL LQLELVFRQR ODVHFUH]LRQHGL LQVXOLQDJOXFDJRQHRUPRQLGHOWUDWWRJDVWURLQWHVWLQDOHVXOIDQLOXUHHPDVRSUDWWXWWRLOLYHOOLHPDWLFLGLJOXFRVLR
,168/,1$©LOSULQFLSDOHRUPRQHLSRJOLFHPL]]DQWHDJLVFHDQFKHVXOODFUHVFLWDHGLIIHUHQ]LD]LRQHFHOOXODUH ,168/,1$GLPLQXLVFHLOLYHOOLHPDWLFLGLJOXFRVLR
DXPHQWDQGRODFDSWD]LRQHGLJOXFRVLRDXPHQWDQGRODVLQWHVLGLJOLFRJHQRGLPLQXHQGRODJOXFRQHRJHQHVLGLPLQXHQGRODGHJUDGD]LRQHGHOJOLFRJHQR
0DODWWLDPHWDEROLFDFURQLFDDEDVHDXWRLPPXQH"FDUDWWHUL]]DWDGDLSHUJOLFHPLD (VLVWRQRIRUPH
GLDEHWHLQVXOLQRGLSHQGHQWH,''0GLDEHWHQRQLQVXOLQRGLSHQGHQWH1,''0
6HFUH]LRQHGL LQVXOLQDGXUDQWHLQIXVLRQHFRVWDQWHGLJOXFRVLR1HOQRUPDOHGXHIDVL1,''0PDQFDOD SULPDIDVH,''0PDQFDQRHQWUDPEHOHIDVL
,FULWHULSHUODGLDJQRVLGL'0LQFOXGRQR
LVLQWRPLGHO'0SROLXULDSROLGLSVLDSHUGLWDGLSHVR FRQFHQWUD]LRQLSODVPDWLFKHGLJOXFRVLRLQSUHOLHYLFDVXDOLPDJJLRULGLPJGO XQDFRQFHQWUD]LRQHSODVPDWLFDGLJOXFRVLRDGLJLXQRVXSHULRUHDPJGO XQDFRQFHQWUD]LRQHSODVPDWLFDGLJOXFRVLRVXSHULRUHDPJGORUHGRSRXQFDULFRRUDOHGLJOXFRVLR (PRJORELQDJOLFRVLODWD+E$FPDUNHULPSRUWDQWH
,OVXRYDORUHHVSULPHODQGDPHQWRGHOODJOLFHPLDQHLPHVLSUHFHGHQWL+EGLYHQWDSLºJOLFRVLODWDVHULPDQHDFRQWDWWRFRQHOHYDWHFRQFHQWUD]LRQLGL]XFFKHUR1HOVDQRYDORUHQRUPDOH©WUDH
5/13/2018 Farmaci endocrinologia - slidepdf.com
http://slidepdf.com/reader/full/farmaci-endocrinologia 5/6
$PHULFDQ'LDEHWHV$VVRFLDWLRQKDVWDELOLWRFKHLOYDORUHGL+E$FGHYHHVVHUHPDQWHQXWRQHOSD]LHQWHGLDEHWLFRDQFKHSHUDOWUHOLQHHJXLGD
,32*/,&(0,==$17,25$/, ,168/,1$(5,&20%,1$17,
,32*/,&(0,==$17,25$/,
%LJXDQLGLPHWIRUPLQD6XOIRQLOXUHHWROEXWDPLGHJOLEXULGHJOLEHQFODPLGHJOLSL]LGHHWF7LD]ROLGLQGLRQLURVLJOLWD]RQHSLRJOLWD]RQHHWF,QLELWRULDOIDJOLFRVLGDVLDFDUERVLR5HSDJOLQLGHEUHYHGXUDWDGLD]LRQHVLPLOHDVXOIRQLOXUHHDOWUDVWUXWWXUD
