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1.
J Clin Endocrinol Metab ; 103(10): 3919-3924, 2018 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-30060172

RESUMEN

Context: The term micromegaly has been used to describe a subset of patients who have elevated IGF-1 levels but apparently normal basal GH (bGH) concentrations and often a glucose-suppressed GH of <1 ng/mL. Objective: To evaluate the prevalence, clinical spectrum, and therapeutic outcome of acromegaly with normal bGH at diagnosis. Design and Methods: Retrospective analysis of a cohort of patients with acromegaly diagnosed and treated at a tertiary care center. Results: A cohort of 528 patients with acromegaly was stratified according to bGH at diagnosis: group 1, <2 ng/mL, n = 16; group 2, 2 to 9.9 ng/mL, n = 202; group 3, 10 to 99 ng/mL, n = 294; and group 4, ≥100 ng/mL, n = 16. Patients in group 1 (normal bGH) constituted 3% of the total cohort and were significantly older and more likely to be male than patients in the other groups. The frequency of acromegalic symptoms, signs, and comorbidities was similar between the four patient groups. Patients in group 1 more often harbored microadenomas (75%) and had significantly lower median IGF-1 and postglucose GH levels. Surgical success rates were similar between patients from groups 1 (53.8%), 2 (54.1%), and 3 (36.9%), whereas only 13.3% of patients in group 4 achieved remission. Conclusion: Normal bGH acromegaly is uncommon in real life. These patients have some distinctive features that argue against this being simply acromegaly in its early stages.


Asunto(s)
Acromegalia/sangre , Hormona de Crecimiento Humana/sangre , Acromegalia/epidemiología , Acromegalia/etiología , Acromegalia/cirugía , Adenoma/complicaciones , Adenoma/cirugía , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/cirugía , Prevalencia , Estudios Retrospectivos , Factores Sexuales , España/epidemiología , Resultado del Tratamiento
2.
J Clin Endocrinol Metab ; 103(6): 2369-2375, 2018 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-29618021

RESUMEN

Context: Diabetes and hypertension are frequent comorbidities of acromegaly. Objective: To analyze the course of diabetes and hypertension at diagnosis and after multimodal therapy in a large cohort of patients with acromegaly. Design and Setting: Retrospective study at a tertiary care center. Patients and Methods: A total of 522 patients with acromegaly treated according to a preestablished protocol. Main Outcome Measures: Prevalence of diabetes and hypertension and its relationship with biochemical indices of acromegalic control. Results: The cohort was stratified according to disease activity upon last visit to clinic: (1) surgical remission (n = 122), (2) pharmacologically controlled (n = 92), (3) active disease (n = 148), (4) insulinlike growth factor (IGF)-1 discordance (n = 64), and (5) growth hormone (GH) discordance (n = 96). The prevalence of diabetes and hypertension at diagnosis was 30% and 37%, respectively, and did not change upon the last visit (30.6% and 38%). Both comorbidities were more prevalent at diagnosis and on the last visit than in the general population. Diabetes was less prevalent on the last visit in patients who achieved surgical remission than in those who persisted with active disease (25% vs 40%, P = 0.01). Upon multivariate analysis, diabetes was associated with an IGF-1 at diagnosis >2× upper limit of normal, with the persistence of active acromegaly, the presence of hypertension upon the last visit, with the presence of a macroadenoma, and with female sex. Conclusion: Our findings underscore the importance of an integral approach when managing these patients, focusing not only on the control of GH and IGF-1 levels but also on the timely diagnosis and the specific treatment of each comorbidity.


Asunto(s)
Acromegalia/terapia , Diabetes Mellitus Tipo 2/epidemiología , Hipertensión/epidemiología , Acromegalia/epidemiología , Adulto , Comorbilidad , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Resultado del Tratamiento
3.
Endocrine ; 53(2): 402-11, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27033541

