Trastorno de identidad de género. Parte II: terapia endocrinológica en el proceso de readecuación corporal / Gender identity disorder. Part II: endocrine therapy in the process of body readjustment

Endocrinology step of transgender readjustment therapy is made according to previously published in the part 1 of article: “gender identity disorder in rev. chil. endocrinol. diabetes 2015, 8 (4): 167-173.During started puberty in Tanner stage 2-3, the persistence of the experience that their identity male or female gender is not coherent with its bodily, authorize to start the endocrinological therapy, as an important step of body readjusting. In the process of transition from male to female or female to male, should stop pubertal development, what we do with GNRH analogues: intramuscle leuprolideor triptorelin 11.25 mg. every 12 weeks or with medroxyprogesterone acetate 150 mg. monthly. This process continues until 16 years, adding antiandrogen, preferably spironolactone in the process of body readjusting of male to female. At 16 years old, starts the cross hormonal therapy to masculinizing or feminizing. Maintaining gonadotrophin suppression, female to male, testosterone undecanoate or other injectable testosterone esters is administered, customizing the date of administration and inMale to female, daily use of oral estradiol valerate or transdermal gel. Plasma levels of estradiol andtestosterone should not be located in high or supraphysiological range to avoid thromboembolism or polycythemia risk in those who receive testosterone. Should to be explained the time to obtain the bodily effects, achieving a realistic attitude of the goals and the need for regular checks. Attendance to emotional changes, mainly to meet the social gender role. The laboratory, metabolic, hormonal, hemogram and electrolytic changes are evaluated. To be indicated bone densitometry and study images of internal genitals and breasts are necesary...

Osteomalacia hipofosfatémica secundaria a sarcoma de muslo: caso clínico / Hypophosphatemic osteomalacia secondary to a sarcoma: report of one case

Tumor induced osteomalacia is uncommon and is characterized by an isolated and not PTH dependent reduction in tubular phosphate reabsorption. This alteration is produced by phosphaturic factors, such as fibroblast growth factor-23 (FGF-23) that are secreted by tumors. We report a 41 years old female presenting with joint pain and progressive loss of muscle strength in the lower limbs. Initial laboratory assessment showed hypophosphatemia, elevated alkaline phosphatases, normal intact parathormone levels, low levels of 25 hydroxy vitamin D and an elevated 24 h phosphaturia. Bone mineral density showed spine and femoral neck osteopenia. A positron emission tomography (PET) revealed a right thigh tumor with lung metastases. Its biopsy disclosed a fibrosarcoma. FGF-23 levels, measured by ELISA were markedly elevated. The patient was discharged with palliative measures.

Aumento del daño en el ADN y estrés oxidativo en espermatozoides de pacientes con oligozoospermia idiopática y antecedentes de criptorquidismo / Extent of sperm DNA damage in spermatozoa from men examined for infertility. Relationship with oxidative stress

Background: Cryptorchidism and oligozoospermia are clinical conditions closely associated with impaired fertility. Oxidative stress and related sperm DNA damage have been identified as significant causes of male infertility. Aim: To determine the extent of sperm nuclear DNA damage in patients affected with idiopathic oligozoospermia or undescended testes and to examine its relationship with oxidative stress. Patients and methods: We studied 20 patients with idiopathic oligozoospermia and 18 with undescended testes (who previously underwent orchiopexy) and 25 normozoospermic healthy controls. All subjects underwent semen analysis. Sperm DNA damage was evaluated by the sperm chromatin structure assay/flow cytometry (SCSA-FCM) and by the dUTP-biotin nick end labeling (TUNEL) assay. Levels of reactive oxygen species (ROS) and total antioxidant capacity (TAC) were assessed by a chemiluminescence assay. Results: DFI (percentage of sperm with denatured DNA) values and percentage of TUNEL positive cells were significantly greater in patients with oligozoospermia (DFI: 28.8±5.6; TUNEL+: 26.9±3.0) or cryptorchidism (DFI: 26.4±10.1; TUNEL+: 29.1±3.9), compared with controls (DFI: 7.1±0.9; TUNEL+: 14.2±1.2). Similarly, both groups of patients had significantly higher (p <0.01) levels of ROS. TAC levels did not differ between control and patient groups, suggesting that the DNA damage occurs before spermiation. Conclusions: Sperm DNA damage is significantly increased in men with idiopathic oligozoospermia and in cryptorchid subjects. The finding of increased ROS levels may indicate that seminal oxidative stress may be involved in the pathogenesis of sperm DNA damage in these patients.

