Attention deficit hyperactivity disorder increases the risk of having abnormal eating behaviours in obese adults.

OBJECTIVE: To determine the rate of abnormal eating behaviours in obese adult patients with attention deficit hyperactivity disorder (ADHD) in comparison with obese adult patients without ADHD. METHOD: This case-control study includes: obese adult patients defined by a body mass index (BMI) ≥30 kg/m², screening positive in the adult ADHD self-report scale-V1.1. (ASRS-V1.1), attending the Nutrition Section, as cases; and obese adult patients screening negative, as controls. Weight, height and BMI were determined in all the participants. The rate of abnormal eating behaviours was determined using an eating pattern questionnaire. RESULTS: Forty-five out of 51 (88.2%) cases vs 127 out of 179 (70.9%) controls had abnormal eating behaviours (p=0.01). Eating between-meal snacks was found in 39 (76.5%) cases vs 107 (59.8%) controls (p=0.03), going on binge eating episodes in 28 (54.9%) vs 42 (23.5%) (p=0.00), waking up at night to eat in 11 (21.6%) vs 16 (8.9%) (p=0.01), eating large amounts of food in 13 (25.5%) vs 38 (21.2%) (p=0.52), and eating in secret in 11 (21.6%) vs 16 (8.9%) (p=0.01), respectively. CONCLUSION: This is the first study that determines the rate of these abnormal eating behaviours in obese adult patients with ADHD in comparison with obese adult patients without ADHD. A high rate of abnormal eating behaviours was observed in obese patients with ADHD. Our results suggest that ADHD is a risk factor for the development of these abnormal eating behaviours, which may be contributing factors of obesity and the unsuccessful treatment of obese patients.

Triple terapia en diabetes tipo 2: revisión sistemática de la evidencia disponible / Triple therapy in type 2 diabetes: systematic review of the available evidence

Las guías terapéuticas actuales difieren en las recomendaciones para la triple terapia cuando no se consiguen los objetivos con el tratamiento combinado dedos agentes orales. También difieren en el tipo de asociación y en la denominación de triple terapia. En el presente trabajo se realiza una revisión de la evidencia científica existente para determinar si la triple terapia es eficaz y segura, así como la asociación más favorable en el paciente con diabetes tipo 2. Revisando los estudios disponibles, se observa que la triple terapia mejora el control glucémico. Sin embargo, los ensayos clínicos aleatorizados disponibles en general no exceden el año de seguimiento, y no ofrecen datos sobre variables finales como morbilidad y mortalidad. En consecuencia, hasta el momento el beneficio a largo plazo y la seguridad de una triple terapia no están demostrados. En conclusión, con los datos disponibles actualmente no hay razón para retrasar la introducción de la insulina en el tratamiento de los pacientes con diabetes tipo 2 tras el fracaso de una terapia combinada doble, excepto en los casos de resistencia de los pacientes al inicio de la insulinización(AU)

Current guidelines differ in their recommendations for triple therapy when targets are not achieved with a combined treatment of two oral agents. In addition, they diverge also in the type of association and the name given for the triple therapy. In the present manuscript we review the available scientific evidence to determine whether triple therapy is effective and safe, as well as themore favorable association in patients with type 2 diabetes. Reviewing available literature, we have noticed that triple therapy improves glycemic control. However, available randomized control trials do not extend more than one year of follow-up and they don’t have data over endpoint variables as morbidity and mortality. Therefore, the long-term safety of triple therapy has not been demonstrated until now. In conclusion, with the currently available data there is no reason to delay introduction of insulin in the treatment of patients with type 2diabetes after failure of dual combination therapy, except in cases of patients’ resistance to initiate insulin therapy(AU)

Manifestaciones adrenérgicas de los tumores del tejido cromafín extraadrenal / High percentage of adrenergic symtoms in extraadrenal chromaffin toumors

