Recomendaciones para el uso correcto de densitometría ósea en la práctica clínica. Consenso de la Sociedad Chilena de Endocrinología y Diabetes / Guidelines of the Chilean Endocrinology Society for the correct clinical use of bone densitometry

Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.

Visión global de la medicina preventiva en Chile / Visión global de la medicina preventiva en Chile

Es importante considerar que la población envejece y debido a la mayor esperanza de vida, es necesario establecer estrategias eficaces de prevención sanitaria que permitan alcanzar la contención de costos en salud. Es necesario mejorar el modelo actual con el objetivo de mejorar el desempeño guiándose a través de parámetros de calidad de la salud de la población. La medicina preventiva se establece en el siglo XXI como un área prioritaria para la salud pública y privada. Esto está reflejado en la presencia cada vez mayor de programas de salud pública y el desarrollo de unidades de medicina preventiva en el sector privado. Se revisan las estrategias de medicina preventiva en las áreas pública y privada, haciendo énfasis en la importancia de los programas de medicina preventiva en el nivel primario y en las personas con enfermedades crónicas

It is important to consider that the population is aging, and because of the increased life expectancy, it is necessary to establish effective preventive health strategies that achieve cost containment in health. It is necessary to improve the current model with the aim of improving performance guided by population health quality parameters. Preventive medicine is established as a priority area for public and private health in the twenty-first century. This is shown by the increasing number of public health programs and the development of preventive medicine units in the private health area. We review the strategies of preventive medicine at public and private areas, emphasizing the importance of preventive medicine programs at the primary level and in people with chronic diseases

Detección precoz de trastornos endocrinológicos / Early detection of endocrinological disorders

Se revisan los trastornos más comunes del sistema endocrino que se detectan en la consulta no especializada. Se hace énfasis en: a) Trastornos tiroideos tales como hipo o hipertiroidismo, nódulos de la tiroides y la importancia de la enfermedad de la tiroides durante el embarazo, b) la enfermedad adrenal en la hipertensión y el enfoque de la incidentaloma suprarrenal c) hiperparatiroidismo primario y la deficiencia de vitamina D d) Trastornos gonadal y la importancia de la detección precoz de la enfermedad hormonal, tanto en la disfunción ovárica y testicular

We review the most common disorders of the endocrine system that are detected in non-specialist consultation. Emphasis is placed on: a) thyroid disorders such as hypo-or hyperthyroidism, thyroid nodules and the importance of thyroid disease during pregnancy, b) adrenal disease in hypertension and the approach to the adrenal incidentaloma c) metabolic disorders such as primary hyperparathyroidism and vitamin Ddeficiency d) gonadal disorders and the importance of early detection of hormonal disease in both ovarian and testicular dysfunction

Tiroides y climaterio / Thyroid gland in the climacteric

Durante el climaterio, las enfermedades tiroideas constituyen una preocupación creciente, esto se debe a la mayor prevalencia de patología tiro idea observada en esta etapa de la vida. Para comprender mejor los trastornos tiroideos durante el climaterio se efectúa una revisión de la fisiopatología de la glándula tiroidea para posteriormente describir los trastornos más frecuentes en este período, su etiopatogenia manifestaciones clínicas y conducta terapéutica recomendada.

During the climacterium, thyroid diseases are a growing concern, this is due to the high prevalence of thyroid disease observed in this stage of life. In this article, the author reviewed the pathophysiology of the thyroid gland and then describe the most common thyroid disorders in this period, its pathogenesis, clinical and therapeutic recommended.

Fracturas vertebrales, osteoporosis y vitamina D en la posmenopausia: Estudio en 555 mujeres en Chile / Vertebral fractures, osteoporosis and vitamin D levels in Chilean postmenopausal women

Background: Approximately one-third of vertebral fractures can be clinically diagnosed. Aim: To study the frequency of vertebral fractures in postmenopausal women. Patients and methods: We recruited 555 postmenopausal women from Santiago, Chile, aged 55-84 years, who manifested interest in their bone health. All were healthy by self-declaration and by general clinical and laboratory tests and had not taken any bone-active therapy. They all underwent a spine and femoral neck (FN) densitometry and a digital lateral spine X-ray from T4 to L4 was obtained. PTH, calcidiol, and other parameters of calcium metabolism were also measured. Results: Overall, 142 of 478 patients with a complete study (29.7 percent) had at least one vertebral fracture. The proportion of women with fractures increased with age. A T score below -2.5 in the spine and hip was found in 32 percent and 14 percent of women, respectively. The proportion of women with spinal opeoporosis doubled between ages 55-70 and remained constant afterwards. In contrast, at the femoral neck, this proportion increased progressively reaching 53.3 percent at age 80-85. However, 56 percent of patients with vertebral fractures did not have densitometric osteoporosis in any location. Calcidiol levels were 16.8±6.8 ng/mL. With a cutoff point of 17 ng/mL, 47.5 percent of the patients had hypovitaminosis D. There was no association between calcidiol levels and vertebral fractures or bone density at the spine or femoral neck. Patients with fractures differed from those without fractures in that they had significantly lower bone density at the spine and hip and were older (p <0.001). However they did not differ in weight, body mass index, or calcidiol levels. Conclusions: Thirty percent of postmenopausal women in this series had a vertebral fractures. Osteoporosis and vitamin D deficiency were also common. Most vertebral fractures were observed in women without osteoporosis by densitometric criteria.

