Estudio de receptor anómalo suprarrenal en sujetos con síndrome de Cushing ACTH-independiente e hiperplasia nodular suprarrenal / Study of abnormal adrenal receptors in subjects with ACTH-independent Cushing's syndrome and nodular adrenal hyperplasia

INTRODUCCIÓN: El síndrome de Cushing ACTH-independiente (SCAI) supone el 15-20% de los casos de síndrome de Cushing, de los cuales <1% son debidos a receptor anómalo. Nuestro objetivo es estudiar la presencia de receptor anómalo en los sujetos diagnosticados de SCAI con hiperplasia nodular suprarrenal en un período de 14 años (2002-2016), así como sus características clínico-biológicas y evolutivas. MATERIAL Y MÉTODOS: Estudio descriptivo multicéntrico de una serie de 15 casos de SCAI con hiperplasia nodular suprarrenal (período de estudio: 2002-2016). En ellos se hizo el despistaje de receptor anómalo, mediante pruebas de estimulación, considerando patológico un aumento de cortisol plasmático ≥ del 25% respecto al valor basal. RESULTADOS: De los 15 casos, 13 fueron mujeres, con una edad media al diagnóstico de 56,8 años. En 12 de los 15 casos estudiados se detectó positividad de las pruebas de estimulación. De ellos, fueron positivos para comida de prueba el 25%, para test postural de deambulación el 58,3%, para desmopresina el 33,3%, para terlipresina el 25%, para GnRH el 33,3%, para LH el 25% y para metoclopramida el 50%. En cuanto al tratamiento, se llevó a cabo suprarrenalectomía bilateral en el 16,7% y unilateral en el 41,7%. El resto continúan en observación con revisiones periódicas (41,7%). CONCLUSIONES: En la mayor parte de los casos estudiados con SCAI e hiperplasia nodular suprarrenal (80%) se detecta una respuesta de cortisol anormal debida a la presencia de receptor anómalo. La prueba con mayor porcentaje de positividad fue el test postural de deambulación (58,3%)

INTRODUCTION: ACTH-independent Cushing's Syndrome (AICS) accounts for 15-20% of cases of Cushing's syndrome, with < 1% due to abnormal receptors. Our aim is to study the presence of abnormal receptors in subjects diagnosed with AICS with nodular adrenal hyperplasia in a 14-year period (2002-2016), as well as its clinical-biological and evolutive characteristics. MATERIAL AND METHODS: A multicentre descriptive study of a 15-case series of AICS with nodular adrenal hyperplasia (study period: 2002-2016). In these cases, abnormal receptor screening was performed by means of stimulation tests, with a plasma cortisol increase of ≥ 25% from baseline being considered pathologic. RESULTS: Of the 15 cases, 13 were female, with a mean age at diagnosis of 56.8 years. In 12 of the 15 cases studied, positivity was detected with stimulation tests, and, of them, 25% were positive for the meal test, 58.3% for posture walking test, 33.3% for desmopressin; 25% for terlipressin; 33.3% for GnRH; 25% for LH and 50% for metoclopramide. Regarding treatment, bilateral adrenalectomy was performed in 16.7% and unilateral adrenalectomy in 41.7%. The rest continue under observation with periodic follow-up (41.7%). CONCLUSIONS: In most of the cases studied with AICS and nodular adrenal hyperplasia (80%), an abnormal cortisol response is detected due to the presence of abnormal receptors. The test with the highest percentage of positivity was the postural walking test (58.3%)

Study of abnormal adrenal receptors in subjects with ACTH-independent Cushing's syndrome and nodular adrenal hyperplasia. / Estudio de receptor anómalo suprarrenal en sujetos con síndrome de Cushing ACTH-independiente e hiperplasia nodular suprarrenal.

INTRODUCTION: ACTH-independent Cushing's Syndrome (AICS) accounts for 15-20% of cases of Cushing's syndrome, with <1% due to abnormal receptors. Our aim is to study the presence of abnormal receptors in subjects diagnosed with AICS with nodular adrenal hyperplasia in a 14-year period (2002-2016), as well as its clinical-biological and evolutive characteristics. MATERIAL AND METHODS: A multicentre descriptive study of a 15-case series of AICS with nodular adrenal hyperplasia (study period: 2002-2016). In these cases, abnormal receptor screening was performed by means of stimulation tests, with a plasma cortisol increase of ≥ 25% from baseline being considered pathologic. RESULTS: Of the 15 cases, 13 were female, with a mean age at diagnosis of 56.8 years. In 12 of the 15 cases studied, positivity was detected with stimulation tests, and, of them, 25% were positive for the meal test, 58.3% for posture walking test, 33.3% for desmopressin; 25% for terlipressin; 33.3% for GnRH; 25% for LH and 50% for metoclopramide. Regarding treatment, bilateral adrenalectomy was performed in 16.7% and unilateral adrenalectomy in 41.7%. The rest continue under observation with periodic follow-up (41.7%). CONCLUSIONS: In most of the cases studied with AICS and nodular adrenal hyperplasia (80%), an abnormal cortisol response is detected due to the presence of abnormal receptors. The test with the highest percentage of positivity was the postural walking test (58.3%).