ResumenEstudio descriptivo retrospectivo de 14 pacientes con un diagnóstico histológico de paraganglioma (PGL) recogidos en el Hospital Universitario de Vigo, Pontevedra, durante los últimos 25 años. Hemos analizado las características clínicas y la evolución de esta serie de enfermos.ResultadosLa forma de presentación de los 14 pacientes fue por efecto masa en 10, clínica adrenérgica en 3 e incidental en uno. Algunos enfermos con PGL simpáticos (PGLS) (6/9) y PGL parasimpáticos (PGLPS) (2/5) presentaron clínica de hiperproducción adrenérgica antes del diagnóstico. La determinación de catecolaminas urinarias fue positiva en los 4 enfermos con PGLPS en quienes se determinó. El tamaño tumoral medio fue de 37,8±18,9mm, sin diferencias entre los PGLS y los PGLPS. Dos PGLS fueron malignos. La evolución resultó favorable en 11 pacientes, 2 pacientes con PGLS fallecieron y el tumor de un paciente con PGLPS intracraneal no se pudo extirpar en su totalidad.ConclusionesLos PGL se presentan con frecuencia clínica adrenérgica secundaria a la producción de catecolaminas. Las características de estos tumores aconsejan un estudio detallado en un ámbito especializado antes de la cirugía(AU)

AbstractDescriptive retrospective study of 14 patients with paragangliomas (PGL) attended in the University Hospital of Vigo (Pontevedra) during the last 25 years to evaluating their characteristics and neuroendocrine potential.Results71.4% were diagnosed due to mass tumoral effect, 21.4% due to adrenergic symptoms and 7.1% incidentally. Regarding to symptoms and signs 66.7% of PGL Simpatic (PGLS) and 40% of PGL Parasimpatic (PGLPS) presented adrenergic symptoms. Urine catecholamine analysis was carried out to 4 PGLS and high levels were found in all patients. The tumoral size reached a mean value of 37.8±18.9mm, there were not differences found between both types of tumors. Inmunohistoquimia showed positive Chromogranine A stain in all patients. Two PGLS were maligns. Eleven patients had positive outcome, 2 PGLS died, and 1 PGLPS remains not cured.ConclusionsHigh percentage of patients had clinical manifestations related to catecholamine hyperproduction. We believe that due to the risk related to surgical treatment, malignance, multiple location and family associations, it would be advisable to carry out a complete examination prior to surgery(AU)

[High percentage of adrenergic symptoms in extraadrenal chromaffin tumors]. / Manifestaciones adrenérgicas de los tumores del tejido cromafín extraadrenal.

UNLABELLED: Descriptive retrospective study of 14 patients with paragangliomas (PGL) attended in the University Hospital of Vigo (Pontevedra) during the last 25 years to evaluating their characteristics and neuroendocrine potential. RESULTS: 71.4% were diagnosed due to mass tumoral effect, 21.4% due to adrenergic symptoms and 7.1% incidentally. Regarding to symptoms and signs 66.7% of PGL Simpatic (PGLS) and 40% of PGL Parasimpatic (PGLPS) presented adrenergic symptoms. Urine catecholamine analysis was carried out to 4 PGLS and high levels were found in all patients. The tumoral size reached a mean value of 37.8+/-18.9 mm, there were not differences found between both types of tumors. Inmunohistoquimia showed positive Chromogranine A stain in all patients. Two PGLS were maligns. Eleven patients had positive outcome, 2 PGLS died, and 1 PGLPS remains not cured. CONCLUSIONS: High percentage of patients had clinical manifestations related to catecholamine hyperproduction. We believe that due to the risk related to surgical treatment, malignance, multiple location and family associations, it would be advisable to carry out a complete examination prior to surgery.

Enfermedad de Behçet asociada a déficit de corticotropina / Behçet disease with isolated acth deficiency

Presentamos un paciente con enfermedad de Behçet de larga evolución, con predominio de manifestaciones neurológicas, que ingresó por insuficiencia suprarrenal, en el que se demostró déficit aislado de corticotropina (DAACTH). El DAACTH es una característica típica de las hipofisitis y se ha descrito en asociación con múltiples enfermedades autoinmunitarias; sin embargo, la afección hipotálamo-hipofisaria en la enfermedad de Behçet es excepcional. Revisamos los casos publicados y los posibles mecanismos patogénicos de esta asociación hasta ahora no descrita (AU)

We report a case of a patient with longstanding Behçet disease, with neurological symptoms predominantly, who became hospitalized for adrenal insufficiency, caused by isolated deficiency of corticotropin (DAACTH). DAACTH is a typical characteristic of hypophysitis, reported in association with many autoimmune diseases. Nevertheless, hypothalamic-pituitary injury in Behçet disease is exceptional. We review the literature and possible mechanisms of this association until now not reported (AU)

[Rate of undernutrition and response to specific nutritional therapy in Crohn's disease]. / Tasa de desnutrición y respuesta al tratamiento nutricional específico en la enfermedad de Crohn.