)DUPDFR%,*8$1,',PHWIRUPLQDQRPHFRPPHUFLDOHJOXFRSKDJH0HFFDQLVPRGD]LRQH©XQDJHQWHLQVXOLQRVHQVLELOL]]DQWHSLºFKHXQLSRJOLFHPL]]DQWHQRQLQGXFHXQULODVFLRGLLQVXOLQDGDOSDQFUHDVHQRQSURYRFDLSRJOLFHPLDQHPPHQRDGRVLHOHYDWH5LGXFHLOLYHOOLGLJOXFRVLRSUHYDOHQWHPHQWHGLPLQXHQGRQHODSURGX]LRQH HSDWLFD EORFFD JOLFRJHQROLVL H JOXFRQHRJHQHVL H DXPHQWDQGR OD]LRQH GHOOLQVXOLQD VX PXVFROL H JUDVVR ,OPHFFDQLVPR GD]LRQH © SRFR FRPSUHVR IRUVH EORFFD OD UHVSLUD]LRQH FHOOXODUH LQWHUDJHQGR FRQ L FRPSOHVVL GHOOD FDWHQDUHVSLUDWRULD,QTXHVWRPRGRULGXFHJOXFRQHRJHQHVLHSDWLFD)DUPDFRFLQHWLFD26HPLYLWDGLRUHHOLPLQD]LRQHUHQDOHLPPRGLILFDWRDVVXPHUHGXUDQWHLSDVWL(IIHWWL FROODWHUDOLGLDUUHDH GLVWXUEL*,QRQYDGDWRLQS]FRQ ,5& XQD IXQ]LRQDOLW¡ UHQDOHULGRWWD© WLSLFDGLXQGLDEHWLFR/XQLFRIDUPDFRDQWLGLDEHWLFRFKHQRQGDDXPHQWRGLSHVR6HLOLYHOOLHPDWLFLGLODWWDWRVXSHUDQRFHUWLYDORULRLQSUHVHQ]DGLGLPLQXLWDIXQ]LRQDOLW¡HSDWLFDRUHQDOHVLGHYHFRQVLGHUDUHORSSRUWXQLWDGLLQWHUURPSHUHLOWUDWWDPHQWRFRQPHWIRUPLQD
)DUPDFR7,$=2/,',1(',21, R*/,7$=21,URVLJOLWD]RQHSLRJOLWD]RQHDQFKHTXHVWLVRQRLQVXOLQRVHQVLELOL]]DQWL0HFFDQLVPR GD]LRQH DJRQLVWL VHOHWWLYL GHO UHFHWWRUH QXFOHDUH 33$5 LO TXDOH VXFFHVVLYDPHQWH WUDVFULYHJHQL LQVXOLQRVHQVLELOLFKHUHJRODQRLOPHWDEROLVPRGHLOLSLGL HGHLJOXFLGL >ULFKLHGRQRTXLQGLODSUHVHQ]DGL LQVXOLQDSHUDJLUH@5LGXFRQRJOXFRQHRJHQHVLHSDWLFDHDXPHQWDQRODJOLFRJHQRVLQWHVLHODOLWRJHQHVLQHOWHVVXWRDGLSRVRDXPHQWDQRVHQVLELOLW¡DOOLQVXOLQDVWLPRODQROLSRVLQWHVLU LGXFHQGROD GLVSRQLELOLW¡GLDFJUDVVL OLEHULFLUFRODQWL ,QROWUH ULGXFRQR OD VHFUH]LRQHGLFLWRFKLQH SURLQILDPPDWRULHGDSDUWHGHOODGLSHULGXFHQGROLQVXOLQRUHVLVWHQ]D)DUPDFRFLQHWLFD26FSVPJGLHHIIHWWRYLVLELOHGRSRVHWWLPDQHPHWDEROLVPRHSDWLFRGHLFLWRFURPLHGHVFUH]LRQHUHQDOH/HPROHFROHVRQRDVVRUELWHHQWURRUHPDOHIIHWWRFOLQLFRPDVVLPRQRQVLRVVHUYDSULPDGLVHWWLPDQH(IIHWWL FROODWHUDOL PRQLWRUDJJLR GHOOD IXQ]LRQH HSDWLFD IRUVH SLº LQ ULFRUGR GHO WURJOLWD]RQH WROWR GDO FRPPHUFLR SHUHSDWRWRVVLFLW¡SRVVRQRSRUWDUHDGDXPHQWRSRQGHUDOHGLPLQXLVFRQRLOULVFKLRGLDFFLGHQWLFDUGLRYDVFRODUH)DUPDFR,1,%,725,'(//*/8&26,'$6,DFDUERVLR0HFFDQLVPRGD]LRQHULGXFRQRODVVRUELPHQWRLQWHVWLQDOHGLDPLGRHGLVDFFDULGLLQLEHQGRTXHVWRHQ]LPDSUHVHQWHVXOORUOHWWRDVSD]]RODGHJOLHQWHURFLWL1RQVWLPRODQRLOULODVFLRGLLQVXOLQDHTXLQGLQRQSURYRFDQRLSRJOLFHPLD8VLLQWHUDSLDSRVVRQRHVVHUHSUHVLLQFRQVLGHUD]LRQHQHLSD]LHQWLDQ]LDQLFDUDWWHUL]]DWLGDLSHUJOLFHPLDSRVWSUDQGLDOH
