Calidad de vida en pacientes con enfermedades tiroideas

Introducción: Las enfermedades del tiroides son relativamente frecuentes, constituyen un importante grupo dentro de las enfermedades crónicas no transmisibles. Objetivo: Determinar la calidad de vida en pacientes con enfermedades tiroideas. Métodos: Se realizó un estudio observacional, descriptivo y transversal. El universo estuvo constituido por 210 pacientes con diagnóstico de enfermedades tiroideas, que cumplieron con los criterios de inclusión y exclusión previstos en el estudio, previo consentimiento informado y la muestra no probabilística de 198 pacientes. Se utilizaron las variables: edad, sexo, enfermedad tiroidea diagnosticada (hipertiroidismo, hipotiroidismo, bocio difuso eutiroideo) y calidad de vida (facetas según dimensiones, según la clasificación de expertos y enfermedades tiroideas y la calidad de vida integral según enfermedades tiroideas). Se utilizó el cuestionario World Health Organization Quality of Life. Resultados: Predominó el hipotiroidismo como afección tiroidea más frecuente en las féminas entre 50 a 59 años. Las manifestaciones clínicas que puntuaron las medias más bajas fueron el dolor y malestar, seguido de indicaciones médicas y sentimientos negativos; las dimensiones físicas y psicológicas puntuaron con medias bajas, al igual que el ambiente, valores considerados como deficientes. Conclusiones: Predominó una calidad de vida integral media en el mayor por ciento de los pacientes, estas enfermedades deben ser identificadas a tiempo, para evitar otras complicaciones en diferentes sistemas del organismo que pudieran comprometer la vida del paciente.

Introduction: Thyroid diseases are relatively frequent; they constitute an important group within chronic non-communicable diseases. Objective: To determine the quality of life in patients with thyroid diseases. Methods: An observational, descriptive and cross-sectional study was carried out. The universe (210 patients) with a diagnosis of thyroid diseases, who met the inclusion and exclusion criteria provided for in the study, prior informed consent, and the non-probabilistic sample (198 patients). The variables used were: age, sex, diagnosed thyroid disease (hyperthyroidism, hypothyroidism, diffuse euthyroid goiter) and quality of life (facets according to dimensions, according to expert classification and thyroid diseases and comprehensive quality of life according to diseases thyroid). The World Health Organization Quality of Life questionnaire was used. Results: Hypothyroidism predominated as the most frequent thyroid condition in women between 50 and 59 years of age. The clinical manifestations that scored the lowest average were pain and discomfort, followed by medical indications and negative feelings; the physical and psychological dimensions scored with low averages, as well as the environment, values ​​considered deficient. Conclusions: An average comprehensive quality of life prevailed in the highest percentage of patients; these diseases must be identified in time, to avoid other complications in different body systems that could compromise the patient's life.

Complicaciones endocrinológicas del síndrome de down en pediatría: revisión de la literatura / Endocrine complications of Down syndrome in pediatrics: a review of the literature

El síndrome de Down constituye la cromosopatía más frecuente a nivel mundial y afecta 6,03 a 7,86 de cada 10.000 nacidos vivos en Colombia. Los pacientes pediátricos de este grupo poblacional presentan una mayor incidencia de complicaciones endocrinológicas comparados con la población general. El objetivo de este artículo es revisar las complicaciones endocrinológicas prevalentes en el paciente pediátrico con síndrome de Down, relacionadas con el hipocrecimiento, desarrollo puberal, patología tiroidea, diabetes mellitus, dislipidemias y obesidad; así como describir su seguimiento y tratamiento. Se realizó una búsqueda en la literatura desde agosto de 2020 hasta diciembre de 2021, en las bases de datos PubMed y Google Scholar; incluyendo un total de 44 publicaciones para la presente revisión. Se concluye que el paciente pediátrico con síndrome de Down evidencia un patrón de hipocrecimiento junto a un mayor riesgo de obesidad y sobrepeso. Adicionalmente, presenta con mayor frecuencia patología tiroidea y diabetes mellitus.

Down syndrome is the most common chromosomal disorder worldwide, affecting 6,03 to 7,86 per 10.000 live births in Colombia. Pediatric patients with Down syndrome have a higher incidence of endocrine disorders compared to the general population. The aim of this paper was to review the endocrinological manifestations prevalent in pediatric patients with Down syndrome related to small stature, pubertal development, thyroid dysfunction, diabetes mellitus, dyslipidemia, and obesity. Additionally, their follow-up and adequate treatment are described. A literature search was carried out from August 2020 to December 2021 in the PubMed and Google Scholar databases. A total of 44 publications were included for this review. It is concluded that pediatric patients with Down syndrome are more likely to have short stature and have a higher risk of obesity and overweight. In addition, thyroid dysfunction and diabetes mellitus are frequent complications.

Síndrome POEMS: desafios no diagnóstico de um caso atípico / POEMS syndrome: challenges in the diagnosis of an atypical case

Introdução: Síndrome POEMS trata de um raro evento paraneoplásico, sem relato atual na literatura sobre sua real prevalência. A maior parte dos casos ocorre em homens de meia idade. Relato do Caso:Paciente masculino, 65 anos, com queixa edema e parestesia em pernas que evoluiu para plegia, associada a hiporexia e fadiga. Investigação ambulatorial inicial evidenciou Polirradiculoneuropatia Inflamatória Desmielinizante Crônica (PIDC) de etiologia indefinida. Excluídos secundarismos, o paciente foi diagnosticado com hipotireoidismo primário, hipogonadismo severo, lesões hipercrômicas em pele, ascite, derrame pleural e trombocitose, além de gamopatia monoclonal IgA Lambda por imunofixação sérica. Sorologias virais negativas. Excluída a possibilidade de Mieloma Múltiplo e outras gamopatias, foi aventada a hipótese de Síndrome POEMS, sendo realizada dosagem de VEGF plasmática (425 pg/mL; VR = <96.2). Trata-se de um caso atípico na medida em que, lesões ósseas, presentes em até 97% dos casos, não foram evidenciadas no paciente em questão, tornando desafiador o diagnóstico. Conclusões: O diagnóstico de síndromes raras, embora desafiante, traz ao clínico um olhar mais amplo do paciente na medida em que incrementa o raciocínio clínico. [au]