RESUMEN

Although aryl hydrocarbon receptor-interacting protein (AIP) mutations are rare in sporadic acromegaly, their prevalence among young patients is nonnegligible. The objectives of this study were to evaluate the frequency of AIP mutations in a cohort of Mexican patients with acromegaly with disease onset before the age of 30 and to search for molecular abnormalities in the AIP gene in teeth obtained from the "Tampico Giant". Peripheral blood DNA from 71 patients with acromegaly (51 females) with disease onset <30 years was analysed (median age of disease onset of 23 years) and correlated with clinical, biochemical and imaging characteristics. Sequencing was also carried out in DNA extracted from teeth of the Tampico Giant. Five patients (7 %) harboured heterozygous, germline mutations of the AIP gene. In two of them (a 9-year-old girl with gigantism and a young man with symptoms of GH excess since age 14) the c.910C>T (p.Arg304Ter), well-known truncating mutation was identified; in one of these two cases and her identical twin sister, the mutation proved to be a de novo event, since neither of their parents were found to be carriers. In the remaining three patients, new mutations were identified: a frameshift mutation (c.976_977insC, p.Gly326AfsTer), an in-frame deletion (c.872_877del, p.Val291_Leu292del) and a nonsense mutation (c.868A > T, p.Lys290Ter), which are predicted to be pathogenic based on in silico analysis. Patients with AIP mutations tended to have an earlier onset of acromegaly and harboured larger and more invasive tumours. A previously described genetic variant of unknown significance (c.869C > T, p.Ala299Val) was identified in DNA from the Tampico Giant. The prevalence of AIP mutations in young Mexican patients with acromegaly is similar to that of European cohorts. Our results support the need for genetic evaluation of patients with early onset acromegaly.


Asunto(s)
Acromegalia/genética , Gigantismo/genética , Péptidos y Proteínas de Señalización Intracelular/genética , Adenoma/genética , Adolescente , Adulto , Femenino , Frecuencia de los Genes , Adenoma Hipofisario Secretor de Hormona del Crecimiento/genética , Humanos , Masculino , México , Mutación , Adulto Joven
4.
J Diabetes Res ; 2015: 972073, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26273680

RESUMEN

OBJECTIVE: To compare the serum concentration of IL-6, IL-10, TNF, IL-8, resistin, and adiponectin in type 1 diabetic patients with and without metabolic syndrome and to determine the cut-off point of the estimated glucose disposal rate that accurately differentiated these groups. DESIGN: We conducted a cross-sectional evaluation of all patients in our type 1 diabetes clinic from January 2012 to January 2013. Patients were considered to have metabolic syndrome when they fulfilled the joint statement criteria and were evaluated for clinical, biochemical, and immunological features. METHODS: We determined serum IL-6, IL-8, IL-10, and TNF with flow cytometry and adiponectin and resistin concentrations with enzyme linked immunosorbent assay in patients with and without metabolic syndrome. We also compared estimated glucose disposal rate between groups. RESULTS: We tested 140 patients. Forty-four percent fulfilled the metabolic syndrome criteria (n = 61), 54% had central obesity, 30% had hypertriglyceridemia, 29% had hypoalphalipoproteinemia, and 19% had hypertension. We observed that resistin concentrations were higher in patients with MS. CONCLUSION: . We found a high prevalence of MS in Mexican patients with T1D. The increased level of resistin may be related to the increased fat mass and could be involved in the development of insulin resistance.


Asunto(s)
Citocinas/sangre , Diabetes Mellitus Tipo 1/sangre , Inflamación/sangre , Síndrome Metabólico/sangre , Adiponectina/sangre , Adulto , Antropometría , Estudios Transversales , Diabetes Mellitus Tipo 1/etnología , Diabetes Mellitus Tipo 1/metabolismo , Ensayo de Inmunoadsorción Enzimática , Femenino , Citometría de Flujo , Glucosa/metabolismo , Humanos , Resistencia a la Insulina , Masculino , Síndrome Metabólico/etnología , Síndrome Metabólico/metabolismo , México , Prevalencia , Resistina/sangre , Factores de Riesgo , Adulto Joven
5.
BMC Endocr Disord ; 15: 16, 2015 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-25886602