OBJECTIVES: to determine the rate of malnutrition in patients with Crohn's disease in our area (Substudy A). We assess in long-term the response of malnourished patients to treatment of nutritional supplement with TGF-beta2 (Substudy B). SUBJECTS: ninety-eight (51% females) patients with Crohn's disease without selection, ages: 39.2 +/- 15.19 years, range: 18-81 years were included in Substudy A. In Substudy B thirty-nine malnourished patients (52% females) were included with an average age of 36.41 +/- 5.2 years and range: 19-45 (Substudy B). METHODS: the design of the Substudy A was an observational and cross sectional study. Whereas, the Substudy B was a longitudinal, open intervention study with active (historical) control. The variables were anthropometric parameters, electrical bioimpedance, biochemical measures, index of disease activity, subjective global assessment and the kind of treatment that every patient has received. MAIN RESULTS: the malnutrition rate was 52%, being the most frequent the caloric malnutrition, followed by mixed malnutrition. Thirty four per cent of the patients had iron deficiency. Twelve months of nutritional therapy with supplement specifically enriched in TGF-beta2 improved the evolution of the disease determined by a decrease in CDAI. CONCLUSIONS: The rate of malnutrition was similar to that of previous studies realized in Spain. Our study confirms the high rate of iron deficiency that the patients suffer with Crohn's disease. The response to the treatment is favorable, especially regarding the natural history of the disease.

[High frequency of non-specific eating disorders in obese persons]. / Alta frecuencia de trastornos de la conducta alimentaria inespecíficos en personas obesas.

OBJECTIVES: Determine frequency of Eating Disorders and Non-Specific Eating Disorders and pathological behaviour in obese patients. SUBJECTS AND METHODS: The study includes fifty-four obese patients (BMI > or = 30) consecutively attended at the Nutrition Section of the University Hospital of Vigo. Aged 37.5 +/- 11.1. Range 18-58, 45 female and 9 male. CONTROL GROUP: 15 adult normal-weight subjects (11 female, 4 male), aged 35,3 +/- 9,2 años. Frequency of Eating Disorders was determined by a lifestyle clinical interview and the following questionnaires: Eating Attitudes Test 26 (EAT26), Bulimic Investigatory Test Edimburgh (BITE) and Questionnaire Eating Weight Patterns Revised (QEWP-R). RESULTS: Twelve out of 54 (20.6%) patients showed Pathological Behavior, while 5 (4.1%) and 3 (2.5%) had Non- Specific Eating Disorders and Classic Eating Disorders respectively, whereas in the control group non subjects showed psychological anomalies. When we divided obese patients by the degree of obesity, differences in the frequencies of the Eating Disorders was no observed. CONCLUSIONS: In our obese patients, Pathological Behavior was the most frequent finding followed for Non-Specific Eating Disorders and Classic Eating Disorders.

Cost of management of invasive growth hormone-secreting macroadenoma.

BACKGROUND: At the time of diagnosis, macroadenomas represent 60-80% of GH secreting adenomas, of which 25-30% are invasive macroadenomas. These aggressive tumors have the worst surgical success rates in terms of cure, and often need several therapeutic approaches in order to control disease status. Acromegalic patients are subject to increased mortality and important health resource consumption related to their associated co-morbidities, in addition to the costs that are related to diagnosis itself and initial treatment of the disease. OBJECTIVE: Assessment of the cost of initial management and outcome of acromegalic patients with invasive pituitary adenomas. STUDY DESIGN: Retrospective and observational study of review of records. SETTING: Two tertiary hospitals. PATIENTS: 11 consecutive patients between 18 and 80 yr old diagnosed with acromegaly due to an invasive pituitary macroadenoma. INTERVENTION: Collection of data of biochemical and radiological tests, specialist visits, hospitalisation, surgery, pharmacological and radiotherapy treatment at diagnosis and over 4 yr of follow-up after initial treatment. Costs were evaluated using the data of the Centre for Health Economics and Social Policy Studies and the Official College of Pharmacists of Spain. MAIN OUTCOME MEASURE: Global and patient/yr follow-up costs of illness. RESULTS: The mean costs for acromegaly for the period of follow-up ranged from 7,072 to 9,874 euro/patient/yr, for biochemically non-controlled (no.=6) and controlled patients (no.=5) respectively. The most important cost in the perioperative period was for admission in the intensive care unit. After surgery, SS analogues were the principal contributors to the economic burden. CONCLUSION: In this paper we have for the first time presented a pharmacoeconomic study of GH secreting invasive macroadenoma. The poor prognosis of our cohort of patients and the higher rate of controlled patients and normal IGF-I levels warrant the employment of multiple therapeutic options. The cost associated with this treatment in this complex disease of low prevalence is not excessive and can be supported by healthcare services.

