Coexistence of GH-Producing Pituitary Macroadenoma and Meningioma in a Patient with Multiple Endocrine Neoplasia Type 1 with Hyperglycemia and Ketosis as First Clinical Sign.

We present the clinical case of a patient who was admitted with an onset of diabetes mellitus (DM) with associated ketosis and whose clinical, hormonal, and radiological evolution revealed the presence of primary hyperparathyroidism, pancreatic neuroendocrine tumor, and GH-producing pituitary macroadenoma in the context of multiple endocrine neoplasia type 1 (MEN1). DM is relatively common in cases of acromegaly, but it is not generally associated with ketosis. Simultaneously, the patient presented a meningioma, which is associated with pituitary macroadenoma only in extremely rare cases.

A favor: Microcarcinoma papilar de tiroides. ¿Es necesario el tratamiento con 131I tras la cirugía? Argumentos a favor / In favor: Papillary thyroid microcarcinoma. Is 131I ablation therapy necessary after surgery? Arguments in favor

El microcarcinoma papilar tiroideo (MPT) es una lesión maligna de diámetro máximo ¾ 10 mm. En nuestra experiencia representa un 18,5% del total de los carcinomas papilares tiroideos y su incidencia ha aumentado en los últimos lustros. Cada uno de los focos de malignidad tiene un origen clonal independiente en un elevado porcentaje de los pacientes. Aunque tiene un pronóstico excelente, con tasas de mortalidad inferiores a un 3% 30 años después del tratamiento quirúrgico, puede dar lugar a morbilidad significativa por metástasis a distancia y/o recidivas regionales. Su descubrimiento puede ser incidental (encontrado de manera inesperada por la intervención de una lesión benigna tiroidea) o no incidental (detectado antes de la intervención, con motivo de una adenopatía palpable, metástasis a distancia o biopsia aspirativa, realizada o no con control ecográfíco). Su tratamiento está en controversia, dada la ausencia de estudios prospectivos de diseño adecuado en los que se haya analizado el tratamiento y el seguimiento posterapéutico más adecuados. Las diferentes líneas directrices no concuerdan en diversos aspectos de los procedimientos terapéuticos. Nosotros, desde hace 35 años, proponemos a la mayoría de nuestros pacientes tiroidectomía total o casi total, seguida de tratamiento ablativo del remanente tiroideo con 131I, basándonos en la eficacia del procedimiento en términos de resultados y para facilitar el seguimiento de una condición en la que no hay marcadores prospectivos inequívocos de recidiva

Papillary thyroid microcarcinoma (PTM) is a malignant lesion with a diameter of 10 mm or less. In our experience, it accounts for 18.5% of all cases of papillary carcinoma and its incidence has been increasing in recent years. In a high percentage of patients, each of the foci in multicentric PTM has an independent clonal origin. Although it has an excellent prognosis, with mortality rates 30 years after surgical treatment below 3%, PTM may give rise to significant morbidity in terms of loco-regional recurrence and/or distant metastases. Clinically, it may present as an incidental lesion, discovered unexpectedly after surgery for benign thyroid disease, or non-incidentally, detected before surgery due to lymph node metastases, distant metastases and/or fine-needle aspiration biopsy of the thyroid, whether guided by ultrasonography or not. Given the absence of prospective, well designed clinical trials, treatment of this entity is controversial. The various guidelines do not agree on therapeutic procedures or follow-up methods. For the past 35 years, we have been performing a relatively uniform therapeutic protocol of total or near total thyroidectomy followed by 131I ablation therapy in most of our patients. So far mortality and morbidity have been acceptable. This approach also facilitates the follow-up of an entity for which no specific markers of future recurrence are available

Hipertiroidismo en la enfermedad de graves-basedow. ¿podemos predecir la remisión? / Hyperthiroidism in Graves-Basedow' s disease. Can we predict remission?

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Enzyme and hormonal markers in the differential diagnosis of human azoospermia.

The serum concentrations of FSH, LH, prolactin, testosterone, and estradiol and the enzymatic activities of hyaluronidase, glucosidases (alpha-glucosidase, beta-glucosidase, alpha-mannosidase, N-acetyl-beta-D-glucosaminidase, beta-glucuronidase, and beta-galactosidase), lactate dehydrogenase and its isoenzymes (LDH1, LDH2, LDH3, LDH-X, LDH4), and total proteins were measured in the semen of 69 subjects (8 normozoospermic controls, 7 secretory, and 54 excretory azoospermic subjects). FSH levels rose with the deterioration in spermatogenesis and served to differentiate the secretory from the excretory azoospermias. The only source of hyaluronidase and LDH-X in the ejaculate is the spermatozoa. alpha-Glucosidase activity essentially originates in the epididymis. The seminal determination of alpha-glucosidase and, to a lesser extent, alpha-mannosidase and N-acetyl-beta-D-glucosaminidase helps rapidly, sensitivity, reliably, and noninvasively to differentiate secretory azoospermias (with higher enzymatic activity) from the excretory type (less enzymatic activity) and may be of use in identifying with a certain degree of reliability the site of obstruction in the male genital tract.