RESUMEN

BACKGROUND: Primary hyperparathyroidism (PHPT) and metabolic syndrome (MS) have been independently related to cardiovascular morbidities, however this association is still controversial. Mexican population has a high prevalence of metabolic syndrome, however its frequency seems to be even higher than expected in patients with PHPT. METHODS: We retrospectively reviewed the charts of patients that underwent parathyroidectomy for PHPT in a referral center and used the criteria from the National Cholesterol Educational Program (NCEP)/Adult Treatment Panel III (ATP III) to define MS before surgery. We compared the characteristics between the patients with and without MS. RESULTS: 60 patients were analyzed, 77% were female and 72% had a single parathyroid adenoma. MS was present in 59% of the patients, this group was significantly older (57 vs. 48 years, p = 0.01) and they had lower iPTH (115 vs. 161 ng/ml, p = 0.017). Other parameters did not show differences. CONCLUSIONS: MS is frequent in our population diagnosed with primary hyperparathyroidism, adverse cardiovascular parameters are common and significant differences in calcium metabolism compared to the non-MS group are present.


Asunto(s)
Hiperparatiroidismo Primario/epidemiología , Síndrome Metabólico/epidemiología , Adenoma/complicaciones , Adenoma/epidemiología , Adulto , Anciano , Estudios Transversales , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Hiperparatiroidismo Primario/complicaciones , Masculino , Síndrome Metabólico/complicaciones , México/epidemiología , Persona de Mediana Edad , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/epidemiología , Prevalencia , Estudios Retrospectivos
6.
Int J Endocrinol ; 2015: 756069, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25737722

RESUMEN

Background. Nonfunctioning pituitary adenomas (NFPAs) are the most common benign lesions of the pituitary gland. Objective. To describe our experience with the management of NFPA. Study Design and Methods. Retrospective evaluation of NFPA patients managed between 2008 and 2013. We analyzed data regarding clinical presentation, imaging diagnosis, hormonal status, surgical, radiotherapeutic, and pharmacological treatment, and outcome. Results. 485 patients (54% men, mean age 53 ± 14 years) were followed for a median of 6.5 years. Visual field abnormalities and headaches were the presenting complaints in 87% and 66%, respectively. The diagnosis of NFPA was made incidentally in 6.2%, and 8% presented with clinical evidence of apoplexy. All patients harbored macroadenomas, with a median volume of 10306 mm(3); 57.9% had supra- or parasellar invasion and 19.6% had tumors larger than 4 cm. Central hypothyroidism, hypogonadism, and hypocortisolism were present in 47.2%, 35.9%, and 27.4%, respectively. Surgical resection was performed at least once in 85.7%. Tumor persistence was documented in 27% and was related to the size and invasiveness of the lesion. In selected cases, radiotherapy proved to be effective in controlling or preventing tumor growth. Conclusions. The diagnosis and treatment of NFPA are complex and require a multidisciplinary approach.

7.
Pituitary ; 18(3): 290-6, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24781039

RESUMEN

OBJECTIVE: To report our day-to day experience with the long-term use of octreotide LAR in the treatment of acromegaly. PATIENTS AND METHODS: Patients with acromegaly managed between 2003 and 2012 with octreotide LAR for a median of 27 months (interquartile ranges 12-60) and who had not received radiation therapy or concomitant treatment with cabergoline were retrospectively evaluated. Both primarily treated patients (n = 33) and patients who received octreotide after failed pituitary surgery (adjunctive treatment, n = 124) were included. Full biochemical response was defined as the achievement of a GH <2.5 ng/mL and an IGF-1 <1.2 times the upper limit of normal (× ULN); we also evaluated efficacy using a GH cut off of <1 ng/mL. RESULTS: Over 60% of the patients achieved a GH of <2.5 ng/mL. The combined GH (<2.5 ng/mL) and IGF-1 (<1.2 × ULN) target was achieved by 35.5 and 33.6% of the patients treated primarily and adjunctively, respectively; these figures dropped to 22.6 and 23% when using a GH target of <1 ng/mL. All patients reported a significant improvement in acromegalic symptoms. Lower pretreatment GH and IGF-1 levels were both associated with a higher probability of achieving the composite biochemical target. CONCLUSION: Currently recommended GH and IGF-1 targets are reached by <36% of patients treated with octreotide LAR in a day-to day practice context. Nevertheless, in most instances a clinical benefit and an improvement in biochemical markers can be clearly documented.