Long-term improvement of metabolic control without increased risk of hypoglycaemia by intensive insulin regimens in type 1 diabetes patients treated in a regular clinical setting.

AIM: To evaluate if intensive insulin regimen with multiple daily injections (MDI) is successful for treating type 1 diabetes patients over a long period of time in a regular clinical setting. METHOD: This is a prospective, observational seven-year study. Fifty-nine (35 male) type 1 diabetic patients with bad metabolic control (HbA1c> or =9%), aged 31.9 years, range 18-47 were included in the present study. All of them had had at least 5 years of diabetes duration after diagnosis and showed negative responses of serum C-peptide to a standard breakfast. The main control variables are: Metabolic control measured by serum HbA1c values (values < 6.2 % was the treatment objective) and the frequency of hypoglycaemic episodes (episodes/patient-month). RESULTS: Significant decreases in mean+/-SD HbA1c values in this group of patients were observed from the first year of follow-up, with the mean values being: 7.5+/-1.5%, 7.2+/-1.8%, 7.6+/-1.6%, 7.1+/-1.7%, 7+/-1.4, 6.6+/-1.6% and 6.8+/-1.4% for the first, second, third, fourth, fifth, sixth and seventh years of follow-up respectively. Sixteen %, 27.5%, 15.7%, 33.3%, 28.6%, 42% and 33% of the patients reached the treatment objective (HbA1c values<6.2%) for each year of follow-up. Throughout the study period the rate of severe hypoglycaemia (episodes/patient-year) was 0.32+/-0.2 which was not significantly different compared with the value of 0.28+/-0.1 observed the year before the study began. Similarly frequencies of mild/moderate hypoglycaemia episodes (episodes/patient-month) varies between 16.5+/-4 and 21.7+/-5, which are not significantly different from the value of 17.7+/-6 observed the year before the study began. CONCLUSION: Long-term improvement in metabolic control was observed in this group of type 1 diabetes patients with previous bad control, during treatment in a regular clinical setting. A considerable percentage of type 1 diabetic patients with MDI reached the treatment objective in every year of follow-up. Furthermore improvement in metabolic control is not associated with significantly increased frequency of hypoglycaemia episodes.

Epidemiología de las enfermedades de la glándula tiroides en Galicia / Epidemiology of thyroid gland disorders in Galicia

Los estudios epidemiológicos realizados por nuestro grupo en la comunidadgallega en el periodo 1984-2004 han demostrado:1. La población del sur de Galicia no padecía de bocio endémico y queel consumo de yodo de la población pediátrica en nuestra área erasuficiente antes de la campaña de promoción del consumo de sal yodada.2. El aumento del consumo de yodo en nuestra población indujo unaumento significativo en la incidencia de hipertiroidismo clínico en lapoblación adulta.3. Que la campaña de promoción del consumo de sal yodada ha sidobeneficiosa a largo plazo sobre la población infantil.4. Que pese a la existencia de la citada campaña, un porcentaje elevadode las mujeres gestantes y aquellas en edad fértil tienen un consumodeficiente de yodo dietético.5. Poseemos en nuestra comunidad datos sobre la prevalencia de lasdistintas formas y grados de disfunción tiroidea.6. Demostramos que la disfunción tiroidea asociada a la gestación o alperiodo posparto es fundamentalmente del tipo subclínico y que la prevalenciade tiroiditis posparto es mayor a partir de los 6 meses. Tambiénque las anomalías psíquicas que presentan algunas mujeres en elposparto no se asocian con disfunción tiroidea o tiroiditis posparto

