The promising role of risk scoring system for Cushing syndrome: Time to reconsider current screening recommendations.

Despite the current screening approach for Cushing syndrome (CS), delayed diagnosis is common due to broad spectrum of presentation, poor discriminant symptoms featured in diabetes and obesity, and low clinical index of suspicion. Even if initial tests are recommended to screen CS, divergent results are not infrequent. As global prevalence of type 2 diabetes and obesity increases, CS may not be frequent enough to back routine screening to avoid false-positive results. This represents a greater challenge in countries with limited health resources. The development of indexes incorporates clinical features and biochemical data that are largely used to provide a tool to predict the presence of disease. In clinical endocrinology, indexes have been used in Graves' ophthalmology, hirsutism, and hypothyroidism. The use of clinical risk scoring system may assist clinicians in discriminating CS in the context of at-risk populations and, thus, may provide a potential intervention to decrease time to diagnosis. Development and validation of clinical model to estimate pre-test probability of CS in different geographic source population may help to establish regional prediction model for CS. Here, we review on the latest progress in clinical risk scoring system for CS and attempt to raise awareness for the use, validation, and/or development of clinical risk scores in CS.

Metástasis cerebrales en pacientes con cáncer de tiroides / Brain metastases in patients with thyroid cancer

Resumen: ANTECEDENTES: el cáncer es una de las primeras causas de morbilidad y mortalidad en el mundo; la neoplasia endocrinológica más frecuente es el cáncer de tiroides. A pesar que la mayoría de los pacientes con cáncer de tiroides tienen buen pronóstico, 10 a 15% de los pacientes muestra recurrencia de la enfermedad e incluso 5% padece metástasis a distancia. Las metástasis cerebrales del cáncer de tiroides son raras y habitualmente conllevan mal pronóstico. OBJETIVO: describir las características demográficas y radiológicas, así como el pronóstico clínico de pacientes con cáncer de tiroides que requirieron consulta neurológica. MATERIAL Y MÉTODO: estudio prospectivo observacional en el que se incluyeron pacientes atendidos en un centro de referencia de tercer nivel con cáncer de tiroides que requirieron consulta neurológica entre enero de 2010 y enero de 2016. Se estudiaron las concentraciones séricas de tiroglobulina, TSH y anticuerpos anti-tiroglobulina, como se ha sugerido previamente. RESULTADOS: encontramos siete pacientes con metástasis cerebrales por cáncer de tiroides y las comparamos con registros encontrados en la bibliografía. El género masculino, la edad avanzada y las concentraciones elevadas de tiroglobulina se asociaron con mayor frecuencia de metástasis a distancia de cáncer de tiroides. CONCLUSIONES: las metástasis cerebrales de cáncer de tiroides son complicaciones poco frecuentes con pronóstico adverso. La tiroglobulina es un marcador tumoral muy útil para el seguimiento de pacientes con cáncer de tiroides ya que está elevada en pacientes con actividad sistémica y muy elevada en sujetos con metástasis cerebrales.

Abstract: BACKGROUND: Cancer is one of the first causes of both mortality and morbidity in the world. Thyroid cancer is the most common endocrine neoplasm. Although most TC patients have a good prognosis, 10 to 15% present recurrent disease and up to 5% show distant metastases. Brain metastases are unusual and are associated with a worse prognosis. OBJECTIVE: To describe the demographic and radiological characteristics, as well as clinical prognosis of patients with thyroid cancer who required neurological consultation. MATERIAL AND METHOD: A prospective observational study in which patients with thyroid cancer who required neurological consultation, attended in a tertiary referral cancer center, was done from January 2010 to January 2016. Serum levels of thyroglobulin, TSH and anti-thyroglobulin antibodies were studied, as suggested previously. RESULTS: We followed around 400 patients with TC and we found seven patients with brain metastases by thyroid cancer and compared them with records found in literature. Male gender, older age and high levels of thyroglobulin were associated with higher incidence of distant metastases of thyroid cancer. CONCLUSIONS: Brain metastases of thyroid cancer are little frequent complications with adverse prognosis. Thyroglobulin is a very useful tumoral marker for the following of patients with thyroid cancer, because it is high in patients with systemic activity and very high in patients with brain metastases.