Introduction: POEMS syndrome is a rare paraneoplastic event, with no current report in the literature about its real prevalence. Most cases occur in middle-aged men. Case Report: Male patient, 65 years old, complaining of edema and paresthesia in the legs that evolved to plegia, associated with hyporexia and fatigue. Initial outpatient investigation revealed Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) of undefined etiology. Excluding secondaries, the patient was diagnosed with primary hypothyroidism, severe hypogonadism, hyperchromic skin lesions, ascites, pleural effusion and thrombocytosis, in addition to monoclonal IgA Lambda gammopathy by serum immunofixation. Viral serologies was negative. Excluding the possibility of Multiple Myeloma and other gammopathies, the hypothesis of POEMS Syndrome was raised, and plasma VEGF measurement was performed (425 pg/mL; RV = <96.2). This is an atypical case in that bone lesions, present in up to 97% of cases, were not evidenced in the patient in question, making the diagnosis challenging. Conclusions: The diagnosis of rare syndromes, although challenging, brings the clinician a broader view of the patient as it increases clinical reasoning. [au]

Interacción del microbioma intestinal y el hueso / Interaction between the intestinal microbiome and bone

El "microbioma" no solo está constituido por los microbios, sino por todos los componen-tes que viven en el mismo hábitat conforman-do un nicho ecológico. Es decir, está conformado por los microorganismos (bacterias, hongos, protozoos, etc.), todo el espectro de moléculas producidas por ellos tales como sus componentes estructurales (ácidos nucleicos, proteínas, lípidos y glúcidos), meta-bolitos, toxinas, etc., y las moléculas producidas por el huésped. El microbioma intestinal (MI) ha emergido como un factor que tiene un gran efecto sobre la cantidad, calidad y fuerza del hueso. Las investigaciones revelan que la homeostasis ósea está ligada al micro-bioma saludable, mientras que la disbiosis (alteración en la biodiversidad microbiana) puede exacerbar la actividad osteoclástica y promover la osteoporosis. Los mecanismos potenciales involucrados en la interacción del microbioma intestinal y el hueso son la influencia del metabolismo del huésped, el mantenimiento de la integridad intestinal y regulación de la absorción de nutrientes, la regulación del eje intestino-sistema inmune y la modulación del sistema endocrino. Es decir que hay múltiples vías por las cuales el MI influye sobre el hueso, pero estos y otros mecanismos deben profundizarse más aún. También es necesario que se identifiquen y caractericen mejor los microorganismos que están asociados a las enfermedades óseas. El conocimiento de estos aspectos podría ser útil para el desarrollo de herramientas terapéuticas basadas en el MI que puedan mejorar la eficacia de los distintos tratamientos existentes. (AU)

The microbiome is not only constituted by microbes, but by all the components that live in the same habitat forming an ecological niche. It is conformed by the microorganisms ( bacteria, fungi, protozoa, etc), the entire spectrum of molecules produced by them (nucleic acids, proteins, lipid and carbohydrates, metabolites, toxins, etc) and the molecules produced by the host. The intestinal microbiome (IM) has emerged as a factor with great effects on the quantity, quality and strength of bone. The investigations reveal that bone homeostasis is linked to the healthy microbiome, while the dysbiosis (alteration in the microbial biodiversity) can exacerbate the osteoclastic activity and promote osteoporosis. The potential mechanisms involved in the interaction between IM and bone are the influence of the host metabolism, the maintenance of the intestinal integrity and regulation of the nutrient absorption, the regulation of the intestine/ immune system axis and the modulation of the endocrine system. That is, there are multiple ways through which IM influences on bone, but these and other mechanisms need to be further studied. It is also necessary to identify and characterize the microorganisms associated with the bone diseases. Knowledge of these aspects could be useful to develop therapeutical tools based on the IM that could improve the efficacy of the current treatments. (AU)

Síndrome POEMS: desafios no diagnóstico de um caso atípico / POEMS syndrome: challenges in the diagnosis of an atypical case

Introdução: Síndrome POEMS trata de um raro evento paraneoplásico, sem relato atual na literatura sobre sua real prevalência. A maior parte dos casos ocorre em homens de meia idade; Relato do Caso: Relatamos o caso de um paciente masculino, 65 anos, admitido com queixa edema e parestesia em pernas que evoluiu para plegia, associada a hiporexia e fadiga. Investigação ambulatorial inicial evidenciou polirradiculoneuropatia inflamatória desmielinizante crônica (PIDC) de etiologia indefinida. Excluídos secundarismos para polirradiculoneuropatia inflamatória desmielinizante crônica, o paciente foi a seguir diagnosticado com hipotireoidismo primário, hipogonadismo severo, lesões hipercrômicas em pele, ascite, derrame pleural e trombocitose, além de gamopatia monoclonal IgA Lambda por imunofixação sérica. Sorologias para HIV, Sífilis e Hepatites todas negativas. Excluída a possibilidade de Mieloma Múltiplo e outras gamopatias, foi aventada a hipótese de Síndrome POEMS, sendo realizada dosagem de Fator de Crescimento Endotelial Vascular (VEGF) plasmática (425 pg/mL; VR = <96.2). O paciente passou então a preencher os critérios obrigatórios para diagnóstico, além de um maior (VEGF elevada) e vários outros menores. Trata-se de um caso atípico na medida em que, lesões ósseas, presentes em até 97% dos casos, não foram evidenciadas no paciente em questão, tornando desafiador o diagnóstico e sendo então necessário recorrer à dosagem de VEGF. O diagnóstico de síndromes raras, embora desafiante, traz ao clínico um olhar mais amplo do paciente na medida em que incrementa o raciocínio clínico. Difundir e explorar esse universo é cada vez mais necessário

Introduction: POEMS syndrome is a rare paraneoplastic event, with no current report in the literature about its real prevalence. Most cases occur in middle-aged men; Case Report: We report the case of a male patient, 65 years old, admitted with complaints of edema and paresthesia in the legs that progressed to plegia, associated with hyporexia and fatigue. Initial outpatient investigation revealed Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) of undefined etiology. Excluding secondaries for chronic inflammatory demyelinating polyradiculoneuropathy, the patient was subsequently diagnosed with primary hypothyroidism, severe hypogonadism, hyperchromic skin lesions, ascites, pleural effusion and thrombocytosis, in addition to monoclonal IgA Lambda gammopathy by serum immunofixation. All serologies for HIV, Hepatitis and syphilis were negative. Excluding the possibility of Multiple Myeloma and other gammopathies, the hypothesis of POEMS Syndrome was raised, and plasma Vascular Endotelial Growth Factor (VEGF) measurement was performed (425 pg/mL; RV = <96.2). The patient then started to fulfill the mandatory criteria for diagnosis, in addition to a major (elevated VEGF) and several other minors. This is an atypical case in that bone lesions, present in up to 97% of the cases, were not evidenced in the patient in question, making the diagnosis challenging and therefore requiring the use of VEGF dosage. The diagnosis of rare syndromes, although challenging, brings the clinician a broader view of the patient as it increases clinical reasoning. Spreading and exploring this universe is increasingly necessary