Thyroid diseases are one of the most common endocrine disorders.Epidemiological data on different alterations normally come from a rangeof areas. Here we present many aspects of thyroid disorders, in thesame area over a twenty-year period (1984-2004).We show that residents of Galicia were not affected by endemic goiter.Iodine intake in the school population in this area was adequate beforethe promotion of consumption of iodized salt.An increase in iodine intake induces a significant increase in the incidenceof clinical hyperthyroidism in the adult population.A long-term benefit has been observed in the young population afterpromotion of iodized salt consumption.However, despite the campaign, an elevated percentage of pregnantwomen or women of fertile age have an insufficient iodine intake.We show that gestation or postpartum-related thyroid disorders are mainlysubclinical. In addition, prevalence of postpartum thyroiditis increasessix months after delivery. Postpartum depression was not related tothyroid dysfunction

Diagnóstico del déficit de hormona de crecimiento en el adulto / Diagnosis of growth hormone deficiency in adults

En la actualidad, el diagnóstico de la deficiencia de hormona de crecimiento en adultos depende de pruebas de estímulo realizadas en un contexto clínico concreto. La mayoría de los autores recomiendan el test de tolerancia a la insulina como prueba de primera línea; no obstante, y a la vista de los datos aportados en la presente revisión, la preferencia se va inclinando por pruebas que no tengan tantas limitaciones e incomodidades como la hormona liberadora de hormona de crecimiento (GHRH) + arginina y la llamada “prueba combinada GHRH + GHRP-6”. Esta última es la que reúne casi todas las condiciones para ser la prueba ideal, y nosotros la recomendamos como prueba de primera línea; cabe recordar que esta prueba se ha desarrollado fundamentalmente en centros españoles. Las otras pruebas diagnósticas disponibles tienen limitaciones. No obstante, un valor bajo de factor de crecimiento similar a la insulina tipo 1 (IGF-I) en un paciente con otros defectos hormonales de la función antehipofisaria sería altamente sugestivo de déficit de hormona de crecimiento. La búsqueda de nuevas pruebas diagnósticas, sencillas, reproducibles, seguras y baratas seguirá siendo materia de investigación hasta que se disponga de una prueba que reúna todas esas condiciones (AU)

Currently, the diagnosis of growth hormone (GH) deficiency depends on stimulation tests performed in a specific clinical context. Most authors recommend the insulin-tolerance test (ITT) as the first line investigation. However, in view of the data described in the present review, tests without the limitations and disadvantages of ITT are increasingly preferred. These tests include GHRH+arginine and the combined GHRH+GHRP-6 test. The latter, which has been developed mainly in Spanish centers, meets nearly all the conditions necessary to be the ideal test and we recommended it as the first line test. The other diagnostic tests available present numerous limitations. Nevertheless a low insulin-like growth factor (IGF1) value in patients with other anterior pituitary hormone deficiencies strongly suggests GH deficiency. Figure 1 shows an algorithm for the diagnosis of GHD in adults. The search for new, simple, reliable, safe and inexpensive diagnostic tests will continue to be the aim of research until a test that unites all these conditions is available (AU)

The role of diabetes duration, pubertal development and metabolic control in growth in children with type 1 diabetes mellitus.