Pancreatitis aguda en una paciente tratada con liraglutida / Acute pancreatitis in a patient treated with liraglutide

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Efecto metabólico del ejercicio físico regular en la población sana / Metabolic effects of regular phisical exercice in healthy population

Objetivo Estudiar el efecto del ejercicio físico aeróbico practicado de forma regular y habitual, no acompañado de cambios en el peso corporal, sobre la resistencia a la insulina y las alteraciones metabólicas acompañantes en la población general. Sujetos y métodos Estudio observacional y transversal en la población adulta, 101 sujetos (30-70 años), sin enfermedad conocida y sin cambios en su peso corporal en los 3 últimos meses. El grupo de ejercicio regular realizaba ejercicio moderado entre 30-60minutos/día 5días/semana (7,5-15h MET/semana) y el grupo control no realizaba ejercicio físico de forma habitual y tenía un estilo de vida sedentario. Los sujetos estaban equiparados en edad y sexo. Se estudiaron parámetros lipídicos, HOMA y síndrome metabólico (SM).Resultados El grupo de ejercicio regular eran 48 sujetos (21 hombres/27 mujeres) y 53 (31 hombres/22 mujeres) el grupo sedentario. No hubo diferencias significativas entre ambos grupos en edad, sexo, IMC, perímetro de cintura y presión arterial. Encontramos diferencias estadísticamente significativas en: TG, cHDL, c-No-HDL y apoB, no así en el CT y cLDL. También hubo diferencias significativas en la insulina plasmática basal (12,1±4,13 y 14,9±4,8mU/l; p = 0,004) y en el índice HOMA (2,8±1,1 y 3,5±4,1; p = 0,001) en el grupo que realizaba ejercicio frente al grupo sedentario. Los sujetos con SM fueron un 20,7% y un 45,8% (p=0,01) en el grupo con ejercicio y sedentario, respectivamente. Conclusión La realización de una vida activa con el ejercicio físico habitual y moderado conduce a un aumento de la sensibilidad a la insulina, un mejor perfil lipídico y una disminución de los componentes del SM sin modificar necesariamente el peso corporal (AU)

Aim To assess the effect of moderate regular aerobic physical activity not associated to body weight changes on insulin resistance and the associated metabolic changes in general population. Sujects and methods A cross-sectional, observational study in an adult population (n=101 sujects aged 30-70 years) with no personal history of disease and with stable weight in the three months prior to the study. The group with regular exercise performed 30-60minutes of moderate regular physical exercise 5 days per week (7.5-15hours MET per week), while a control group performed no regular physical excersice and had a sedentary lifestyle. Subjects were age- and sex-matched. Lipids, lipoproteins, and HOMA index were measured using standard methods. Results The group with regular physical activity consisted of 48 subjects (21 male/27 female), while the group with no regular physical activity included 53 subjects (31 male/22 female). No significant differences were found between the groups in age, sex, BMI, waist circunference, and blood presure. Significant differences were found between the groups in fasting serum triglyceride, HDL-C, and apoB levels. Fasting plasma insulin levels (12.1±4.13 vs 14.9±4.8mU/L, P= .004) and HOMA index (2.8±1.1 vs 3.5±4.1, P= .001) were significantly lower in the group with regular physical activity as compared to the sedentary group. Prevalence rates of metabolic syndrome were 20.7% and 45.8% (P=.01) in the regular physical activity and sedentary groups respectively. Conclusion Moderate regular physical activity is associated to higher insulin sensitivity, an improved lipid profile, and a decrease in components of metabolic syndrome with no change in weight or BMI (AU)

Metabolic effects of regular physical exercise in healthy population.

AIM: To assess the effect of moderate regular aerobic physical activity not associated to body weight changes on insulin resistance and the associated metabolic changes in general population. SUBJECTS AND METHODS: A cross-sectional, observational study in an adult population (n=101 subjects aged 30-70 years) with no personal history of disease and with stable weight in the three months prior to the study. The group with regular exercise performed 30-60 minutes of moderate regular physical exercise 5 days per week (7.5-15 hours MET per week), while a control group performed no regular physical exercise and had a sedentary lifestyle. Subjects were age- and sex-matched. Lipids, lipoproteins, and HOMA index were measured using standard methods. RESULTS: The group with regular physical activity consisted of 48 subjects (21 male/27 female), while the group with no regular physical activity included 53 subjects (31 male/22 female). No significant differences were found between the groups in age, sex, BMI, waist circumference, and blood pressure. Significant differences were found between the groups in fasting serum triglyceride, HDL-C, and apoB levels. Fasting plasma insulin levels (12.1 ± 4.13 vs 14.9 ± 4.8 mU/L, P= .004) and HOMA index (2.8 ± 1.1 vs 3.5 ± 4.1, P= .001) were significantly lower in the group with regular physical activity as compared to the sedentary group. Prevalence rates of metabolic syndrome were 20.7% and 45.8% (P=.01) in the regular physical activity and sedentary groups respectively. CONCLUSION: Moderate regular physical activity is associated to higher insulin sensitivity, an improved lipid profile, and a decrease in components of metabolic syndrome with no change in weight or BMI.