Impacto cardiovascular, conducta diagnóstica y terapéutica del feocromocitoma como causa de hipertensión arterial / Cardiovascular impact, diagnostic and therapeutic management of pheochromocytoma as a cause of arterial hypertension

INTRODUCCIÓN. Los feocromocitomas son tumores que provienen de las células neuroendócrinas de la médula adrenal y producen alta secreción de catecolaminas. Generan complicaciones cardiovasculares graves que suelen asociarse con crisis hipertensivas. Es importante valorar el impacto cardiovascular de esta entidad. OBJETIVO. Realizar una revisión exhaustiva de las diversas manifestaciones de los feocromocitomas como causa de hipertensión arterial, su impacto cardiovascular, conducta diagnóstica y terapéutica. MATERIALES Y MÉTODOS. Revisión bibliográfica y análisis de 141 artículos científicos que incluyeron temas sobre el impacto cardiovascular, conducta diagnóstica y terapéutica del feocromocitoma como causa de hipertensión arterial. Se usó bases de datos: Medline, Embase, Scopus, Pubmed, Google Académico. Criterios de búsqueda en DECS, MeSH: "pheochromocytoma OR hypertension arterial AND cardiomyopathy", en inglés- español. Fueron seleccionados: 13 publicaciones de texto completo, 10 artículos retrospectivos, 2 guías de práctica clínica y 1 revisión. Se excluyeron 128 artículos científicos. RESULTADOS. Se realizó una revisión de las manifestaciones clínicas de los feocromocitomas como causa de hipertensión arterial y el impacto cardiovascular se relacionó con la producción de catecolaminas. Para el diagnóstico, la sensibilidad de la resonancia magnética es del 93-100%; la especificidad de resonancia magnética o tomografía computarizada en combinación con gammagrafía con metayodobencilguanidina con 123I es cercana al 100%. La resección del feocromocitoma tiene potencial curativo. CONCLUSIÓN. Los feocromocitomas presentan variabilidad clínica, se asocian a complicaciones cardiovasculares y cerebrovasculares graves por producción de catecolaminas. El diagnóstico oportuno y eficaz debe realizarse mediante resonancia magnética y gammagrafía en caso de alta sospecha clínica. El tratamiento quirúrgico es de elección.

INTRODUCTION. Pheochromocytomas are tumors arising from the neuroendocrine cells of the adrenal medulla and produce high secretion of catecholamines. They generate severe cardiovascular complications that are often associated with hypertensive crises. It is important to assess the cardiovascular impact of this entity. OBJECTIVE. To perform an exhaustive review of the various manifestations of pheochromocytomas as a cause of arterial hypertension, their cardiovascular impact, diagnostic and therapeutic conduct. MATERIALS AND METHODS. Bibliographic review and analysis of 141 scientific articles that included topics on the cardiovascular impact, diagnostic and therapeutic behavior of pheochromocytoma as a cause of arterial hypertension. The following databases were used: Medline, Embase, Scopus, Pubmed, Google Scholar. Search criteria in DECS, MeSH: "pheochromocytoma OR hypertension arterial AND cardiomyopathy", in English-Spanish. The following were selected: 13 full-text publications, 10 retrospective articles, 2 clinical practice guidelines, and 1 review. A total of 128 scientific articles were excluded. RESULTS. A review of the clinical manifestations of pheochromocytoma as a cause of arterial hypertension was performed and the cardiovascular impact was related to catecholamine production. For diagnosis, the sensitivity of MRI is 93-100%; the specificity of MRI or computed tomography in combination with 123I-methiodobenzylguanidine scintigraphy is close to 100%. Resection of pheochromocytoma has curative potential. CONCLUSION. Pheochromocytomas present clinical variability, are associated with severe cardiovascular and cerebrovascular complications due to catecholamine production. Timely and effective diagnosis should be made by MRI and scintigraphy in case of high clinical suspicion. Surgical treatment is the treatment of choice.

Aumento da Rigidez Arterial Pulmonar e Comprometimento do Acoplamento Ventrículo Direito-Artéria Pulmonar na SOP / Increased Pulmonary Arterial Stiffness and Impaired Right Ventricle-Pulmonary Artery Coupling In PCOS

Resumo Fundamento: A síndrome dos ovários policísticos (SOP) é a doença endócrino-metabólica mais comum em mulheres em idade reprodutiva, e ocorre em uma a cada 10 mulheres. A doença inclui irregularidade menstrual e excesso de hormônios masculinos e é a causa mais comum de infertilidade em mulheres. A dispneia é um sintoma frequente e muitas vezes acredita-se que seja decorrente da obesidade, mas não se sabe se é decorrente de disfunção cardíaca. Objetivo: Avaliar o acoplamento ventrículo-arterial (VDAP) e a rigidez arterial pulmonar em pacientes com SOP. Métodos: Foram incluídos 44 pacientes com SOP e 60 controles; amostras de sangue venoso foram coletadas para exames laboratoriais e ecocardiograma transtorácico 2-D, Modo-M e com Doppler tecidual foram realizados em todos os participantes. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados: Quando comparadas ao grupo controle, as pacientes com SOP apresentaram valores maiores de rigidez da artéria pulmonar (p = 0,001), que se correlacionaram positivamente com o índice HOMA-IR (r = 0,545 e p <0,001). O acoplamento VDAP também estava comprometido em 34% dos pacientes do estudo. Conclusão: A rigidez da artéria pulmonar está aumentada e o acoplamento VDAP está comprometido em pacientes com SOP. (Arq Bras Cardiol. 2021; 116(4):806-811)