Asunto(s)
Acromegalia/tratamiento farmacológico , Octreótido/uso terapéutico , Centros de Atención Terciaria , Acromegalia/sangre , Acromegalia/diagnóstico , Adulto , Algoritmos , Biomarcadores/sangre , Vías Clínicas , Femenino , Hormona de Crecimiento Humana/sangre , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
8.
J Clin Endocrinol Metab ; 99(12): 4438-46, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25210882

RESUMEN

CONTEXT: Acromegaly is usually due to the excessive secretion of GH by a pituitary adenoma. It is frequently accompanied by comorbidities that compromise quality of life and results in elevated mortality rates. OBJECTIVE: To evaluate mortality and morbidity in patients with acromegaly receiving multimodal care. SETTING: Tertiary care center. DESIGN, PATIENTS, AND METHODS: Retrospective evaluation of 442 patients (65.4% women; mean age, 43.5 ± 13.1 y) followed for a median of 6 years (interquartile range [IQR], 3-10). RESULTS: Twenty-two patients died during the study period (4.9%), representing a total standardized mortality ratio (SMR) of 0.72 (95% confidence interval [CI], 0.41-1.03). Standardized mortality ratios were 1.5 and 0.44 for patients whose last GH was above and below 2.5 ng/mL, respectively; 1.17 and 0.16 for those whose last GH was above and below 1 ng/mL, respectively; and 0.94 and 0.46 for those whose last IGF-1 was above and below 1.2 times the upper limit of normal (ULN), respectively. The prevalence of diabetes mellitus, hypertension, heart disease, and cancer was 30%, 35%, 8%, and 4.7%, respectively. The most common cause of death was cancer. On multivariate analysis, diabetes, heart disease, and cancer were related to a baseline GH > 10 ng/mL; the presence of cancer and the last IGF-1 were significant predictors of mortality. Survival decreased as the latest GH levels increased from < 1 ng/mL to > 5 ng/mL and as IGF-1 increased from < 1.2 to > 2 times the ULN. CONCLUSIONS: Mortality in acromegaly can be successfully reduced, provided patients are treated using a multimodal approach with careful management of comorbidities.


Asunto(s)
Acromegalia/terapia , Acromegalia/complicaciones , Acromegalia/mortalidad , Adolescente , Adulto , Anciano , Estudios de Cohortes , Terapia Combinada , Comorbilidad , Femenino , Hormona de Crecimiento Humana/sangre , Humanos , Factor I del Crecimiento Similar a la Insulina/análisis , Masculino , México/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Adulto Joven
9.
Endocrinol Nutr ; 61(10): 523-30, 2014 Dec.
Artículo en Inglés, Español | MEDLINE | ID: mdl-25008035

RESUMEN

OBJECTIVE: To evaluate expression of somatostatin receptor subtypes 2 and 5 (SSTR 2 and 5) by RT/PCR and immunohistochemistry (IHC) in GH-secreting adenomas, seeking correlations with response to octreotide. METHODS: SSTR2 and 5 expression was tested by IHC (n=37), RT/PCR (n=36) or both (n=13) in GH-secreting adenomas from 60 patients with acromegaly who had undergone pituitary surgery; 36 had been treated preoperatively with octreotide LAR for 3-6 months, and were categorized as responders (achievement of GH <2.5ng/mL and a normal age-adjusted IGF-1), partial responders (GH and IGF-1 reduction >50% and >30%, respectively) or non-responders. IHC was performed on a tissue microarray using specific antibodies directed to the carboxyl terminus of SSTR2 and 5. RESULTS: SSTR5 was the predominantly expressed receptor subtype by both IHC and RT/PCR in all tumors tested, regardless of whether they came from octreotide-naïve, octreotide-responsive, or octreotide-resistant patients. Immunostaining was concentrated in the cytoplasm. Neither SSTR2 nor SSTR5 expression correlated with baseline or post-octreotide GH or IGF-1 levels or tumor volume by either method. The agreement rate between RT/PCR and IHC was 77% in all 13 adenomas in which both methods were used. CONCLUSION: Expression of these receptors does not guarantee an adequate response to somatostatin analogs; other functional aspects of this interaction, such as receptor homo- and heterodimerization, and the resulting signaling cascade, probably play a role in determining whether a patient will respond or not to these agents.


