Utilidad diagnóstica de la ecografía tiroidea en la evaluación de nódulos tiroideos en niños y adolescentes / Diagnostic utility of thyroid ultrasound ecografy in thyroid nodules evaluation in children and adolescents

AIM: To evaluate the diagnostic utility of ultrasonography and other antecedents and exams usually availables, in the study of patients with thyroid nodules aged 0-20 years. SUBJECTS AND METHODOLOGY: Cross-sectional analytical observational study. We reviewed the data of patients undergoing FNAP (thyroid puncture with a fine needle) and / or thyroidectomy between January 2007 and December 2013. The ultrasound evaluation was performed by 3 specialists. The surgical biopsy was considered an indicator of benignity or malignancy and, in its absence the FNAP (excluding the Bethesda diagnoses 3 and 4). The association between cancer and the different variables was evaluated through binary logistic regression, with measure of association of odds ratio (OR). With the initially significant variables, a multivariate analysis was carried out and a cut-off score was subsequently defined to allow the diagnosis to be discriminated. RESULTS: 104 nodules are included in the analysis (100 patients), 89♀ / 11♂; age x16 ± 2.8; TSH 2.8 uIU / ml ± 5; lymphocytic thyroiditis 30%; pathological anatomy: benign 46 (44%) cancer 58 (56%). Sonographic findings predictive of malignancy were: hypoechogenicity (OR 2.95 p = 0.008) irregular shape (100% CA) non-smooth edges (OR 8.5 p = 0.000) microcalcifications (OR 39 p = 0.000) thick calcifications (OR 18 p = 0.001) and presence of suspicious adenopathy (100% CA). In the TIRADS classification, cases classified as 4 and 5 corresponded to cancer in 50 and 92%. The presence of thyroiditis did not show an insignificant association with malignancy. From the joint analysis of the significant variables, a score with adequate sensitivity and specificity is obtained. CONCLUSIONS: The usefulness of ultrasound as a fundamental examination in the evaluation of the pediatric patient who consults by thyroid nodule is corroborated. Accurately describing their sonographic characteristics and, above all, analyzing them together, allows us to determine an approximate risk of malignancy and define with greater certainty the indication of performing FNAP

Hipocalcemia asociada a hiperfosfemia y PTH elevada: caso clínico / Hypocalcemia, vitamin D deficiency and elevated PTH levels in a patient with celiac disease: report of one case

We report a 56 years old woman that presented a severe hypocalcemia, with a serum calcium of 4.7 mg/dl, after the intake of bisphosphonates. Laboratory examination showed elevated PTH levels (167 pg/ml), hyperphosphatemia, hypomagnesemia and normal phosphate tubular reabsorption. Therefore, the diagnosis of pseudohypoparathyroidism was considered (PHP). However, further studies showed low levels of 25 OH Vitamin D (13.6 ng /ml), osteoporosis, positive anti endomysium antibodies and an endoscopic biopsy, that confirmed the presence of a celiac disease.

Síncope y bocio nodular: desafío diagnóstico / Syncope associated to a thyroid nodule: report of one case

We report a 60 years old male presenting with a history of repeating syncopal episodes lasting seven days. The patient had a history of an intestinal lymphoma treated four years ago. Imaging studies showed a macro nodule in the left thyroid lobe. The pathological study disclosed a type B non Hodgkin lymphoma. The patient was treated with chemotherapy with a favorable outcome. The association of syncope and cervical tumors has been described previously.

Alteraciones metabólicas asociadas al uso de terapia antipsicótica: [revisión] / Atypical antipsychotic induced weight gain and metabolic disorders: [revision]

The advent of new antipsychotic drugs has improved the treatment of schizophrenic patients as well as those suffering from other severe psychiatric disorders. Its widespread use, however, has been associated to the development of obesity and metabolic disturbances such as diabetes mellitus, dyslipidemia and increased coronary risk. This has caused a serious concern, due to the high cardiovascular mortality that prematurely affects these patients. The etiology of these abnormalities is still a matter of debate, although it is generally believed that the new antipsychotic drugs have a control stimulating effect on appetite, and their use is associated to an increased level of cortisol and to an insulin-resistance state. In addition, there is an increase in inflammatory mediator and cytokine production, induced by the pathophysiology of the schizophrenic process itself and also caused by the direct action of the antipsichotic drugs. In spite of the mounting evidence, the metabolic management of these patients is still deñcient. A cióse follow-up in the initial stages of the antipsychotic treatment is recommended, as well as giving advice about diet and physical exercise. Finally, when obesity or other conditions associated to metabolic syndrome appear, the recommendation is to switch to drugs with less secondary effects or to add adjuvant medications to improve the overall evolution of these patients.

La macroprolactina, diagnóstico diferencial de la hiperprolactinemia / The macroprolactina, differential diagnosis of the hyperprolactinaemia

La macroprolactina es una isoforma de la prolactina (PRL) humana que se encuentra en escasa proporción en el plasma y que en algunos pacientes se puede encontrar anormalmente elevada, causando hiperprolactinemia, que puede presentarse como asintomática, pero también presentar sintomatología dada por el exceso de prolactina, también ha sido relacionada a adenomas hipofisiarios. Por esta causa es necesario contar con métodos confiables para su detección y medición. El origen de esta macromolécula, patogenia, regulación hormonal e historia natural aun no está esclarecido, se postula que corresponde a un complejo antigénico IgG-PRL, con bioactibidad reducida.El Gold Standard para la determinación de la macroprolactina es la Cromatografía de filtración en gel, pero su uso se restringe a la investigación por su alto costo y tiempo de desarrollo. Existen otros métodos para su detección, siendo hasta ahora el de precipitación por Polietilenglicol el más aceptado.

Macroprolactin is an isoform of human prolactin (PRL) existing in low doses in plasma. In some patients, prolactine can be found in higher proportion, causing hyperprolactinaemia, in asyntomaticor symptomatic form. This abnormality has been also related to hypophysis adenome, doing necessary to count on reliable methods for its detection and measurement. The origin of this macromolecule, patogenia, hormonal regulation and natural history are not even clear, an antigenic complex IgG-PRL with reduced bioactivity is proposed. The Gold Standard for determination of macroprolactin is gel filtration chromatography, but its high costs and slowness restricts its use toresearch. Other methods for its detection already exist, the Polyethylene glycol precipitation is beingmostly accepted.