Efecto de dosis bajas de calcitonina sobre la remodelación ósea en mujeres postmenopáusicas con alto recambio / Effects of low calcitonin doses on bone remodeling in postmenopausal women with high bone turnover rate

Background: Calcitonin is specially indicated for the treatment of osteoporosis in women that cannot receive estrogen replacement therapy or that have a high bone turnover rate. Aim: To study the effects of low intranasal calcitonin doses on bone remodeling in postmenopausal women with a high bone turnover. Patients and methods: Forty one healthy women aged 56 ñ 6 years old, with a mean lapse after menopause of 7.6 ñ 6.5 years and with a high bone turnover rate, evidenced by an urinary hydroxyproline (mg/dl)/creatinine (g/dl) ratio of 52.4 ñ 7.2, were studied. They were randomly assigned to receive 100 or 50 U/calcitonin thrice a week during 3 months or to a control group that received placebo. All received 500 mg/day calcium carbonate. Urinary hydroxyproline/creatinine ratio was measured a 0, 15, 30, 60 and 90 days. Plasma bone fraction of alkanine phosphatases was measured at 0, 30 and 90 days. Results: Initial urinary hydroxyproline/creatinine ratio and plasma bone fraction of alkanine phosphatases were similar in all study groups and there was no change in these parameters during the study period. Conclusions: Intranasal calcitonin in doses of 100 U thrice a week or less, does not modify accelerated bone turnover in postmenopausal women

Síndrome de Cushing por secreción ectópica de ACTH: análisis del mecanismo fisiopatológico de la hipokalemia: comunicación de dos casos / Cushing syndrome with severe hipokalemia caused by ectopic ACTH secretion: report of two cases

We report a 42 years old male and a 66 years old female with a Cushing syndrome caused by ectopic ACTH secretion secondary to a carcinoid tumor. These patients had both severe hypokalemia, resistant to medical treatment and that subsided with bilateral adrenalectomy and supplementation with dexametasone. Cushing syndrome caused by ectopic ACTH secretion is characterized by a severe and rapidly evolving hypercortisolism. Hypokalemia is present in 90 percent of cases and is probably caused by a defect in 11 ß hydroxysteroid dehydrogenase, that limits the binding of cortisol to aldosterone receptor, metabolizing it to cortisone. Therefore, this alteration will increase the mineralocorticoid action of cortisol

Frecuencia de insulino resistencia y dislipidemia en mujeres jóvenes con síndrome de ovarios poliquísticos / Frequence of insulin resistence and dislipidemia in young women with polycystic ovarian syndrome

Se realizó una caracterización clínica, hormonal, de lipoproteínas y de resistencia insulínica en 31 pacientes con síndrome de ovarios poliquísticos sin tratamiento médico. Destaca la importante frecuencia de factores de riesgo cardiovascular en ellas; todas tienen índice de masa corporal aumentando, siendo el 71 por ciento obesas; 6,5 por ciento tienen presión arterial diastólica elevada; 35,5 por ciento de ellas presenta hipercolesterolemia, 13 por ciento tiene hipertrigliceridemia, y 83 por ciento son insulino resistentes. Estos hallazgos justifican la evaluación metabólica en mujeres anovulatorias hiperandrogénicas para indicar las medidas terapéuticas necesarias no sólo desde el punto de vista hormonal y de fertilidad, sino también desde el aspecto metabólico

Poliadenopatías cervicales por enfermedad de Kikuchi y Fujimoto / Cervical polyadenopathies by Kikuchi's and Fujimoto's diseases

Kikuchi and Fujimoto disease is a benign subacute necrotizing lymphadenitis, probably associated to a viral infection, that affects mostly young Asian women. We report a 19 years old woman, with a vast familiar history of thyroid disease (3 uncles with papillary thyroid carcinoma and one with Hashimoto thyroiditis). After an upper respiratory infection, she presented with painless cervical adenopathies. Cervical ultrasound examination detected an 8 mm thyroidal nodule. She was operated with the diagnosis of thyroidal cancer. The pathological examination confirmed that the nodule was papillary thyroidal cancer, but the study of the resected lymph nodes, revealed a Kikuchi and Fujimoto disease

Macrotumor suprarrenal diagnosticado por tomografía axial computarizada: experiencia clínica en 33 casos / Adrenal macrotumor diagnosed by computarized tomography: clinical experience in 33 cases