Asunto(s)
Adenoma/química , Adenoma Hipofisario Secretor de Hormona del Crecimiento/química , Hormona de Crecimiento Humana/metabolismo , Proteínas de Neoplasias/biosíntesis , Octreótido/uso terapéutico , Receptores de Somatostatina/biosíntesis , Acromegalia/etiología , Adenoma/complicaciones , Adenoma/tratamiento farmacológico , Adenoma/cirugía , Antineoplásicos Hormonales/uso terapéutico , Terapia Combinada , Resistencia a Antineoplásicos , Regulación Neoplásica de la Expresión Génica , Adenoma Hipofisario Secretor de Hormona del Crecimiento/complicaciones , Adenoma Hipofisario Secretor de Hormona del Crecimiento/tratamiento farmacológico , Adenoma Hipofisario Secretor de Hormona del Crecimiento/cirugía , Hormona de Crecimiento Humana/análisis , Humanos , Hipofisectomía , Factor I del Crecimiento Similar a la Insulina/análisis , Proteínas de Neoplasias/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Receptores de Somatostatina/genética , Análisis de Matrices Tisulares
10.
Endocr Pract ; 19(1): 59-63, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23186963

RESUMEN

OBJECTIVE: To evaluate different elements of the calciotropic system in a group of house staff physicians, comparing them with age, gender, and body mass index (BMI) matched controls. METHODS: We measured vitamin D, calcium, phosphorus, parathyroid hormone (PTH), glucose, insulin (estimating the insulin resistance index by the homeostatic model [HOMA]), and lipid levels in 20 medical residents and 20 age-, gender-, and BMI-matched controls. We looked for correlations between elements of the calciotropic system and metabolic indices. RESULTS: Medical residents and controls were similar in regard to gender distribution, weight, height, BMI, abdominal circumference, as well as systolic and diastolic blood pressure. No differences were found between the two groups in regard to low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, plasma insulin levels, and HOMA-IR. Vitamin D and calcium levels were significantly lower among the medical residents (P = .001 and P = .003, respectively), whereas PTH concentrations tended to be higher. We found an inverse correlation between triglyceride concentrations and vitamin D (r = -0.31, P = .04). CONCLUSION: Vitamin D deficiency among resident physicians is frequent and could have metabolic effects. Our findings highlight the consequences of the lack of sun exposure due to occupational reasons. We recommend a higher intake of vitamin D during this period.


Asunto(s)
Calcio/sangre , Hormona Paratiroidea/sangre , Fósforo/sangre , Deficiencia de Vitamina D/diagnóstico , Vitamina D/sangre , Adulto , Glucemia/metabolismo , Índice de Masa Corporal , Femenino , Humanos , Insulina/sangre , Resistencia a la Insulina/fisiología , Lípidos/sangre , Masculino , Médicos , Deficiencia de Vitamina D/sangre
11.
Eur J Endocrinol ; 166(1): 21-6, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21993154

RESUMEN

BACKGROUND: Somatostatin analogs (SA) have been used for over 25 years in the treatment of acromegaly. A major disadvantage is the need to continue therapy indefinitely. OBJECTIVE: To evaluate the feasibility of discontinuing therapy in well-controlled patients with acromegaly treated chronically with SA. DESIGN AND METHODS: Of the 205 subjects on octreotide LAR, we selected those who met the following criteria: two or more years of treatment, a stable dose and injection interval of 20  mg every 8 weeks or longer for the previous year, no history of radiation, no cabergoline for the previous 6 months, a GH <1.5  ng/ml, and an IGF1 <1.2×upper limit of normal (ULN). Octreotide LAR was stopped and both GH and IGF1 were measured monthly for 4 months; a glucose-suppressed GH value and magnetic resonance imaging were obtained at the 4th month, thereafter, basal GH and IGF1 were measured q. 3 months, for 12-18 months. Patients were removed from the study if GH or IGF1 rose to 1.5  ng/ml or 1.2×ULN respectively. RESULTS: Twelve patients (ten women, mean age 48±13 years) were studied. Seven patients (58.3%) relapsed biochemically within 1 year of having stopped the SA; two patients relapsed by GH and IGF1 criteria, the remaining five patients kept GH levels within target. Five patients (41.7%) remain in remission after 12 months of follow-up. Non-recurring patients were on longer injection intervals but no other characteristic was associated with a successful withdrawal. CONCLUSION: Withdrawal of SA is possible in a small but distinct subset of patients, particularly in those who are very well controlled on relatively low doses administered at long intervals.