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ªLOSLFFRGLLQVXOLQDVLDFRLQFLGHQWHFRQLOSLFFRGLJOXFRVLRDOWROHJDPHFRQOHSURWHLQHHFL³HVSRQHODWHUDSLDFRQVXOIDQLOXUHHDGLQWHUD]LRQLIDUPDFRORJLFKHHPLYLWDPROWRYDULDELOLGDIDUPDFR D IDUPDFRWROEXWDPLGH GLRUHJOLSL]LGHH JOLEXULGH RUHFORUSURSDPLGH RUHPHWDEROLVPRHSDWLFR HGHVFUH]LRQHUHQDOHGHLPHWDEROLWL,IDUPDFLGLSULPDJHQHUD]LRQHKDQQRGRVDJJLPROWRDOWLJGLHPHQWUHTXHOOLGLVHFRQGDPROWRSLºEDVVLPJGLH(IIHWWL FROODWHUDOL QRQ VRQR IUHTXHQWL SRVVRQR SRUWDUH D LSRJOLFHPLD H FRPD LSRJOLFHPLFR QDXVHD H YRPLWR DXPHQWRSRQGHUDOHQRQXWLOL]]DUHLQJUDYLGDQ]DTXHVWLIDUPDFLVXELVFRQRPROWLVVLPHLQWHUD]LRQLFRQDOWULIDUPDFL1HLSD]LHQWLDQ]LDQLOLSRJOLFHPLDJUDYHVLSX³SUHVHQWDUHVRWWRIRUPDGLXQHPHUJHQ]DQHXURORJLFDDFXWDFKHSX³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
5/13/2018 Farmaci endocrinologia - slidepdf.com
http://slidepdf.com/reader/full/farmaci-endocrinologia 6/6
/DVRPPLQLVWUD]LRQH VRWWRFXWDQHD GL LQVXOLQD VL GLVWLQJXHGDOOD VHFUH]LRQH ILVLRORJLFD GHOORUPRQH SHUDOPHQR DVSHWWL SULQFLSDOL OHFLQHWLFKHQRQPLPDQR LO QRUPDOH LQFUHPHQWRUDSLGRH LO UHSHQWLQRGHFOLQRGHOODVHFUH]LRQHGLLQVXOLQDLQULVSRVWDDOOLQJHVWLRQHGLVRVWDQ]HQXWULWL]LHHOLQVXOLQDVLGLIIRQGHQHOFLUFRORSHULIHULFRLQYHFHGLHVVHUHOLEHUDWDQHOODFLUFROD]LRQHSRUWDOHYLHQHTXLQGLSHUVROHIIHWWRGLUHWWRGHOOLQVXOLQDVHFUHWDVXLSURFHVVLPHWDEROLFLGHOIHJDWR /HGRVLGLLQVXOLQDVRQRHVSUHVVHLQXQLW¡8QXQLW¡GLLQVXOLQD©HTXLYDOHQWHDOODTXDQWLW¡GLRUPRQHULFKLHVWDSHUULGXUUHODFRQFHQWUD]LRQHSODVPDWLFDGLJOXFRVLRDPJGO
&LVRQRWUHWLSLSULQFLSDOLGLLQVXOLQDLQVXOLQDDHIIHWWRUDSLGRLQVXOLQDVROXELOHRQHXWUD,QL]LRGRSRKHIIHWWRPD[KGXUDWDHIIHWWRK,PSRUWDQWHQHOOHHPHUJHQ]HHVFKHWRDFLGRVL6HXVDWDGDVRODFLYRJOLRQRLQLH]LRQLGLHSULPDGHLSDVWLHSX³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©VWDWDLQWURGRWWDVF'DTXHVWLPLFURSUHFLSLWDWLVLULODVFLDQROHQWDPHQWHLFULVWDOOLGLLQVXOLQDFKHDWWUDYHUVDQRODPHPEUDQDGHLFDSLOODULVDQJXLJQLLQTXHVWRPRGR