Abstract Background: Polycystic ovary syndrome (PCOS) is the most common endocrine-metabolic disease in women in reproductive age, and occurs in one of 10 women. The disease includes menstrual irregularity and excess of male hormones and is the most common cause of female infertility. Dyspnea is a frequent symptom and is often thought to be due to obesity, and whether it is due to cardiac dysfunction is unknown. Objective: To evaluate right ventricle-pulmonary artery (RV-PA) coupling and pulmonary arterial stiffness in patients with PCOS. Methods: 44 PCOS patients and 60 controls were included; venous blood samples were taken for laboratory tests and 2-D, m-mode and tissue doppler transthoracic echocardiography were performed for all the participants. P<0,05 was considered as statistically significant. Results: When compared to the control group, PCOS patients had higher pulmonary artery stiffness values (p=0,001), which were positively correlated with HOMA-IR (r=0,545 and p<0,001). RV-PA coupling was also impaired in 34% of the study patients. Conclusion: Pulmonary artery stiffness is increased and RV-PA coupling is impaired in patients with PCOS. (Arq Bras Cardiol. 2021; 116(4):806-811)

Convulsiones, derrame pericárdico y rabdomiólisis en debut de coma mixedematoso / Myxedema coma presenting with seizures, pericardial effusion, and rhabdomyolysis

RESUMEN El coma mixedematoso es la complicación más grave de un hipotiroidismo. Ocurre, por lo general, en mujeres ancianas con hipotiroidismo conocido sin un adecuado manejo y en presencia de un evento desencadenante. El diagnóstico es difícil y debe realizarse en forma oportuna para disminuir el riesgo de muerte. El coma es una de las presentaciones neurológicas de esta urgencia endocrinológica y no es necesario su presencia para el diagnóstico. En este reporte de caso se presentan varías manifestaciones inusuales en un paciente masculino con hipotiroidismo profundo que, al diagnóstico, debutó con coma mixedematoso con predictores de mal pronóstico durante la hospitalización, pero debido al abordaje temprano y el manejo integral, se dio una resolución satisfactoria a esta urgencia endocrinológica infrecuente.

SUMMARY Myxedema coma is the most serious complication of hypothyroidism. It usually occurs in the context of elderly women, with known hypothyroidism without proper management and in the presence of a triggering event. The diagnosis is challenging and must be made in a timely manner to prevent the development of adverse outcomes. Coma is one of the neurological manifestations of the entity, not being necessary for its diagnosis. This case report presents a constellation of unusual manifestations of a male patient with myxedema coma at the debut of severe hypothyroidism with predictors of poor prognosis during hospitalization, but due to the early approach and comprehensive management, this uncommon endocrinological emergency was satisfactorily resolved.

Thyroid parafollicular cell hyperplasia and carcinoma in a sheep with enzootic calcinosis due to Nierembergia rivularis poisoning / [Hiperplasia e carcinoma de células parafoliculares da tireóide em ovino com calcinose enzoótica associada a intoxicação por Nierembergia rivularis]

Calcinose enzoótica, causada por Nierembergia rivularis, no Uruguai, e Nierembergia veitchii, no Brasil, é uma doença caracterizada por mineralização de tecidos moles, hiperplasia das células parafoliculares da tireoide e elevação nos níveis de cálcio e fósforo. Descreve-se um caso de hiperplasia e carcinoma de células parafoliculares bilateral em um ovino de quatro anos, com calcinose enzoótica associada à intoxicação por Nierembergia rivularis. O diagnóstico histológico de hiperplasia e carcinoma de células parafoliculares é suportado pelas marcações imuno-histoquímicas positivas para calcitonina, peptídeo relacionado ao gene da calcitonina e enolase neurônio específica. Como a hiperplasia de células parafoliculares é uma lesão pré-neoplásica induzida por hipercalcemia, sugere-se que a hipercalcemia crônica causada pela intoxicação por N. rivularis pode ter induzido hiperplasia de células parafoliculares seguida de transformação em carcinoma, neste caso. Os efeitos carcinogênicos das plantas calcinogênicas no sistema endócrino devem ser melhor explorados.(AU)

Sexualidad en el contexto de los procesos de vida de mujeres y varones con endocrinopatías: una aproximación cualitativa / Sexuality in the life processes context of women and men with endocrinopathies: A qualitative approach

Resumen Antecedentes las enfermedades del sistema endocrino pueden afectar la sexualidad por sus efectos hormonales, las comorbilidades asociadas y su impacto psicosocial, tema poco estudiado desde las perspectivas de personas con estas enfermedades. Objetivos: se realizó un estudio cualitativo dirigido a comprender las experiencias sexuales de mujeres y varones con enfermedades endocrinas que producen cambios en la apariencia física. Método: se estructuró un diseño de estudio analítico-interpretativo. Participaron 68 personas entre 20 y 45 años de edad, atendidos en el Instituto Nacional de Endocrinología, La Habana, Cuba. Los instrumentos de recolección de la información utilizados fueron una planilla de datos generales, una guía de entrevista en profundidad y dos pruebas psicológicas proyectivas. Los aspectos éticos fueron considerados. Resultados: de las entrevistas en profundidad, emergieron 4 temas: 1) la expresión multidimensional de la enfermedad, 2) enfermedad y áreas de vida, 3) ejercicio de la sexualidad con la enfermedad, y 4) estrategias de afrontamiento en el área sexual; vinculados con los significados expresados sobre la salud, el cuerpo, el género y la sexualidad. Conclusiones: las/los participantes contextualizaron sus experiencias sexuales en el impacto biopsicosocial de la enfermedad. La reproducción o cuestionamiento de los significados expresados influyó en la calidad de sus experiencias sexuales. El estudio mostró que esta constituye un área de vulnerabilidad para la salud integral de las/los participantes.

Abstract Background endocrine disorders may affect sexuality due to hormonal changes, associated comorbidities and psychosocial impact. This topic remains poorly researched from the perspective of people with these conditions. Objectives: a qualitative research was conducted to understand the sexual experiences of women and men living with endocrine disorders that change their physical appearance. Methods: an analytical-interpretive study was carried out with a sample of 68 participants aged between 20 and 45, and treated at the National Institute of Endocrinology, Havana, Cuba. Data collection instruments were a personal information sheet, an in-depth interview guide and two projective psychological tests. Ethical aspects were considered. Results: in-depth interviews gave rise to four topics: 1) multidimensional expression of the disease, 2) the disease and life areas, 3) sexuality with the disease, and 4) coping strategies in the sexual area. These topics were linked to the meanings of health, body, gender and sexuality. Conclusions: the participants contextualized their sexual experiences within the biopsychosocial impact of the endocrine disorder, as well as the reproduction or questioning of the meanings that influenced the quality of their sexual experiences. The study showed that sexuality is a vulnerable area for the participants' comprehensive health.