Asunto(s)
Acromegalia/tratamiento farmacológico , Octreótido/administración & dosificación , Octreótido/uso terapéutico , Acromegalia/metabolismo , Adulto , Anciano , Esquema de Medicación , Femenino , Estudios de Seguimiento , Hormona de Crecimiento Humana/metabolismo , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Persona de Mediana Edad
12.
Gac Med Mex ; 147(1): 12-6, 2011.
Artículo en Español | MEDLINE | ID: mdl-21412391

RESUMEN

BACKGROUND: Persistence of papillary thyroid carcinoma is usually associated with elevated stimulated thyroglobulin levels. AIM OF THE STUDY: To evaluate the association between moderately elevated stimulated thyroglobulin levels and the persistence of papillary thyroid carcinoma one year after thyroidectomy and radioiodine ablation. METHODS: Out of a cohort of 97 patients with papillary thyroid carcinoma, we selected those with available stimulated thyroglobulin level measurements (in the absence of thyroglobulin antibodies) after one year of initial treatment with surgery and radioiodine. The subjects were stratified according to whether the stimulated thyroglobulin level was between 1-10 ng/ml or above 10 ng/ml. RESULTS: Twenty-seven patients were included in the study, 11 with a stimulated thyroglobulin level between 1-10 ng/ml, and 16 with values greater than 10 ng/ml. Median age and gender proportion was similar between both groups. As expected, median stimulated thyroglobulin levels were significantly greater in the second group (5.1 vs. 42 ng/ml; p < 0.001). A stratified analysis aiming at associating stimulated thyroglobulin levels with disease persistence yielded an overall risk of 0.58 (95% CI: 0.1-3.09; p = 0.52) for those subjects with levels between 1-10 ng/ml, while for those with levels > 10 ng/ml the overall risk was 1.71 (95% CI: 0.32-9.1; p = 0.52). The positive predictive value for a stimulated thyroglobulin level between 1-10 ng/ml was 64%. CONCLUSION: A moderately elevated stimulated thyroglobulin level is an uncertain predictor of papillary thyroid carcinoma persistence.


Asunto(s)
Tiroglobulina/sangre , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma , Carcinoma Papilar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/terapia , Insuficiencia del Tratamiento , Adulto Joven
13.
Arch Med Res ; 42(1): 48-52, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21376263

RESUMEN

BACKGROUND AND AIMS: Transsphenoidal surgery remains the treatment of choice in acromegaly, yet 40-50% of patients require secondary forms of therapy such as radiation therapy (RT) and somatostatin analogues (SA). We undertook this study to evaluate the efficacy and safety of RT in acromegaly. METHODS: Forty patients with acromegaly treated with RT (mean dose, 52 Gy) after failed pituitary surgery between 1993 and 2007 were analyzed; all were clinically and biochemically active. Patients were evaluated with yearly hormonal measurements [basal and glucose-suppressed growth hormone (GH), IGF-1, thyroid-stimulating hormone (TSH), free T4, cortisol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone or estradiol and prolactin (PRL)] and with magnetic resonance imaging every 2 years. RESULTS: Mean age of patients was 52.9 ± 12.1 years and 85% were female. All subjects had been followed for 1 year, 75% for 3 years, 70% for 5 years and 35% for 10 years. The median basal GH level fell from a baseline of 8.8 ng/mL to 2.27 ng/mL at 5 years (p = 0.001) and to 1.88 ng/mL at 10 years (p = 0.001). A GH <1 ng/mL was achieved by 46% and 57% of the patients at 5 and 10 years of follow-up, respectively. The proportion of patients achieving a normal IGF-1 was 36% at 5 years and 43% at 10 years. Before RT, hypothyroidism, hypocortisolism and hypogonadism were present in 44%, 26% and 74% of patients, respectively. After 5 years of follow-up (n = 28), these figures increased to 51%, 41% and 79% and over a third of the group had panhypopituitarism. One patient developed optic neuritis and another patient was diagnosed with a meningioma 10 years after RT. No cerebrovascular events or deaths occurred. CONCLUSIONS: RT is an effective, low-cost and reasonably safe means of controlling acromegalic activity, particularly useful in parts of the world where SA are not readily available.