FRQ XQD VLQJROD VRPPLQLVWUD]LRQH VL KD XQD FRQFHQWUD]LRQHFRVWDQWH QHOOH RUH FRQ XQ ULVFKLR GL LSRJOLFHPLDQRWWXUQDSLºEDVVRGHOULVSHWWRDTXDQWRDFFDGHFRQLQVXOLQDDOHQWDFHVVLRQH)XWHQWDWDOLQWURGX]LRQHGLLQVXOLQDSHUYLDLQDODWRULDPDSRFRGRSRYHQQHULWLUDWDGDOPHUFDWRSHUSRFDSHQHWUD]LRQH
8VLLQWHUDSLDWUDWWDPHQWRGHLSD]LHQWLFRQ'0WLSR,HSD]LHQWLFRQ'0WLSR,,LQVWDGLRDYDQ]DWR/XVRD EUHYHWHUPLQHFRQLQVXOLQDSX³HVVHUHQHFHVVDULRLQSD]LHQWLFRQ'0WLSR,,GXUDQWHHYHQWLLQWHUFRUUHQWLLQIH]LRQLLQIDUWRPLRFDUGLRJUDYLGDQ]DLQWHUYHQWL FKLUXUJLFL R QHO WUDWWDPHQWR GL HPHUJHQ]D GHOOD LSHUNDOLHPLD OLQVXOLQD YLHQH VRPPLQLVWUDWD FRQ JOXFRVLR SHUDEEDVVDUHLOSRWDVVLRH[WUDFHOOXODUHSURPXRYHQGRQHODULGLVWULEX]LRQHQHOOHFHOOXOH(IIHWWLFROODWHUDOLSULQFLSDOHHIIHWWRLQGHVLGHUDWR©OLSRJOLFHPLD)DUPDFR6,7$*/,37,1H9,/'$*/,37,10HFFDQLVPRGD]LRQHVRQRLQLELWRULGHOODGLSHSWLGLOSHSWLGDVL,9'33,9HQ]LPDFKHPHWDEROL]]DOHLQFUHWLQH*,3H*/3FKHYHQJRQRSURGRWWHGDOOLQWHVWLQRVRSUDWWXWWRLQULVSRVWDDGXQSDVWR(VVHUHJRODQRORPHRVWDVLGHOJOXFRVLRIDYRUHQGRODOLEHUD]LRQHGHOOLQVXOLQDHODVXDDWWLYLW¡DOLYHOORSHULIHULFR)DUPDFRFLQHWLFD26HPLYLWDEUHYLRUHFLUFDHOLPLQD]LRQHUHQDOHLPPRGLILFDWDSHUVLWDJOLSWLQHGRSRPHWDEROLVPRUHQDOHSHUYLOGDJOLSWLQHQWUDPEHSHUSURFHVVLGLVHFUH]LRQHWXEXODUH8VLLQWHUDSLDQRQKDQQRXQDDWWLYLW¡PLJOLRUHGLDOWULIDUPDFLQRQRVWDQWHHVVLVLDQRVWDWLLQWURGRWWLLQFRPPHUFLRVRORGDSRFKLDQQL3RWUHEEHURHVVHUHXQDEXRQDEDVHGLSDUWHQ]DSHUORVYLOXSSRGLQXRYLIDUPDFLSHULO'0GLWLSR,,(IIHWWL FROODWHUDOLPROWREHQWROOHUDWLSRWUHEEHURULVHUYDUH DOFXQHVRUSUHVHYLVWR FKHQRQVLFRQRVFRQR JOL DOWULPHWDEROLWLGL
TXHVWHGLSHSWLGLOSHSWLGDVL,97HUDSLDGHOGLDEHWHPHOOLWRGLWLSR,,FRPHSULPRSDVVRGLVROLWRVLXVDXQVHFUHWDJRJRGHOOLQVXOLQDPHJOLWLQLGLRVXOIDQLOXUHHR ODPHWIRUPLQDELJXDQLGL QHOVHFRQGR VWHS GHOODWHUDSLDVLXVDQR FRPELQDWL$O WHU]RPRPHQWRGHOODWHUDSLDTXDQGR LOFRQWUROORJOLFHPLFRGHLIDUPDFLLSRJOLFHPL]]DQWLRUDOLIDOOLVFHVLDJJLXQJHOLQVXOLQDSULPDGHLSDVWLHLQILQHVLSX³LQWURGXUUHXQ7''FRQWXWWLLIDUPDFLSUHFHGHQWHPHQWHGHVFULWWL