Thirty three patients aged 9 to 86 years old, 15 female, with an adrenal macrotumor diagnosed by CAT scan, were analized. Thirty percent of tumors were functioning (70 percent secreted cathecolamines and 30 percent cortisol). Eighty two percent had an adrenal localization and 18 percent were para-adrenal. Thirty four percent were malignant. These tumors were mostly non functioning, 70 percent occured in men and 67 percent were metastatic. Most adrenal macrotumors in this series were non functioning and 36 percent were malignant

Rendimiento comparativo entre biopsia y citología obtenidas por aspiración con aguja fina en nódulos sólidos del tiroides / Comparative useful between biopsy and cytology obtained by fine needle aspiration in thyroid nodules

The correct management of thyroid nodules requires an accurate histological diagnosis to doscard carcinoma. One hundred and forty three thyroid nodules were punctured with a 21 G needle under continous aspiration obtaining a sample for cytological and histological diagnosis. Fifty patients were subjected to a thyroidectomy. The age of studied patients ranged from 12 to 78 years old and 94 percent were female. Mean nodule diameter was 2.7ñ1.4 cm. Two percent of procedures were complicated with local hematomas, that subsided spontaneously. A diagnosis of cancer was reached in 16 percent of all patients and 46 percent of operated patients. Cytology had a 50 percent sensitivity, 87.5 percent specificity, a 89.4 percent positive predictive value and a 87.5 percent negative predictive value. The figures for fine needle aspiration biopsy were 82.6, 100, 100 and 87 percent respectively. Fine needle aspiration biopsy has a better diagnostic accuracy than cytology and is a simple and safe procedure

Insuficiencia cardíaca grave como complicación de hipotiroidismo primario / Severe cardiac failure as complication of primary hypothyroidism

We report a 29 years old female admitted due to a congestive cardiac failure that failed to respond to therapy with furosemide and enalapril. Serum thyroid hormone profile showed a TSH over 40 uIU/ml, a thyroxine of 0.8 ug/dl and a triiodothyronine below 20 ng/dl. Levothyroxine therapy was started with remission of cardiac failure. The study of thyroid function in patients with cardiac failure of unknown origin and resistant to therapy, should be bore in mind

Neoplasia endocrina múltiple tipo 2A: presentación de un caso de evolución inhabitualmente agresiva / Multiple endocrine neoplasia type 2A: report of a case with an aggressive outcome

We report a 28 years old woman who consulted for diarrhea of 2 years and thyroid nodule. A medullary thyroid carcinoma was diagnosed and a thyroidectomy performed. There was a local relapse 2 months later and distant metastases were found 5 months later. A MIBG-1131 scontigraphic image of the adrenal lead to the suspicion of a bilateral pheochromocytoma. The surgical resection of the adrenals confirmed the diagnosis. There was no response to chemotherapy and the patient continued with severe hypercalcemia, repeated infections, persistent diarrhea and cachexia, dying one year after the aggressive presentation of a multiple endocrine neoplasia type 2A

Elevación asintomática de fosfatasas alcalinas plasmáticas secundaria a hiperfosfatasemia familiar benigna en un paciente / Asymptomatic elevation of alkaline phosphatases secondary to benign familial hyperphosphatasemia in a patient

We report a 33 years old male consulting for abdominal pain. Initial diagnostic work up showed high levels of alkaline phosphatases, that were confirmed in a new blood sample. Using electrophoresis, total alkaline phosphatases were 198 U/l (normal values=30-117) and the bone fraction was 101 U/l (normal values=0-35). Bone scintiscan and endocrinological assessment were normal. One year later, the same values persisted. Studying the family, 3 of 4 brothers had the same alterations in alkaline phosphatases. It was concluded that these subjects had the rare condition known as benign familial hyperphosphatasemia

Hipocortisolismo por déficit selectivo de CRH de resolución espontánea: análisis de un caso / Hypocortisolism related to selective deficiency of CRH with spontaneous resolution: a case analysis

Hypocortisolism derived from hypothalamic deficiency of corticotropin releasing hormone is a highly unusual cause of adrenal insufficiency and its pathogenesis is still not fully understood. We report a mildly symptomatic patient having repeated low basal plasma cortisol levels with normal cortisol response to ACTH and lisine-vasopresine; however, she showed a clearly limited response to deep hypoglycemia, while GH reached a normal concomitant response. After 7 years of cortisol replacement the endogenous cortisol returned spontaneously to normality. The rest of pituitary function has been always normal