Asunto(s)
Acromegalia/radioterapia , Hipófisis/efectos de la radiación , Resultado del Tratamiento , Acromegalia/sangre , Acromegalia/tratamiento farmacológico , Acromegalia/cirugía , Adulto , Anciano , Femenino , Hormona de Crecimiento Humana/sangre , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Persona de Mediana Edad , Hipófisis/efectos de los fármacos , Hipófisis/cirugía , Hormonas Hipofisarias/sangre , Hormonas Hipofisarias/deficiencia , Somatostatina/análogos & derivados , Somatostatina/farmacología , Somatostatina/uso terapéutico
14.
Pituitary ; 14(3): 231-5, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21161601

RESUMEN

To determine the prevalence of diabetes, glucose intolerance and impaired fasting glucose in Mexican patients with acromegaly and establish associations with clinical, anthropometric and biochemical variables. 257 patients with acromegaly were evaluated by a 75 g-oral glucose tolerance test with measurements of both GH and glucose (0, 30, 60, 90 120 min) as well as baseline IGF-1. Normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes (DM) were defined based on the 2003 ADA criteria. NGT, IFG, IGT and DM were found in 27.6, 8.9, 31.6 and 31.9% of the subjects, respectively; 42 of the DM patients were unaware of the diagnosis. Patients with diabetes were older than subjects in the other 3 categories (P = 0.001), and the proportion of women was significantly higher in the DM (74%) and IGT (68%) groups than in the NGT group (52%) (P = 0.004). Odds ratio for the development of DM was 3.29 (95% CI 3.28-3.3). GH and IGF-1 levels were comparable among the different groups. In a multivariable analysis DM was significantly associated with age, presence of a macroadenoma, disease duration and a basal GH > 30 µg/dl. DM and probably IGT are more prevalent in acromegaly than in the general Mexican population. DM was more frequent in females of all ages, in subjects with severely elevated GH concentrations, in patients with macroadenomas, and long-standing disease duration. The odds ratio for DM in our subjects with acromegaly is more than 3 times higher than in the general population.


Asunto(s)
Acromegalia/epidemiología , Diabetes Mellitus/epidemiología , Intolerancia a la Glucosa/epidemiología , Acromegalia/sangre , Adulto , Glucemia/metabolismo , Diabetes Mellitus/sangre , Femenino , Glucosa/metabolismo , Intolerancia a la Glucosa/sangre , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad
15.
Rev Med Inst Mex Seguro Soc ; 46(6): 651-8, 2008.
Artículo en Español | MEDLINE | ID: mdl-19263670

RESUMEN

BACKGROUND: Treatment of acromegaly with somastostatin analogues, albeit highly effective, is not curative and its elevated cost represents a major disadvantage. Hereby we describe our Center's experience using a fixed, 20 mg q.4 weeks- dose of octreotide LAR. METHODS: 97 patients, 69 females, 71 with macroadenomas, treated with 20-mg im injections of octreotide LAR every 4 weeks, in 23 as primary therapy. No dose escalation was allowed. Patients were evaluated with GH and IGF-1 levels at 4 weeks after the third injection; thereafter, assessments occurred at 3 to 6 months intervals. In 27 unselected patients, evaluations were also performed 6 weeks after the SA injection. RESULTS: A GH concentration < 2.5 ng/mL was reached by 71%, 75% and 83% of patients at the 3rd , 6th and 12th months of follow up respectively, whereas over 30% achieved an IGF-1 index < or = 1.0 at each of these time points, and both biochemical goals were achieved by 30%, 33% and 32% of patients at the same time points. Biochemical success was the same for those patients treated primarily and those treated secondarily and prior radiation made no difference. A baseline GH level > 10 ng/mL was associated with a poor response. CONCLUSIONS: A biochemical control rate comparable with other published series it is feasible to reach with the treatment with a fixed dose of 20 mg.