OBJECTIVE: To investigate whether pubertal development, duration of type 1 diabetes mellitus (DM1), or metabolic control play some role in the anomalies in growth observed in diabetic children. PATIENTS: We conducted a prospective evaluation of 83 patients (37 female, 46 male) who were followed from the onset of DM1 at the prepubertal stage until they reached final height. All patients were treated with a conventional regimen of insulin. METHODS: Height SDS, weight SDS, BMI SDS, duration of DM1 in years, and values of HbA1c were the study variables. RESULTS: In prepubertal (P1) girls (data for the initial vs the intermediate evaluations): weight SDS was -0.14 +/- 0.19 vs 0.11 +/- 0.20, p = ns; BMI SDS -0.25 +/- 0.15 vs 0.01 +/- 0.13, p = ns. In postpubertal (P3) girls, weight SDS was 0.49 +/- 0.2 vs 1.2 +/- 0.32, p <0.01; BMI SDS 0.09 +/- 0.16 vs 1.03 +/- 0.24, p <0.01, whereas in P1 boys, height SDS was 0.16 +/- 0.30 vs -0.20 +/- 0.27, p <0.05; and in P3 boys: 0.09 +/- 0.21 vs -0.28 +/- 0.26, p <0.05. Thus pubertal development influenced changes observed in girls with DM1, but did not do so in boys. The anomalies described in children with DM1 were observed from the third year of DM1 duration in both girls and boys. We did not observe any correlation between HbA1c values with height SDS, weight SDS or BMI SDS. CONCLUSIONS: The anomalies in growth observed in girls with DM1 are related to pubertal development, but this is not the case in boys. Alterations in children with DM1 were found from the third year of DM1 duration. Furthermore, the present data also indicate that the degree of metabolic control observed in our patients treated with modern but conventional regimen did not play a major role in the anomalies observed.

Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution.

This study was carried out to investigate the clinical and biochemical factors which might be of importance in predicting the outcome of patients with myxoedema coma. Eleven patients (ten female) aged 68.1+/-19.5 years attended our institution over a period of 18 years. Glasgow and APACHE II scores and serum free thyroxine and TSH were measured in all the patients on entry. Patients were selected at random to be treated with two different regimens of l-thyroxine. Four patients died with the mortality rate being 36.4%. The patients in coma at entry had significantly higher mortality rates than those with minor degrees of consciousness (75% vs 14.3% respectively, P=0.04). The surviving patients had significantly higher Glasgow scores than those who died (11.85+/-2.3 vs 5.25+/-2.2 respectively, P<0.001). Comparison of the mean values of APACHE II scores between the surviving group and those who died was significantly different (18.0+/-2.08 vs 31.5+/-2.08 respectively, P<0.0001). The degree of consciousness, the Glasgow score and the severity of the illness measured by APACHE II score on entry were the main factors that determined the post-treatment outcome of patients with myxoedema coma.

Seguridad del tratamiento con hormona de crecimiento en adultos deficitarios / Safety of growth hormone replacement therapy in adults with growth hormone deficiency

Los innegables beneficios demostrados del tratamiento sustitutivo con rhGH en pacientes adultos deficitarios de GH, hace que no se puedan realizar estudios controlados a largo plazo en el análisis del perfil de seguridad de este tipo de tratamiento. Por lo que este aspecto tan importante de la terapéutica tiene que ser evaluado por el estudio de los registros de farmacovigilancia. En la presente revisión se revisan los resultados de seguridad de dos bases de datos que incluyen una muestra grande de pacientes con un período de seguimiento a medio plazo, KIMS e HypoCCs. Los efectos adversos que con más frecuencia se observan en estos pacientes son la presencia de edema y las artralgias, que afectan al 30 por ciento de ellos con predominio en pacientes del sexo femenino. Suelen ser una manifestación transitoria y mejora al reducir la dosis de rhGH. Respecto a alteraciones metabólicas, el 1,3 por ciento de los pacientes del KIMS y 3,16 por ciento del HypoCCs presentaron diabetes o intolerancia hidrocarbonada en el curso del tratamiento. El primer informe bianual del HypoCCs revela que como era de esperar los eventos vasculares son más frecuentes en el grupo de pacientes de mayores de 60 años. Sin embargo ni la frecuencia de alteraciones metabólicas ni los eventos vasculares fueron mas frecuentes que lo esperado en la población general. Respecto a la incidencia de tumores de novo, de los 4.457 pacientes que comprende el cuarto informe anual de KIMS, únicamente se observó una incidencia superior a la esperada en la población general de tumores intracraneales, pero no de tumores del tracto gastrointestinal, mama o próstata que son los que se asocian a concentraciones elevadas de GH o IGF-I séricos. En relación con la recurrencia o progresión de tumores previos, de los 2.590 pacientes de esta categoría estudiados en el tercer informe del KIMS, 90 presentaron recurrencia o progresión, siendo los tipos más frecuentes: cordoma 33 por ciento, adenoma hipofisario no-secretor 30,4 por ciento, meningioma 14,8 por ciento, craneofaringioma 13,4 por ciento. En conclusión, el análisis a corto-medio plazo de los pacientes adultos tratados con rhGH revela un buen perfil de seguridad de esta sustancia, ya que la frecuencia de trastornos metabólicos, eventos vasculares e incidencia de tumores es similar a la observada en la población general (AU)

A single growth hormone (GH) determination is sufficient for the diagnosis of GH-deficiency in adult patients using the growth hormone releasing hormone plus growth hormone releasing peptide-6 test.