Recomendaciones para el uso de la hormona de crecimiento humana recombinante en pacientes pediátricos de talla baja en Colombia / Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

resumen está disponible en el texto completo

Abstract In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinant human growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation, the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order to standardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium of clinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada de Servicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private health institutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia Clínica Keralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm, biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use among the indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consent and a medication fact sheet available for parents and patients.

Problemas gastrointestinales, nutricionales, endocrinológicos y de microbiota en el trastorno del espectro autista / Gastrointestinal, nutritional, endocrine, and microbiota conditions in autism spectrum disorder

Los problemas médicos gastrointestinales, nutricionales, metabólicos, endocrinológicos y de microbiota en los pacientes pediátricos con diagnóstico de trastorno del espectro autista (TEA) son parte de los problemas médicos concomitantes al diagnóstico. La prevalencia alcanza a más del 91 % en el caso de los problemas gastrointestinales, hasta el 89 % para los nutricionales y metabólicos, más del 50 % de disfunción tiroidea y hasta el 100 % para los relacionados con la microbiota.Es urgente actualizar la práctica médica para incluir la evaluación, testeo, diagnóstico y tratamiento de estos problemas médicos concomitantes al diagnóstico de TEA en la población pediátrica, adolescente y adulta. El tratamiento riguroso de dichos problemas genera cambios positivos en la calidad de vida y en la sintomatología bajo la cual el TEA se diagnostica en muchos casos. Debe basarse en evidencia científica de alta calidad, con control y cuidado médico adecuado

Gastrointestinal, nutritional, metabolic, endocrine, and microbiota medical problems in pediatric patients diagnosed with autism spectrum disorder (ASD) are some of the coexisting medical conditions in ASD diagnosis. Their prevalence reaches more than 91 % for gastrointestinal problems, up to 89 % for nutritional and metabolic disorders, more than 50 % for thyroid dysfunction, and up to 100 % for microbiota-related conditions.There is an urgency for medical practice to be updated and to include the assessment, testing, diagnosis, and treatment of these coexisting medical conditions in ASD diagnosis in the pediatric, adolescent, and adult population. A strict management of such conditions results in positive changes in the quality of life and symptoms based on which ASD is diagnosed many times. It should be based on high-quality scientific evidence with an adequate medical care and control

Endocrinopatía múltiple autoinmune autoinmune / Autoimmune polyendocrinopathy

Los autoanticuerpos son proteínas producidas en el organismo por la inducción de un antígeno propio del individuo el cual no reconocen y rechazan. Su aparición en sangre puede iniciarse tiempo antes de la presentación de síntomas o signos. El deterioro funcional de dos o más glándulas es una afectación endocrinológica múltiple que puede asociarse con otras patologías autoinmunes no endocrinas, tales como vitiligo, alopecia areata, gastritis autoinmune y anemia perniciosa. Se clasifica en tres síndromes poliendocrinos autoinmunes (SPA). En Europa la incidencia del tipo I es menor a 1:100000 por año y los 2 y 3 varían entre 1­2:100000 por año. Colombia no cuenta con registros que permitan calcularla. Se reporta el caso de un hombre de 18 años diagnosticado con hipotiroidismo autoinmune, a los 15 años de edad debutó con cetoacidosis diabética y a los 17 con posterior aparición de vitiligo. El manejo inicial se realizó con levotiroxina sódica y análogos de insulina. Este caso corresponde a un SPA tipo IIIA, ya que cursa con hipotiroidismo autoinmune, diabetes mellitus y como último hallazgo cronológico la asociación con vitiligo. La detección de una endocrinopatía autoinmune en pacientes jóvenes debe alertar sobre la posible existencia de un SPA

Autoantibodies are blood proteins produced in response to and counteracting a specific antigen. Autoantibodies may be present before signs and symptoms occur. A polyendocrinopathy is characterized by the coexistence of at least two endocrine glands insufficiency and may be associated with another non-endocrine autoimmune illness including vitiligo, alopecia areata, autoimmune gastritis and pernicious anemia. It is classified into three types of autoimmune polyglandular syndromes (APS). In Europe the incidence of APS-1 is less than one new case per 100000 persons per year and the incidence of the other two APS types vary between1 to 2 new cases per 100000 persons per year. APS incidence in Colombia cannot be estimated due to lack of records on this subject. We report the case of an 18-year-old male with autoimmune hypothyroidism diagnosed at 15 years of age, with onset of diabetic ketoacidosis at 17 followed by vitiligo. Therapy with levothyroxine 100 mcg daily and insulin glargine 10 units daily did not yield successful correction of APS in the patient. This patient was affected by APS- IIIA, characterized by the association of autoimmune hypothyroidism, diabetes mellitus and vitiligo, as the last manifestation. Detecting an autoimmune polyendocrinopathy in young patients should raise the suspicion of APS.

Efectos endocrinológicos tardíos del tratamiento oncológico en supervivientes de meduloblastoma / Endocrinological late effects of oncologic treatment on survivors of medulloblastoma

INTRODUCCIÓN: La radioterapia, quimioterapia y la cirugía empleada en el tratamiento de los tumores cerebrales tienen efectos en el eje hipotálamo-hipofisario y pueden resultar en disfunción endocrina hasta en el 96% de los casos. PACIENTES Y MÉTODO: Estudio retrospectivo y descriptivo en pacientes diagnos ticados de meduloblastoma sometidos a tratamiento con quimio y radioterapia en los últimos 20 años en un hospital terciario. Se analizan variables edad, sexo, peso, talla, índice de masa corporal (IMC) al final del seguimiento, estadio de maduración sexual, niveles séricos de TSH y T4 libre, ACTH/cortisol e IGF-1, FSH, LH, estradiol, testosterona, perfil lipídico (colesterol total) y prueba de función dinámica de hormona de crecimiento. RESULTADOS: Muestra total de 23 pacientes. El déficit de hormona de crecimiento es la secuela más frecuente (82 %) seguido de disfunción ti roidea (44,8%) y disfunción puberal (24,1%). Solo se diagnosticó un caso de diabetes insípida y 2 casos de déficit de corticotrofina. CONCLUSIONES: El seguimiento a largo plazo de los supervivientes de meduloblastoma tratados con quimio y radioterapia revela una prevalencia muy alta de disfun ción endocrina, particularmente de deficiencia de hormona del crecimiento y de hipotiroidismo. Creemos oportuna la monitorización y el seguimiento a largo plazo de estos pacientes con el fin de garantizar un manejo terapéutico adecuado de aquellas disfunciones tratables.