[Sertoli-Leydig-cell ovarian tumor with a retiform pattern and heterologous elements: a rare cause of virilization]. / Tumor ovárico de células de Sertoli-Leydig con patrón retiforme y elementos heterólogos: una rara causa de virilización.

The case is presented of a young female with virilization signs and total circulating testosterone levels above 4 ng/ml, without a concomitant increase in cortisol, 17 OH-progesterone, DHEA-S, or androstenedion levels. On CT scan exam a tumoral mass in the left ovary was observed with polycystic characteristics similar to those observed in ovarian cystadenoma, inspite of the fact that most androgenic ovarian tumors are solid. The pathological study revealed an ovarian Sertoli-Leydig tumor associated to a reticular pattern with heterologous chondroid and mucinoid elements of cystadenoma.

Semen characteristics and diabetes mellitus: significance of insulin in male infertility.

A study was made of semen quality and serum hormonal profiles (FSH, LH, prolactin, testosterone) of patients with type I diabetes mellitus. Semen parameters and levels of prolactin and testosterone were significantly altered in the diabetic state. The concentration of insulin in serum and seminal plasma and the serum levels of FSH, LH, and testosterone were measured in 80 men classified in the following groups: fertile subjects, infertile normoglycemic subjects, subjects with carbohydrate intolerance, and excretory and secretory azoospermic subjects. In all groups, seminal insulin concentrations were higher than those obtained in serum. The hormone appears to freely cross the blood-testis barrier, there to be concentrated in the semen. The levels of insulin in serum and seminal plasma did not correlate with semen parameters and are not suitable markers of seminal quality. For unknown reasons, the concentrations of insulin in seminal plasma were lower in the subjects suffering from carbohydrate intolerance.

Primary hypothyroidism and human spermatogenesis.

Spermatogenic function was studied in 10 patients, previously diagnosed as having primary hypothyroidism, in whom a state of hypothyroidism has been induced by discontinuation or a decrease in treatment with levothyroxine over at least one spermatogenic cycle. Most of the patients had fathered children before the study. When the results obtained in the hypothyroid state were compared with those from a group of 16 controls with proven fertility, slight anomalies were observed; these were characterized by a decrease in seminal volume (p less than 0.05), progressive forward motility (p less than 0.01), and the cumulative percentage of mobile forms (p less than 0.01). There were no anomalies in sperm density or in the percentage of spermatozoa with normal morphology. No alterations in circulating levels of testosterone and gonadotropins existed. Induction of hypothyroidism did not lead to seminal or hormonal modifications compared with the same patients in a situation of euthyroidism. Short-term postpuberal hypothyroidism did not cause seminal alterations sufficiently intense to induce male infertility.

Androgen environment and beta-glucuronidase activity in the human kidney.

Basal beta-glucuronidase activity was measured in the cytosol of renal cortex in 10 women and nine men, and its levels were correlated to the concentrations of the main circulating androgens and to the cytoplasmic androgen receptor content. beta-Glucuronidase activity in women was similar to that found in men, despite blood testosterone levels being higher in the latter. The activity of the enzyme does not appear to be related to circulating levels of either testosterone or androstenedione. Only in men the androgen receptor content and dehydroepiandrosterone-sulphate levels were inversely correlated to beta-glucuronidase. In the human kidney cytosol there is no evidence of sexual dimorphism in basal beta-glucuronidase activity; whereas the total testosterone circulating levels do not seem to control the enzyme activity.

Beta-endorphin and male infertility.

Beta-endorphin (beta-ED) levels were evaluated in blood and seminal plasma of men with infertility due to varicocele, obstructive and nonobstructive azoospermia, and idiopathic oligoasthenospermia. The relation of this opiate to serum levels of gonadotropins, prolactin, testosterone, androstenedione, and dehydroepiandrosterone sulfate has also been investigated. beta-ED levels in seminal plasma were significantly higher than in blood plasma (p less than 0.001) in all persons studied. No statistically significant differences were found for beta-ED concentrations in semen or blood among any of the infertility situations studied. Nor were significant correlations observed between the concentration of this opiate and that of gonadotropins, prolactin, and androgens. The measurement of beta-ED in semen has little value in the differential diagnosis of male infertility. Nonetheless, its presence in high levels in semen must have some unknown function. Possibly, it comes from the various sites of the male reproductive tract, since no significant differences were found between obstructive and nonobstructive azoospermias.

Urinary kinetics of triiodothyronine and their modification with aging.

The urinary kinetics of triiodothyronine (T3) in healthy young and old people has been studied. The behavior of urinary excretion is similar in both age groups, expressed in our mathematical model in the cumulative kinetics as well as in the urinary rate. However, a significant decrease (P less than 0.025) of renal clearance of T3 in elderly individuals has been found. No significant differences (P greater than 0.05) were observed in any other kinetic parameters. The possible influence of the reduction of glomerular filtrate has been discussed as the most important pathogenic factor of the decreased renal clearance of this hormone. Possibly, modifications of the distribution volumes are also involved. Due to the limited number of persons studied, for ethical reasons, the results obtained are not definitive.