BACKGROUND: The diagnosis of GH deficiency in adults is based on the provocative testing of GH secretion. When testing a patient with suspected GH deficiency, clinicians assess the whole secretory curve and select the GH peak as an index of secretory capability. This procedure is time consuming and the determination of GH in several samples is necessary. The combined administration of growth hormone releasing hormone (GHRH) plus growth hormone releasing peptide-6 (GHRP-6) is an effective test of GH secretion, and it has been unambiguously demonstrated that the elicited GH peak is capable of segregating normal GH secretion subjects from GH deficient patients on an individual basis. The GHRH + GHRP-6 test biochemically classifies patients into three groups; those with a stimulated GH peak >/= 20 micro g/l are considered normal and those with peaks at

Intrasellar tuberculoma--a difficult diagnosis.

Tuberculosis is an exceptional cause of intrasellar mass lesion and diagnosis is usually established after histological examination following surgery. We report a 32-year-old woman with headache and amenorrhea, analytical features of hypopituitarism and an intrasellar mass lesion in radiological studies. A transsphenoidal approach was performed and tissue examination revealed pituitary tuberculoma. Additionally, we review the previously reported cases.

Monitoring of treatment success in patients with acromegaly: the value of serum insulin-like growth factor binding protein-3 and serum leptin measurements in comparison to plasma insulin-like growth factor I determination.

The aim of the present study was to determine the value of serum insulin-like growth factor binding protein-3 (IGFBP-3) and serum leptin measurements in comparison with plasma insulin-like growth factor I (IGF-I) measurements as indicators of treatment success in patients with acromegaly. Thirty-five acromegaly patients, 25 female and 10 male, divided into groups of patients with postadenomectomy "active" acromegaly (n = 20) and patients with postadenomectomy "controlled" acromegaly (n = 15), and 44 healthy volunteers sex- and age-matched with the acromegaly patients were included in the present study. We comparatively analyzed plasma IGF-I, serum IGFBP-3, and serum leptin levels in the aforementioned groups. Because serum leptin has sex dimorphism, the groups were divided into sexes when leptin was evaluated. As expected, the patients with active acromegaly had significantly higher mean values of plasma IGF-I and serum IGFBP-3 and lower mean values of serum leptin (only in women) than the control group. However, individual evaluation showed that 1 of 20, 9 of 20, and many patients with postadenomectomy active acromegaly patients had values that overlapped values of control subjects for plasma standard deviation score (SDS)-IGF-I, serum SDS-IGFBP-3, and sex-adjusted serum leptin, respectively. Application of the receiver operating characteristic (ROC) curves method shows that plasma IGF-I measurement has the best discriminatory power to differentiate patients with postsurgical active acromegaly from healthy people. Its area under the curve (AUC) was 0.95, with a sensitivity and specificity of 86% and 94%, respectively. Its positive and negative likelihood ratios were 14 and 0.15. Serum IGFBP-3 has certain discriminatory power, its AUC being 0.89, with a sensitivity and specificity of 83% and 77%. Its positive and negative likelihood ratios were 3.6 and 0.22. Serum leptin, both in women and in men, has a poor performance with sensitivity and specificity of 53% and 50% for women and 55% and 56% for men and positive and negative likelihood ratios of 1.06 and 0.94 for women and 1.26 and 0.8 for men. Application of the ROC curves method and the determination of positive and negative likelihood ratios in comparative evaluation of serum IGFBP-3 and serum leptin with plasma IGF-I as indicators of treatment success in acromegalic patients showed that neither serum IGFBP-3 nor serum leptin determinations have accuracy better than or similar to that of plasma IGF-I for monitoring treatment success in acromegaly patients. Serum IGFBP-3 is accurate but does not increase accuracy for age-adjusted plasma IGF-I, whereas determination of serum leptin level has no value in monitoring these patients.