INTRODUCTION: Radiation therapy, chemotherapy, and surgery used to treat brain tumors have effects on the hy pothalamic-pituitary-adrenal axis and can result in endocrine dysfunction in up to 96% of cases. PATIENTS Y METHOD: Retrospective and descriptive study in patients diagnosed with medulloblasto ma who underwent treatment with chemo and radiotherapy in the last 20 years in a tertiary hospital. The variables analyzed were age, sex, weight, height, body mass index (BMI) at the end of follow-up, sexual maturity stage, serum levels of TSH and free T4, ACTH/cortisol and IGF-1, FSH, LH, estradiol, testosterone, lipid profile (total cholesterol), and growth hormone dynamic function test. RESULTS: Total sample of 23 patients. Growth hormone deficiency is the most frequent sequelae (82%) fo llowed by thyroid dysfunction (44.8%), and disorders of puberty (24.1%). Only one case of diabetes insipidus and two cases of corticotropin deficiency were diagnosed. CONCLUSIONS: Long-term follow- up of medulloblastoma survivors treated with chemo and radiotherapy reveals a very high prevalence of endocrine dysfunction, especially growth hormone deficiency and hypothyroidism. We believe that monitoring and long-term follow-up of these patients is necessary in order to ensure adequate therapeutic management of those treatable dysfunctions.

Particularidades de la erupción dentaria en individuos infanto-juveniles con enfermedades endocrinas frecuentes / Particularities of tooth eruption in infantile and juvenile individuals with common endocrine diseases

RESUMEN Introducción: la erupción de los dientes es un fenómeno biológico de interés médico y social. Este puede ser alterado por causas congénitas y adquiridas. Objetivo: caracterizar el brote dentario en individuos infanto-juveniles con enfermedades endocrinas frecuentes. Métodos: se realizó un estudio epidemiológico, descriptivo y transversal, en el Hospital Universitario Pediátrico José Luis Miranda, de Villa Clara, en el período comprendido de marzo de 2016 a abril de 2017. Se tomó una muestra intencional de 114 individuos de ambos sexos, desde tres meses a 14 años de edad, con diabetes mellitus, hipotiroidismo congénito, hipertiroidismo o hiperplasia adrenal congénita. Se aplicó un cuestionario contentivo de variables relacionadas con el tipo de enfermedad endocrina y el brote dentario, la información fue procesada mediante el paquete estadístico SPSS versión 15.0. Resultados: la muestra se caracterizó por una prevalencia del sexo masculino, del grupo de edad de 7 a 11 años. Las enfermedades endocrinas más frecuentes fueron en orden ascendente: el hipertiroidismo, el hipotiroidismo congénito y la diabetes mellitus. El brote dentario se relacionó significativamente con el tipo de enfermedad; predominó el brote dentario tardío (presente en la mayoría de los pacientes con diabetes mellitus). Conclusiones: existió una relación altamente significativa entre el tipo de enfermedad endocrina y el brote dentario.

ABSTRACT Introduction: tooth eruption is a biological phenomenon of social and medical interest. This can be altered by congenital and acquired causes. Objective: to characterize tooth eruption in infantile and juvenile individuals with common endocrine diseases. Methods: an epidemiological, descriptive and cross-sectional study was conducted at José Luis Miranda Pediatric University Hospital in Villa Clara, from March 2016 to April 2017. An intentional sample of 114 individuals of both genders, from three months to 14 years of age who suffered from diabetes mellitus, congenital hypothyroidism, hyperthyroidism or congenital adrenal hyperplasia was taken. A questionnaire containing variables related to the type of endocrine disease and tooth eruption was applied; the information was processed using the statistical package SPSS version 15.0. Results: the sample was characterized by a prevalence of male gender, from the age group of 7 to 11 years. The most frequent endocrine diseases were in ascending order: hyperthyroidism, congenital hypothyroidism and diabetes mellitus. Tooth eruption was significantly related to the type of disease; the late tooth eruption was predominant in most of patients with diabetes mellitus). Conclusions: there was a highly significant relationship between the type of endocrine disease and tooth eruption.

Alteraciones endocrinas asociadas al uso medicamentos en el Programa Distrital de Farmacovigilancia de Bogotá durante el periodo 2012 a 2016 / Medication-use related endocrine disruption reported to the local pharmacovigilance program in Bogota, during 2012- 2016 / Alterações endócrinas associadas ao uso de medicamentos no Programa Distrital de Vigilância farmacológica em Bogotá no período 2012-2016

Objetivos. Conocer las reacciones adversas tipo endocrino asociado al uso de medicamentos y reportado al Programa Distrital de Farmacovigilancia de Bogotá durante el periodo 2012 a 2016. Materiales y métodos. Los reportes analizados corresponden al periodo del 1º de enero de 2012 al 31 de diciembre de 2016 del Programa Distrital de Farmacovigilancia. Su análisis se hizo mediante algoritmos de causalidad y por tipo de evento. Resultados. Se analizaron 85 reportes. Uno de ellos relacionado con una sospecha de problema de calidad del medicamento, los otros 84 relaciona-dos con reacciones adversas sobre los cuales se centró la investigación. De los 84 reportes, 36 (42,9 %) corresponden a reacciones adversas a medicamento tipo A y 26 (31 %) a reportes de reacciones adversas a medicamentos de tipo fallo terapéutico. Los principales efectos secundarios a los medicamentos fueron el aumento de los niveles de hormona paratiroidea por uso de cinacalcet en 27 (34,1 %) reportes, seguidas por el síndrome de Cushing relacionado con la administración de prednisolona en 12 (14,1 %), bocio por uso de adalimumab en 12 (14,1 %), hiperprolactinemia por el uso de risperidona en 10 (11,8 %) e hipotiroidismo inducido por amiodarona en 3 (3,4 %). Conclusiones. El desarrollo de estos estudios permite conocer las principales reacciones adversas que se presentan durante el uso habitual de los medicamentos, así como su perfil de seguridad.