Asunto(s)
Acromegalia/tratamiento farmacológico , Octreótido/uso terapéutico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
16.
Ginecol Obstet Mex ; 75(8): 459-64, 2007 Aug.
Artículo en Español | MEDLINE | ID: mdl-18293675

RESUMEN

BACKGROUND: Macroprolactinemia is defined as hyperprolactinemia with predominance of the big-big prolactine isoform. Its frequency has not been clearly established due to technical difficulties to identify it. This method used to detect it is gel filtration chromatography, an expensive and complicated procedure that could not be used routinely. OBJECTIVE: To validate the PEG precipitation technique, to identify the presence of macroprolactinemia and to correlate it with the clinical characteristics in a group of pre-selected patients with elevated serum PRL levels from different causes. PATIENTS AND METHOD: There were studied 14 patients non pre-selected with high PRL serum levels. Prolactine levels were determined with commercial immunometric quimioluminescence essays. All the essays were duplicated, and healthy patients serum (without hyperprolactinemia) were used. Technique consists on mixing 250 microL of serum with the same volume of polyethylene glycol. Later it was centrifugated at 3000 rpm during 30 minutes at 4 degrees C. Prolactine level was measured in supernatant. RESULTS: Within patients 7 to 14 macroprolactinemia was ruled out and confirmed truth hyperprolactinemia, some times slight and nontumoral, some times mild, and some times due to prolactin-producer hypophysial macroadenomas. CONCLUSIONS: Polyethylene glycol precipitation technique is reliable to detect macroprolactinemia.


Asunto(s)
Hiperprolactinemia/sangre , Prolactina/sangre , Técnicas de Química Analítica/métodos , Humanos , Peso Molecular , Proyectos Piloto , Polietilenglicoles
17.
Rev. méd. Panamá ; 11(3): 164-70, sept. 1986. ilus
Artículo en Español | LILACS | ID: lil-37899

RESUMEN

Se informa un caso de aneurisma ventricular de etiología chagásica, que sufría de arritmia refractaria al tratamiento farmacológico. Por esa razón se le practicó la resección del aneurisma. Desde entonces efectúa sus actividades en forma normal y no ha presentado nuevamente la arritmia que tenía


Asunto(s)
Persona de Mediana Edad , Humanos , Masculino , Arritmias Cardíacas/terapia , Cardiomiopatía Chagásica/fisiopatología , Aneurisma Cardíaco/cirugía , Aneurisma Cardíaco/etiología
18.
Rev. méd. Caja Seguro Soc ; 17(2): 103-11, mayo 1985. ilus, tab
Artículo en Español | LILACS | ID: lil-32496

RESUMEN

Se hace una revisión del Síndrome de Wolff-Parkinson-White haciendo énfasis en el mecanismo de producción; mecanismo de la taquiarritmia, nuevas técnicas de diagnóstico y de Clínicas de pacientes atendidos en nuestros Centros Hospitalarios que presentan el Síndrome


Asunto(s)
Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Síndrome de Wolff-Parkinson-White
19.
Rev. méd. Panamá ; 10(1): 32-40, ene. 1985. tab
Artículo en Español | LILACS | ID: lil-31597

RESUMEN

Se estudia la incidencia de endocarditis infecciosa observada de 1974 a 1984 en el Hospital Santo Tomás. La mayoría de los casos fueron del sexo masculino, entre 20 y 30 años de edad. Los síntomas más frecuentemente mencionados fueron las fiebre, la sensación de escalofrío con cada ascenso febril y el malestar general. Las manifestaciones físicas más frecuentemente encontradas fueron el soplo cardíaco y la fiebre. Se menciona que el 33% de los casos tenían historia de cardiopatía reumática. El microorganismo aislado con más frecuencia fue el Staphylococcus aureus. Se estableció que la puerta de entrada de la infección fue una herida en la piel o la instrumentación vesical, cardiovascular u odontológica. En las infecciones debidas a S. aureus o a Histoplasma capsulatum se prescribió un sólo antibiótico; en las infecciones debidas a otro agente bacteriano se usaron dos antibióticos, siempre por vía intravenosa. Se estudió la evolución de la enfermedad, las complicaciones observadas y se explica la razón de la baja mortalidad, de 16.6%


Asunto(s)
Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Endocarditis Bacteriana/microbiología , Staphylococcus , Streptococcus , Histoplasma
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