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.

Anatomía patológica y correlaciones anatomoclínicas de la acromegalia / Pathology and anatomoclinical correlations of acromegaly

Aproximadamente el 95% de los casos de exceso de secreción de hormona de crecimiento es debido a la presencia de un adenoma hipofisario secretor de hormona de crecimiento. Gracias a los hallazgos histológicos y a las técnicas de inmunohistoquímica y microscopia electrónica se han identificado 8 diferentes lesiones hipofisarias relacionadas con la acromegalia. En relación con su estructura, la inmensa mayoría de los adenomas se engloba en 2 tipos celulares relacionados, los de células densamente y escasamente granuladas. Hay controversia acerca de la implicación pronóstica y del abordaje terapéutico de los pacientes con diferentes tipos de afección histológica. En diversos estudios se han intentado relacionar estos diferentes patrones --distribución de filamentos de queratina, presencian de células foliculares, mutaciones relacionadas con cambios ultraestructurales--, con la actividad clínica y la evolución tumoral, con resultados variables. A continuación exponemos una revisión de los conocimientos disponibles hasta el momento acerca de las correlaciones entre histología, clínica y respuesta terapéutica de los adenomas hipofisarios secretores de hormona de crecimiento (AU)

More than 95% of patients with acromegaly harbor a GH-secreting pituitary adenoma. The introduction of sophisticated morphologic procedures, such as hystopathology, immunocytochemistry and electron microscopy has shed light on structural characteristics of pituitary adenomas. As a result, the pituitary lesions of patients with acromegaly are now divided into eight different types. Among them, densely granulated somatotroph adenomas and sparsely granulated somatotroph adenomas are the most frecuent and represent two morphologically distinct types of GH producing adenoma. However, the correlations between clinical characteristics, treatment and prognosis of these different morphologically variants are still unclear. Several studies have correlated distinct profiles as cytoqueratin distribution, folicular cells and mutations related with ultraestructural changes, acromegaly activity and tumor progression. Data were controversial. This review deals with the morphologic features and their correlations with hystology, clinical characteristics and terapeutic response of growth hormone-producing tumors of the human pituitary (AU)

[Levothyroxine treatment of the solitary thyroid nodule]. / Tratamiento con levotiroxina del nódulo tiroideo solitario.

The aim of this study was to review all published randomized clinical trials evaluating the efficacy of suppressive therapy with levothyroxine for solitary thyroid nodules. No significant differences were observed in reducing the volume of benign solitary cold thyroid nodules between the placebo and levothyroxine groups.

Diabetes mellitus tras resección del insulinoma

No disponible

Tratamiento con levotiroxina del nódulo tiroideo solitario / Levothyroxine treatment of the solitary thyroid nodule

El propósito de esta revisión es comprobar la eficacia del tratamineto supresor con levotiroxina (LT4) en los nódulos tiroideos solitarios fríos (NTSF). Para ello se seleccionaron los cuatro únicos trabajos publicados entre 1962 y 1996 con diseño prospectivo, randomizado, controlado por placebo, con medición objetiva del tamaño nodular y tipificación por punción aspiración con aguja fina. De estos cuatro estudios, tres conseguían niveles de tirotropina (TSH) suprimida, según los autores. El volumen nodular no disminuyó tras LT4 en los 99 casos de tipo coloide incluidos en el análisis tanto cuantitativo (T de Student no pareada) (Media ñ DT: 2,72 ñ 0,86 ml antes vs 2,57 ñ 0,87 ml después) como por métodos cualitativos (disminución = 50 porciento vs disminución < 50 porciento, Chi2 = 1,18; p = ns). A pesar del resultado negativo, antes de alcanzarse conclusiones definitivas, debieran llevarse a cabo ensayos multicéntricos y que cumplan los criterios de diseño antes referidos (AU)