Objective. Becoming familiar with medication-use related endocrine disruption reported to the local pharmacovigilance program in Bogotá during 2012-2016.Tools and methods. Analyzed reports are dated between January 1st, 2012 and December 31st, 2016 and were gathered from the Pharmacovigilance Program in Bogotá. The analysis of the said reports was conducted through causality algorithms and event type.Results. Out of 87 analyzed reports, two were not included in the study due to lack of information for its classification in one case and, medication-related problems in another case. 36 reports (42.9 %) were found to have adverse reaction to type A medications, while 26 reports (34.1%) were found to have medication related problem type therapeutic failure. The main medication related problems were associated to the use of Cinacalcet with increased levels of parathormone in 27 out of 87 analyzed reports in this study. Other medication related problems found were: Cushing Syndrome, associated with the use of prednisolone in 12 reports; Goiter associated to the use of adalimumab in 12 reports; Hyperprolactinemia associated to the use of Risperidone in 10 reports and, Hypothyroidism associated to the use of Amiodarone in 3 reports. Conclusions: Carrying out such studies allows for the understanding of the main medication-use problems that are shown during common use of medications, as well as their safety profile.

Objetivo. O objetivo do artigo é conhecer as alterações endócrinas associadas ao uso de medicamentos reportadas pelo Programa Distrital de Vigilância farmacológica em Bogotá. Materiais e métodos. Os reportes analisados correspondem ao período de janeiro de 2012 a dezembro 2016 e a analise foi realizada com algoritmos de causalidade e por tipo de evento. Resultados. Foram analisados 87 reportes, embora no final dois deles foram desconsiderados, um por corresponder a um problema relacionado com o medicamento e o outro por falta de informações para classifica-lo. Encontraram-se 36 (42%) de reportes associados a reações adversas perante os medicamentos tipo A e 26 (31%) de reportes de RAM tipo falho terapêutico. As principais RAM foram por uso de cinacalcet com aumento dos níveis de parathormona em 27 reportes (34%), seguidas de Síndrome de Cushing relacionado com prednisolona em 12 reportes (14,1%), bócio por uso de adalimumab em outros 12 re-portes, hiperprolactinemia por uso de risperidona em 10 casos (11,8%) e hipotiroidismo induzido por amiodarona em 3 casos. Conclusoes. O desenvolvimento destes estudos, permite conhecer as principais reações adversas causadas pelo uso habitual dos medicamentos mesmo como seu perfil de segurança.

Impactos das práticas integrativas e complementares na saúde de pacientes crônicos / Impacts of integrative and complementary practices on the health of chronic patients

RESUMO A inclusão das práticas integrativas e complementares nos serviços de saúde pública tem acontecido de forma gradual e lentificada, há cerca de 10 anos. Este estudo visa a colaborar com a ampliação do conhecimento sobre as práticas integrativas, tendo como objetivo principal apresentar os impactos do reiki e da reflexologia podal na saúde de pacientes crônicos atendidos em um centro especializado em endocrinopatias, localizado em Salvador (BA). Trata-se de um estudo observacional retrospectivo, de corte transversal, que utilizou registros em prontuários médicos. Observaram-se, a partir da análise dos dados, impactos aparentes das terapias complementares no alívio de sintomas psicológicos, emocionais e físicos, tais como ansiedade, estresse e dores no corpo.

ABSTRACT The inclusion of integrative and complementary practices in public health services has been gradual and slow, about 10 years ago. This study aims to contribute to the expansion of knowledge about integrative practices, with the main objective of presenting the impacts of reiki and foot reflexology on the health of chronic patients attended at a center specialized in endocrinopathies, located in Salvador (BA). This is a cross-sectional retrospective observational study, that used records in medical records. From the data analysis, apparent impacts of complementary therapies on the relief of psychological, emotional and physical symptoms, such as anxiety, stress and body aches, were observed.

Lesões de adrenais em 300 cães / Adrenal lesions in 300 dogs

Foram estudadas as adrenais de 300 cães submetidos à necropsia no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria, no período de março de 2012 a junho de 2013. Os tecidos coletados foram fixados em formol 10% e encaminhados ao processamento his­tológico de rotina para confecção e análise de lâminas histológicas. Posteriormente, foram revisados os protocolos de necropsia e dados epidemiológicos referentes aos cães que tiveram as adrenais coletadas foram anotados. Dos 300 cães analisados, 82% tinham uma ou mais alterações nas adrenais, que foram classificadas de acordo com a patogênese e a prevalência. Lesões hiperplásicas foram as mais prevalentes, com 91,5% das ocorrências, seguido de lesões degenerativas (26,%), circulatórias (20,3%), neoplásicas (15%), inflamatórias (4,1%) e outras lesões (14,2%). Macroscopicamente, as hiperplasias caracterizavam-se por variável quantidade de nódulos brancacentos, de até 1,5cm de diâmetro. Em 72,9% dos casos de hiperplasia, os nódulos eram constituídos de células da camada glomerulosa. A maioria dos animais que apresentou lesões hiperplásicas era constituída de fêmeas (60,4%), idosos (46,9%) e cães com raça definida (55,6%). A degeneração gordurosa foi a lesão degenerativa mais prevalente (54,7%) e era caracterizada por células da zona fasciculada e da zona reticular com grandes vacúolos citoplasmáticos. Entre as alterações neoplásicas, tumores primários foram mais prevalentes (75,7%), com predomínio de adenomas (57,1%), seguido de feocromocitomas (25%) e carcinomas corticais (17,9%). Os tumores metastáticos perfizeram 24,3% dos casos de alterações neoplásicas. As adrenais foram sítio de metástase de carcinoma mamário, osteossarcoma, melanoma, linfoma, colangiocarcinoma, sarcoma histiocítico e adenocarcinoma pulmonar. No item "outras lesões", adrenal de estresse foi a alteração mais prevalente (37,1%). Essa alteração era caracterizada histologicamente por córtex de aspecto variegado, com áreas de fina vacuolização citoplasmática das células da camada fasciculada, intercaladas por grupos de células hipereosinofílicas. Este estudo possibilitou concluir que lesões nas adrenais de cães são extremamente frequentes, de modo que a avaliação cuidadosa desse órgão se faz necessária na rotina de diagnóstico em patologia.(AU)