Cortisol y dehidroepiandrosterona nocturnos como marcadores pronósticos en pacientes críticos / Nocturnal cortisol and dehydroepiandrosterone like prognostic markers in critical patients

El cortisol plasmático guarda correlación con la severidad y duración del estado crítico, y el papel de la Dehidroepiandrosterona sulfato (DHEA-S) no ha sido identificado claramente. El paciente crítico muestra una activación máxima inicial del eje suprarrenal, si la situación crítica se prolonga, se puede producir una insuficiencia suprarrenal relativa. Midiendo cortisol y DHEA-S durante la noche de las 24 primeras horas críticas se podría hacer más evidente esta insuficiencia resultando una mejor correlación entre estas hormonas, APACHE II y mortalidad. Diseño: Estudio observacional en pacientes críticos de la UTI del Hospital de Urgencia Asistencia Pública. Cuarenta y ocho (48) pacientes (30 hombres y 18 mujeres) sin antecedentes de: insuficiencia suprarrenal, uso de fenitoína, anticonvulsivantes, rifampicina, ketoconazol, corticosteroides, síndrome de Cushing, patología pituitaria, daño hepático crónico, insuficiencia renal crónica, alcoholismo activo crónico o readmisiones. EL APACHE II fue evaluado al ingreso. Cortisol y DHEA-S fueron medidos a las 00.00 de las primeras 24 h de su ingreso a UTI. Resultados: EL APACHE II (25,1±6,7 contra 16,3±7, p=0,001) y edad (59,5±15,8 contra 44,4±18,1, p 0,011) fueron significativamente más elevados en los fallecidos. En los fallecidos el cortisol mostró una tendencia a niveles más elevados. El DHEA-S mostró niveles considerablemente más altos en los sobrevivientes (5450,9±3824,0 contra 2980,3±2159,3 p= 0,03) junto como el índice DHEA-S/cortisol (12,66±14,19 contra 3,91±4,06, p= 0,004). Conclusiones: La tendencia a niveles más altos de cortisol nocturno observado en las 24 primeras horas induce para pensar que la insuficiencia suprarrenal relativa no desempeñaría un papel en las 24 primeras horas del estado crítico. Los niveles de DHEA-S y el índice DHEA-S/Cortisol son marcadores de sobrevida en nuestra población estudiada.

Tratamiento del hirsutismo con espironolactona y con espironolactona más dexametasona / Treatment of hirsutism with spironolactone and with spironolactone plus dexamethasone

Background: Spironolactone has an anti androgenic effect, inhibiting the binding of androgens to their receptor. This antagonistic effect is the basis for the use of spironolactone in the treatment of hirsutism. Aim: To study the effectiveness and safety of spironolactone in the treatment of hirsute women and of the association of spironolactone plus dexamethasone in the treatment of hirsutism with glucocorticoid sensitive hyperandrogenism. Patients and method: Sixteen women (group 1) with peripheral hirsutism (defined as those with normal androgens levels, normal menstrual cycles and ovulation) and 24 women (group 2) with glucocorticoid sensitive hyperandrogenic hirsutism were studied. Group 1 was treated with spironolactone 50 mg bid and group 2 with same spironolactone dose plus dexamethasone 0.5 mg at 23 h during one month and 0.25 mg thereafter. Patients were followed during one year. Results: After one year of treatment, a 54 percent reduction in Moncada hirsutism escore was observed in group 1 and 52 percent reduction in group 2. Observed secondary effects of spironolactone were increases in diuresis, fatigability, acne aggravation and seborrhea in two patients. Two additional patients had spotting. No secondary effect attributable to glucocorticoid use were observed. Conclusions: Spironolactone is effective and safe in the treatment of hirsutism. Androgenic supression did no increases its effectiveness, underscoring the peripheral anti androgenic activity os spironolactone