Prevalencia de la deleción 185AG del gen BRCA1 en mujeres chilenas con cáncer de mama / Prevalence of BRCA1 gene 185AG deletion in Chilean women with breast cancer

Background: The most important identified pathogenic factor for breast cancer is the presence of mutations in BRCA1 gene. These are associated with familial breast cancer in up to 80 percent of cases. The most frequent mutation of BRCA1 gene in Caucasian populations is the exon 2 185AG deletion. Aim: To study the presence of 185AG deletion in Chilean women with sporadic or familial breast cancer. Patients and methods: We studied 15 women with familial breast cancer, in whom at least one close relative was affected, and 40 women with sporadic breast cancer. In genomic DNA obtained from a blood sample, an allele specific polymerase chain reaction was done. This reaction allows the identification of 185AG deletion and uses two pairs of primers. One for the native form that renders a 118 base pairs product and one for the deletion that renders a 170 base pairs product, both with a respective 280 base pairs internal control. Results: The diagnosis of breast cancer was done at 40ñ5 and 65ñ10 years old in women with familial and sporadic breast cancer, respectively. In none of the samples, the amplification of the 170 base pairs band that corresponds to 185AG deletion, was obtained. In both groups, the product of the amplification was the 118 base pairs band, that corresponds to the native form of BRCA1 gene. The polymerase chain reaction was optimized for a duration of 90 minutes. Conclusions: 185AG deletion of BRCA1 gene was not detected in this group of Chilean women with sporadic or familial breast cancer

Carcinoma papilar esclerosante difuso del tiroides: comunicación de dos casos / Diffuse sclerosing papillary thyroid carcinoma: report of two cases

Unlike classical papillary carcinoma, diffuse sclerosing papillary thyroid carcinoma presents as a diffuse goiter with a discretely irregular surface, associated to hypo or hyperthyroidism, specially in young women. We report two women aged 41 and 23 years old with this disease, one with normal thyroid function and the other with hyperthyroidism. It is concluded that diffuse sclerosing papillary thyroid carcinoma must be suspected in patients with rapidly growing goiter with irregular surface or diffuse minute calcifications, specially in the presence of hypo or hyperthyroidism. Fine needle aspiration is a good diagnostic procedure

Cáncer tiroídeo tipo intermedio folicular-medular; una forma inhabitual, particular y agresiva: comunicación de tres casos / Mixed medullary and follicular carcinoma of the thyroid: report of three cases

Mixed medullary and follicular carcinomas of the thyroid shares secretory and immunohistochemical features of both follicular and parafollicular thyroidal cells. We report three women, aged 34, 63 and 61 old with this type of tumor. Its diagnosis must be bore in mind in patients with thyroidal tumors and a histological appearance of a medullary or undifferentiated carcinomas. An early diagnosis of a mixed medullary and follicular carcinomas of the thyroid is important, considering its special treatment and negative prognosis

Quistes paratiroideos funcionantes y no funcionantes: entidades con origen y clínica diferente en dos casos / Functioning and non functioning parathyroid cysts: report of 2 cases

We report two women presenting with parathyroid cysts. A 20 years old woman presented with goiter and a cystic lesion in the left thyroid lobe was identified on ultrasound examination and CAT scan. The patient had hypercalcemia and elevated PTH levels. The content of the cyst, obtained by needle aspiration, had an extremely high PTH concentration. The patient was operated, removing the cyst and a remaining thymus. Pathological study confirmed the diagnosis of a parathyroid cyst. An 11 years old girl presented with a mass in the left thyroid lobe. An ultrasound examination disclosed the presence of a cystic nodule. The patient was otherwise asymptomatic and laboratory work up was normal. The patient was operated and pathological examination of the surgical piece revealed a parathyroid cyst