[Treatment of clinically nonfunctioning pituitary adenomas]. / Tratamiento de los adenomas hipofisarios clínicamente no funcionantes.

Clinically nonfunctioning adenomas are the most frequent pituitary macroadenomas in adults. These tumors are characterized by the absence of detectable hormonal hypersecretion and are diagnosed when compression symptoms or hormonal deficiencies occur. The treatment of choice of macroadenomas is surgery, but tumoral resection is often incomplete or the patient develops tumoral recurrence. Medical therapy has been shown to produce modest tumoral reduction in some patients. Postoperative irradiation should be considered in patients with large tumoral remnants or enlargement of remnants during follow-up. Stereotactic radiotherapy has been developed to diminish the long-term complications of radiotherapy. Microadenomas tend to remain small and surveillance alone is recommended. The present article reviews the results of medical, surgical and radiation treatments.

Tratamiento de los adenomas hipofisarios clínicamente no funcionantes / Treatment of clinically nonfunctioning pituitary adenomas

Los adenomas hipofisarios clínicamente no funcionantes son los macroadenomas más frecuentes en adultos. Se caracterizan por no acompañarse de hipersecreción hormonal detectable en plasma y diagnosticarse cuando aparece sintomatología compresiva o déficits hormonales. El tratamiento de elección es la resección quirúrgica, pero es frecuente que no sea curativa o haya recidivas y se requieran tratamientos adicionales. Los fármacos tienen escasa eficacia y solo han conseguido pequeñas reducciones tumorales en algunos pacientes. Debe considerarse tratamiento con RT postquirúrgica en pacientes con grandes restos o crecimiento de los restos durante el seguimiento. Las técnicas estereotáxicas se han desarrollado para disminuir las complicaciones de la irradiación. En los microadenomas el crecimiento no es frecuente, por lo que solo se recomienda observación (AU)

Clinically nonfunctioning adenomas are the most frequent pituitary macroadenomas in adults. These tumors are characterized by the absence of detectable hormonal hypersecretion and are diagnosed when compression symptoms or hormonal deficiencies occur. The treatment of choice of macroadenomas is surgery, but tumoral resection is often incomplete or the patient develops tumoral recurrence. Medical therapy has been shown to produce modest tumoral reduction in some patients. Postoperative irradiation should be considered in patients with large tumoral remnants or enlargement of remnants during follow-up. Stereotactic radiotherapy has been developed to diminish the long-term complications of radiotherapy. Microadenomas tend to remain small and surveillance alone is recommended. The present article reviews the results of medical, surgical and radiation treatments (AU)

Cabergolina en la hiperprolactinemia y enfermedad vascular cardíaca / Cabergoline in hyperprolactinemia and valvular heart disease

Introducción: La cabergolina a dosis elevadas se ha relacionado con insuficiencia valvular y retracción y engrosamiento valvular en pacientes con enfermedad de Parkinson. Objetivos: Realizar un análisis sistemático de las publicaciones sobre pacientes con hiperprolactinemia tratados con cabergolina y su efecto en las válvulas cardíacas. Resultados: Ninguna de las 7 series revisadas, con 463 pacientes en total, detectó insuficiencia valvular clínicamente significativa. Se encontró insuficiencia tricuspídea (IT) moderada sólo en un estudio, e IT ligera en otras 2 publicaciones. El aumento del área de tenting mitral sólo se ha demostrado en uno de los dos estudios realizados. Hubo calcificaciones y engrosamiento valvular solamente en una de las series. Conclusiones: La cabergolina parece ser segura a las dosis empleadas en la hiperprolactinemia. Hay aumento de prevalencia de IT como hallazgo ecográfico, pero es asintomática. Aunque se precisan estudios longitudinales prospectivos, se recomienda la vigilancia de los pacientes tratados, especialmente con dosis elevadas (AU)

Introduction: High-dose cabergoline therapy has been related to cardiac valve regurgitation in patients with Parkinson’s disease. Aims: To perform a systematic analysis of reports on low-dose cabergoline treatment in hyperprolactinemia and its effect on the cardiac valves. Results: None of the seven reports analyzed, including 463 patients in total, found clinically significant valve regurgitation. Only one report found moderate tricuspid valve regurgitation, and other two reports found mild tricuspid valve regurgitation. An increase in the mitral tenting area was documented in only one of two reports. Valve thickening and calcifications were found in only one study. Conclusions: Cabergoline seems to be safe at the doses employed in hyperprolactinemic patients. There is a higher prevalence of tricuspid regurgitation, detected by systematic echocardiography, but this abnormality is asymptomatic. Although prospective longitudinal studies are needed, vigilance of these patients is recommended, especially those treated with high-dose cabergoline (AU)

[Primary hyperparathyroidism. An alternative to the surgery]. / Hiperparatiroidismo primario. Una alternativa a la cirugía.

Primary hyperparathyroidism is caused by an adenoma/hyperplasia in the parathyroid glands in which hypercalcemia is mainly due to an increased secretion of parathormone (PTH). The only definitive treatment is surgery. There are some patients at high surgical risk or who refuse surgery, and whose hypercalcemia cannot be controlled with conventional medical therapy such as hydration, diuretics and/or oral biphosphonates. We suggest the use of two drugs indicated for the treatment of hypercalcemia of other etiologies: zoledronic acid, a parenteral bisphosphonate, and cinacalcet, a calcimimetic agent that reduces PTH secretion. We present the case of a woman with hypercalcemia due to primary hyperparathyroidism caused by an adenoma, who was treated with both drugs.

Hiperparatiroidismo primario. Una alternativa a la cirugía / Primary hyperparathyroidism. An alternative to the surgery

El hiperparatiroidismo primario es una enfermedad causada por un adenoma/hiperplasia en las glándulas paratiroides, en la que la hipercalcemia debida a una excesiva secreción de parathormona (PTH) es el rasgo principal, y cuyo único tratamiento definitivo es la cirugía. Hay pacientes en los que la cirugía supone un gran riesgo, o que la rechazan, y en los cuales la hipercalcemia no puede ser controlada mediante el tratamiento médico convencional con hidratación, diuréticos y/o bisfosfonatos. Proponemos el uso de dos fármacos indicados en el tratamiento de la hipercalcemia de otras etiologías: el ácido zoledrónico, bisfosfonato de uso parenteral, y el cinacalcet, calcimimético que disminuye la secreción de PTH. Presentamos el caso de una mujer con hipercalcemia por un hiperparatiroidismo primario causado por un adenoma, tratado con ambos fármacos (AU)

Primary hyperparathyroidism is caused by an adenoma/hyperplasia in the parathyroid glands in which hypercalcemia is mainly due to an increased secretion of parathormone (PTH). The only definitive treatment is surgery. There are some patients at high surgical risk or who refuse surgery, and whose hypercalcemia cannot be controlled with conventional medical therapy such as hydration, diuretics and/or oral biphosphonates. We suggest the use of two drugs indicated for the treatment of hypercalcemia of other etiologies: zoledronic acid, a parenteral bisphosphonate, and cinacalcet, a calcimimetic agent that reduces PTH secretion. We present the case of a woman with hypercalcemia due to primary hyperparathyroidism caused by an adenoma, who was treated with both drugs (AU)

Tratamiento de reasignación de sexo en pacientes transexuales / Treatment of sexual reassignment in transexual patients

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