The adrenal glands of 300 dogs, underwent to necropsy in the Laboratório de Patologia Veterinária at the Universidade Federal de Santa Maria (LPV/UFSM), were studied from March 2012 to June 2013. The collected tissues were fixed in 10% buffered formalin and sent to the routine histological processing in order to preparation and analysis of histological slides. Subsequently, it was reviewed the necropsy reports and the epidemiological data of the dogs which had the adrenal glands collected. Out of the 300 dogs examined, 82% had one or more adrenal lesions that were classified according to the pathogenesis and prevalence. The hyperplastic lesions were the most prevalent, comprising 91.5% of the cases, followed by degenerative (26%), circulatory (20.3%), neoplastic (15%), inflammatory (4.1%) and other lesions (14.2%). Grossly, hyperplasia was characterized by a variable amount of whitish nodules, ranging from 0.2-1.5 cm of diameter. In 72.9% of the hyperplasia cases, the nodules were composed by cells of the glomerulosa zone. Most of the animals that showed hyperplastic lesions consisted of females (60.4%), elderly (46.9%) and purebred dogs (55.6%). Fatty degeneration was the most prevalent degenerative lesions (54.7%), characterized by cells of the fasciculata and reticularis zones with large cytoplasmic vacuoles. Among the neoplastic changes, primary tumors were the most prevalent (75.7%), with predominance of adenomas (57.1%), followed by pheochromocytomas (25%) and cortical carcinomas (17.9%). Metastatic tumors corresponded to 24.3% of all cases of neoplastic changes. The adrenal glands were the site of metastasis of mammary gland carcinoma, osteosarcoma, melanoma, lymphoma, cholangiocarcinoma, histiocytic sarcoma and lung adenocarcinoma. Under "other lesions", adrenal of stress was the most prevalent change (37.1%). It was characterized histologically by a cortex with irregular appearance, with areas of mild cell vacuolation in the fasciculata zone, interspersed with hypereosinophilic cell groups. This study allowed the conclusion that the lesions in adrenal glands of dogs are extremely common, highlighting the importance of a careful evaluation of this organ in the routine of pathological diagnostic.(AU)

Neoplasmas da tireoide em cães: 26 casos / Thyroid neoplasms in dogs: 26 cases

Foram revisados os protocolos de biópsias e necropsias do Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV/UFSM) entre 2004 e 2014, e todos os casos de tumores que acometeram a glândula tireoide foram selecionados. A partir disso, foram anotados sexo, idade e raça dos cães afetados. Também foi avaliado o significado clínico dos tumores, presença de aumento de volume cervical, lobos afetados, tamanho dos tumores, presença e localização de metástases e padrão histológico dos neoplasmas. Nos 11 anos que compreenderam este estudo, foram diagnosticados 26 tumores de glândula tireoide (quatro eram provenientes de exames de biópsias e 22 de necropsias), 53,9% dos cães eram fêmeas e 46,1% eram machos; 65,4% eram cães com raça definida. Desses, Boxers foram os mais afetados (15,4% dos casos). Dos 23 protocolos em que a idade foi informada, 60,9% dos cães eram idosos e 39,1% eram adultos. A avaliação dos protocolos permitiu constatar que 38,5% dos animais haviam apresentado aumento de volume cervical no momento do exame clínico. Dos cães necropsiados 13,6% morreram ou foram submetidos à eutanásia em decorrência de complicações causadas por metástases dos tumores de tireoide. Dessa forma, em 86,4% dos cães, os neoplasmas foram considerados achados incidentais de necropsia. Nos quatro casos provenientes de material de biópsia, o desfecho não foi conhecido. Em nenhum cão os tumores causaram síndrome clínica devido à hipo ou hiperfunção da tireoide. Em 24 protocolos havia informação sobre os lobos afetados e 75% dos cães tiveram acometimento unilateral da glândula. Os diagnósticos histológicos dos tumores permitiram constatar que 16 (61,5%) neoplasmas eram carcinomas de células foliculares (nesses casos, o padrão folicular-compacto foi o mais frequente [43,75%]), seis (23,1%) eram adenomas de células foliculares, dois (7,7%) eram carcinossarcomas e dois (7,7%) eram tumores de células C (adenoma e carcinoma).(AU)

Biopsy and necropsy reports of the Laboratório de Patologia Veterinária at the Universidade Federal de Santa Maria (LPV/UFSM) were reviewed, including data from 2004 to 2014; all cases of the thyroid tumors were selected. From this point on, it was recorded the gender, age and breed of affected dogs. Additionally, it was evaluated the clinical significance of these tumors, presence of cervical swelling, affected lobes, tumors size, presence and location of metastasis and histological pattern of neoplasms. Twenty six thyroid tumors were diagnosed in the study period (four came from biopsies while the other 22 were from necropsies). Of the affected dogs, 53.8% were females and 46.2% were males; most of the animals (65.4%) were purebred. Of these, Boxers were the most affected (15.4%). In 23 protocols the age was informed; 60.9% of the dogs were elderly and 39.1% were adults. The protocols evaluation allowed establishing that 38.5% of the animals had cervical swelling, at the time of clinical examination. Out of the dogs necropsied, only 13.6% died or were euthanized due to complications caused by metastases of thyroid tumors. Thus, in 86.4% of the dogs, the neoplasms were considered as incidental necropsy findings. In the four cases from biopsy samples, the outcomes were not known. There were no tumors causing clinical syndrome in these dogs, due to thyroid hypo- or hyperfunction. In 24 protocols it was found information about the affected lobes, indicating that 75% of the dogs had unilateral glandular involvement. The histological diagnosis showed that 16 (61.5%) neoplasms were follicular cell carcinomas (in these cases, the follicular-compact pattern was the most frequent [43.8%]); 6 (23.1%) were follicular cells adenoma; two (7.7%) were carcinosarcomas and two (7.7%) were C cells tumors (adenoma and carcinoma).(AU)

¿Nos enferman las preocupaciones? Una respuesta desde la Psiconeuroinmunoendocrinología / Do we get worried sick? An answer from the Psiconeuroinmunoendocrinology

La Psiconeuroinmunoendocrinología estudia la interacción entre los procesos psíquicos y los sistemas nervioso, endocrino e inmune y, de forma integradora, las interrelaciones del proceso salud-enfermedad. Diversas investigaciones muestran la estrecha relación entre el surgimiento y desarrollo de enfermedades somáticas con determinadas alteraciones psicológicas, entre ellas el estrés, la ansiedad y depresión. El objetivo de este trabajo es sistematizar los elementos teóricos que sustentan la interrelación entre la psiquis, el sistema nervioso, endocrino e inmune en el proceso salud - enfermedad y exponer las evidencias clínicas que sustentan su validez.

The Psychoneuroimmunoendocrinology studies the interaction between psychic processes and the Nervous, Endocrine and Immune systems and, in an integrative way, the health-disease process interrelationships. Several researches show the close relation between the somatic diseases emergence and development with certain psychological alterations, among them stress, anxiety and depression. This work is aimed at systematizing the theoretical elements which demonstrate the interrelation between the psyche, the Nervous System, Endocrine and Immune System in the health - illness process and to present the clinical evidences which support its validity.