Ginecomastia e hipertiroidismo: estudio hormonal a propósito de un caso / Gynecomastia and hyperthyroidism : hormonal study of one case

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Coma prolongado con daño neurológico por un insulinoma oculto / Prolonged coma with severe neurological damage due to an unsuspected benign insulinoma

Una mujer de 30 años ingresó en el hospital en coma profundo sin causa aparente ni duración conocida. Los estudios posteriores revelaron un hiperinsulinismo endógeno con hipoglucemia como origen del cuadro. La cateterización selectiva arterial de las ramas del tronco celíaco con inyección de calcio y recogida de muestras en vena hepática permitió localizar un insulinoma en la cabeza pancreática, no evidente en ninguna de las otras exploraciones practicadas. La cirugía subsiguiente fue curativa, pero quedaron secuelas neurológicas con lesiones groseras evidentes en la RMN. Aunque infrecuente, la posibilidad de una hipoglucemia debida a un insulinoma debe tenerse presente en el diagnóstico diferencial de un paciente en coma sin etiología evidente. El debut de un insulinoma con un único episodio de coma puede tener un efecto devastador a nivel cerebral, con importantes secuelas neurológicas (AU)

[Primary adrenal failure and AIDS: report of 11 cases and review of the literature]. / Insuficiencia suprarrenal primaria y SIDA: descripción de once casos y revisión de la literatura.

OBJECTIVE: To know the prevalence of adrenal insufficiency (AI) in our patients with acquired immunodeficiency syndrome (AIDS) and to compare the clinical manifestations with those reported in previous series in the literature. PATIENTS AND METHODS: Retrospective study with review of clinical records of patients with AIDS diagnosed of AI (plasma cortisol after synthetic ACTH < 18 micrograms/dl) in our hospital for a period of 6 and a half years. RESULTS: Eleven out of 65 patients (17%) with the hormonal study performed were diagnosed of AI. The prevalence of AI in our patients with AIDS was 1.66%. The response of plasma cortisol to synthetic ACTH was abnormal in the 11 patients (mean increase: 1.89 micrograms/dl). Nine out of the 11 patients had a decreased basal plasma cortisol level (mean: 4.75 micrograms/dl). Basal plasma ACTH levels were increased (mean: 638.9 pg/ml) in seven out of nine patients. Patients were severely immunosuppressed (mean CD4: 21/microliter). While the clinical course was subacute (mean: 5.1 weeks), nine out of the eleven patients developed an adrenal crisis which required emergency therapy. Ten patients had an opportunist infection--M. tuberculosis (3), M. avium-intracellulare (3), Cytomegalovirus (3), histoplasmosis (1)--which could involve the adrenal glands in ten patients. All patients responded to treatment but their mean survival was 5.6 weeks. CONCLUSIONS: Although the prevalence of AI in our patients with AIDS was low (1.66%), it is important to be aware of the disease and to order a basal plasma cortisol value after synthetic ACTH, as treatment improves the life quality of patients if AI is confirmed, despite a short survival time.