Supresión del eje hipotálamo-hipofisario-suprarrenal por la exposición crónica a glucocorticoides de uso tópico. Presentación de dos casos clínicos / Suppression of the hypothalamic-pituitary-adrenal axis due to chronic topical corticoid therapy. Report of two cases

No disponiblePresentamos 2 casos clínicos con psoriasis extensa en los que el mal uso prolongado de corticoides tópicos indujo la supresión del eje hipotálamo-hipofisario-suprarrenal y, como consecuencia, una insuficiencia suprarrenal secundaria. Se comentan los mecanismos y los factores que pueden dar lugar a dicha supresión

We present 2 patients with adrenal insufficiency due to incorrect prolonged use of topical corticoid therapy for psoriasis. The prolonged topical corticoid therapy suppressed the hypothalamic-pituitary-adrenal axis. We discuss the mechanisms and risk factors that may lead to hypothalamic-pituitary-adrenal suppression

Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism.

OBJECTIVE: To identify a reliable yet simple indirect method for detection of insulin resistance (IR). RESEARCH DESIGN AND METHODS: A total of 65 subjects (44 men and 21 women aged 30-60 years) were selected by a simple random sampling method. Inclusion criteria were voluntary participation from staff and hospital personnel, absence of abnormal glucose tolerance, and normal results of lipid profile and basic blood chemistry. A blood sample was taken after a 12-h overnight fast to determine plasma lipid, glucose, and insulin levels. An intravenous glucose tolerance test with administration of insulin after 20 min and extraction of multiple blood samples for glucose and insulin measurements and calculation of the minimal model approximation of the metabolism of glucose (MMAMG) S(i) value were performed. Three indirect indexes used to predict insulin sensitivity or IR were calculated, and metabolic syndrome was diagnosed using the Adult Treatment Panel III (ATP III) criteria. All results were correlated with those of the MMAMG. RESULTS: The 75th percentile value as the cutoff point to define IR corresponded with a fasting plasma glucose level of 12 mU/l, a homeostasis model assessment of 2.6, a 25th percentile for S(i) value of 21, and QUICKI (quantitative insulin sensitivity check index) and McAuley indexes of 0.33 and 5.8, respectively. The S(i) index correlated (P < 0.001) with all the indirect indexes and parameters of the metabolic syndrome. CONCLUSIONS: When compared with the S(i) index, the most sensitive and specific indirect method was the score proposed by McAuley et al. (specificity 0.91, sensitivity 0.75, 9.2 probability ratio of a positive test), followed by the existence of metabolic syndrome (specificity 0.91, sensitivity 0.66, 7.8 probability ratio of a positive test).

Abdominal obesity, insulin resistance, and metabolic syndrome in a southern European population.

BACKGROUND: Our objective was to investigate the relationship between abdominal obesity (AO), as measured by waist circumference (WC), insulin resistance (IR), and components of the metabolic syndrome (MS). METHODS: A cross-sectional study was carried out with 283 subjects (130 males and 153 females aged 25-65 years) from a primary care outpatient clinic in Valencia (Spain) over a period of 1 year. Body mass index (BMI), waist circumference (WC), blood pressure (BP), total cholesterol, triglycerides, HDL-C, glucose, and insulin were measured by standard methods. IR was defined as HOMA-IR equal to or greater than 3.8. RESULTS: The prevalence of IR was 39.6%. Subjects were divided into groups according to WC. A 'normal' WC was defined as below 88 cm in women and below 102 cm in men; 'AO' was defined as a WC equal to or above 88 cm in women and equal to or above 102 cm in men. The prevalence of IR was 31.7% in the group with normal WC and 54.6% in the AO group (P<0.001). The percentage of subjects with the MS (high BP, dyslipemia or abnormal glucose tolerance) significantly increased (P<0.001) in subjects with AO (48.4 vs. 18.8% in normal WC subjects). AO is an indicator of IR with an odds ratio of 2.59 (95% CI 1.55-4.29). CONCLUSIONS: AO, expressed as WC, appears to be a good indicator of risk for IR and the MS, particularly in non-obese subjects (BMI<30). The main independent parameters of risk for IR are WC and TG, whereas those for the MS are IR, WC, and age.