Infundibulo-hypophysitis-like radiological image in a patient with pituitary infiltration of a diffuse large B-cell non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL) is a hematological tumor caused by abnormal lymphoid proliferation. NHL can arise in any part of the body, including central nervous system (CNS). However, pituitary involvement is a quite rare presentation. The diffuse large B-cell lymphoma (DLBCL) is the most common subtype when pituitary is infiltrated. Here, we report a case of pituitary infiltration of NHL DLBCL type in a woman with hypopituitarism and an infundibulum-hypophysitis-like image on magnetic resonance imaging (MRI). A female aged 64 years, complained of dyspepsia, fatigue, weight loss and urine volume increment with thirst. Endoscopy and gastric biopsy confirmed diffuse large B-cell lymphoma. Treatment with chemotherapy using R-CHOP was initiated. During her hospitalization, hypotension and polyuria were confirmed. Hormonal evaluation was compatible with central diabetes insipidus and hypopituitarism. Simple T1 sequence of MRI showed thickening of the infundibular stalk with homogeneous enhancement. After lumbar puncture analysis, CNS infiltration was confirmed showing positive atypical lymphocytes. Pituitary and infundibular stalk size normalized after R-CHOP chemotherapy treatment. In conclusion, pituitary infiltration of NHL with infundibular-hypophysitis-like image on MRI is a rare finding. Clinical picture included hypopituitarism and central diabetes insipidus. Diagnosis should be suspected after biochemical analysis and MRI results. Treatment consists of chemotherapy against NHL and hormonal replacement for pituitary dysfunction. LEARNING POINTS: Pituitary infiltration by lymphoma can present with signs and symptoms of panhypopituitarism and diabetes insipidus.MRI findings can resemble an autoimmune hypophysitis.Patients can recover pituitary function as well as normalization of MRI after chemotherapy treatment.

Association of the metabolic syndrome and long-term renal function in kidney donors.

BACKGROUND: Metabolic syndrome (MetS) may represent risk factor for long-term renal function of kidneys from living donors. The aim of this study was to evaluate the impact of MetS on renal function in donors. METHODS: Data regarding the presence or absence of MetS and renal function, as assessed by estimated glomerular filtration rate (eGFR) were obtained from 140 kidney donors before nephrectomy (BN) and at follow-up (AF). Donors were divided into those with (group 1; n =28) versus without MetS (group 2; n = 112). RESULTS: Comparing the groups, we observed a significantly greater reduction in eGFR among the group with MetS BN versus AF 27.5% (19.3-33.0) versus 21.4% (9.6-34.1 P = .02) respectively using a Cox regression model, including age, gender, serum uric acid, body mass index (BMI), and basal eGFR, MetS BN (hazard ratio = 2.2; 95% confidence interval [CI], 1.21-4.01; p = .01) was an independent factor associated with a greater risk of a-eGFR <70 mL/min/1.73 m(2) at follow-up (P < .001). Additionally, age (hazard ratio = 1.03%; 95% CI, 1.01-1.06; P < .001), and female gender (hazard ratio = 1.86; 95% CI, 1.03-3.36; P = .03) were associated with a greater decrease in eGFR. Individuals with MetS BN showed a GFR <70 mL/min/1.73 m(2) at significantly shorter follow-up time (5.6 ± 0.8 years) versus persons without MetS (12.8 ± 1.0 years; P = .001) CONCLUSION: Kidney donors with MetS BN experiment a significantly greater decrease in eGFR at follow-up.

Significant increment in the prevalence of overweight and obesity documented between 1994 and 2008 in Mexican college students.

We describe the changes in the prevalence of overweight and obesity in 4606 students that applied to a Mexican University during 1994 to 2008. The mean (± standard deviation [SD]) age was 17.7 ± 1.2 years-old. Progressive and significant increments of bodyweight (female [F] = 2.6, P = 0.03), body mass index (BMI) (F = 4.4, P = 0.001), and waist circumference (F = 30.08, P < 0.0001) in women, and bodyweight (male [M] = 8.9, P < 0.001), BMI (M = 10.4, P < 0.001), and waist circumference (M = 13.01, P < 0.001) in men were observed. A significant increment (P < 0.05) in the prevalence of overweight since 1994 (n = 87, 12.1%) throughout 1997 (n = 102, 14.1%), 1998 (n = 133, 18.4%), 1999 (n = 1993, 26.8%), and 2008 (n = 206, 19.9%) was documented. Similarly, the prevalence of obesity had a significant increment in all students evaluated (P < 0.0001) since 1994 (n = 29, 13.2%) through 1997 (n = 11, 5.0%), 1998 (n = 45, 20.5%), 1999 (n = 53, 24.1%), and 2008 (n = 82, 37.3%). The increment was significant in both women (P = 0.02) and men (P < 0.001). In summary, we report a significant increment in the prevalence of overweight and obesity in Mexican students living in an urban setting over a time period of 14 years.