Acromegalia: casuística y alternativas de tratamiento / Acromegaly casuistics and alternative treatments

Introducción: La acromegalia se caracteriza por elevación de los niveles de hormona de crecimiento (GH) y factor de crecimiento tipo 1 similar a la insulina (IGF-1). Su tratamiento puede ser quirúrgico, médico o por radiación hipofisaria para el control de los síntomas. Objetivo: Dar a conocer la importancia de la enfermedad, hacer diagnóstico oportuno, evitar complicaciones y exhortar al envío al especialista. Material y métodos: Expedientes de pacientes con acromegalia no tratados, operados, irradiados o en tratamiento médico con octreotida de acción prolongada (OCT LAR) entre 1990 y 2010. Categorías: curación: supresión de GH > 1.0 ng/ml a los 3-12 meses luego de la cirugía; controlados: mínimo 6 meses de tratamiento, niveles seguros de GH (media) < 2.5 ng/ml; en ambos niveles de IGF-1 normales para edad y sexo; activos, quienes no cumplan estos criterios o estén recién diagnosticados. Resultados: Se analizaron 109 expedientes (se descartaron tres por defunción); 7.2 pacientes por año; 80 fueron tratados quirúrgicamente (73%); 60 activos (75%); edad promedio: 47.5 años (rango 18-76); se detectaron 37 microadenomas y 69 macroadenomas; 65 mujeres, 41 varones, relación de 1.5:1; comorbilidades: prediabetes, diabetes tipo 2 e hipertensión arterial; tasa de cura bioquímica: 25%; tasa de control con OCT LAR: 27%. Conclusiones: El tratamiento de elección continúa siendo quirúrgico; los componentes del síndrome metabólico aumentan el riesgo cardiovascular. La curación se incrementó del 7% al 20% y el control un 27%

Acromegalia: casuística y alternativas de tratamiento / Acromegaly casuistics and alternative treatments

Introducción: La acromegalia se caracteriza por elevación de los niveles de hormona de crecimiento (GH) y factor de crecimiento tipo 1 similar a la insulina (IGF-1). Su tratamiento puede ser quirúrgico, médico o por radiación hipofisaria para el control de los síntomas. Objetivo: Dar a conocer la importancia de la enfermedad, hacer diagnóstico oportuno, evitar complicaciones y exhortar al envío al especialista. Material y métodos: Expedientes de pacientes con acromegalia no tratados, operados, irradiados o en tratamiento médico con octreotida de acción prolongada (OCT LAR) entre 1990 y 2010. Categorías: curación: supresión de GH > 1.0 ng/ml a los 3-12 meses luego de la cirugía; controlados: mínimo 6 meses de tratamiento, niveles seguros de GH (media) < 2.5 ng/ml; en ambos niveles de IGF-1 normales para edad y sexo; activos, quienes no cumplan estos criterios o estén recién diagnosticados. Resultados: Se analizaron 109 expedientes (se descartaron tres por defunción); 7.2 pacientes por año; 80 fueron tratados quirúrgicamente (73%); 60 activos (75%); edad promedio: 47.5 años (rango 18-76); se detectaron 37 microadenomas y 69 macroadenomas; 65 mujeres, 41 varones, relación de 1.5:1; comorbilidades: prediabetes, diabetes tipo 2 e hipertensión arterial; tasa de cura bioquímica: 25%; tasa de control con OCT LAR: 27%. Conclusiones: El tratamiento de elección continúa siendo quirúrgico; los componentes del síndrome metabólico aumentan el riesgo cardiovascular. La curación se incrementó del 7% al 20% y el control un 27%(AU)

[Acromegaly treatment with octreotide LAR in 42 cases]. / Tratamiento de acromegalia con octreotida LAR en 42 casos.

OBJECTIVE: To evaluate the efficacy of octreotide (OCT) LAR in patients with acromegaly. METHODS: Observational, retrospective, transversal and descriptive study was done. Forty two patients with acromegaly (recently diagnosed and who have undergone surgery but not cured) followed up for 24 weeks were studied. There were 14 males (30 %) and 28 females (70 %) with an average age of 44 (range: 18-67 years). Dose adjustments of 10, 20 and 30 mg were made. RESULTS: OCT LAR was administered in 24 patients who had been operated without cure and in 18 newly diagnosed patients. At 24 weeks of treatment in those patients not operated, GHm decreased 56 % and IGF-1 decreased 30 %. In patients who were operated but not cured, GHm decreased 49 % and IGF-1 decreased 53 %. For microadenomas, GHm decreased 57.6 % and IGF-1 60 %. For macroadenomas, decrease was 50 % and 37 %, respectively. The efficacy of OCT LAR on microadenomas, success was achieved (total and partial) in 65 % of patients and in 28 % of patients with macroadenomas. CONCLUSIONS: Patients with microadenomas and with lesser hypersomatotropinemia have a better response to treatment.

[Acromegaly. Report of 84 cases]. / Acromegalia. Informe de 84 casos.

BACKGROUND: acromegaly is a rare disease, it is characterized by elevation of the levels of growth hormone and Insulin-like growth factor 1 (IGF-1). The definitive treatment of this disease is surgical. OBJECTIVE: to know the importance of this clinical disease and to exhort to the medical community for opportune delivery to specialist, to prove diagnosis and to treat with opportunity in order to avoid complications. METHODS: the clinical files of the patients received at Endocrinology Service from 1995 to 2005 were reviewed. The data of serum growth hormone levels after a 75 g oral glucose tolerance test, tumor size, criteria for cure, co-morbidities, affectation of hormonal axes and visual field defects of operated patients and not operated patients, were collected. RESULTS: 84 patients were studied, 35 men and 49 women, with an average of 42 years of aged agreement to the Classification of Hardy Vezina, was greater number of cases in degree 2 (macro adenoma with local expansion of the chair). 35 patients with microadenomas: and 25 with macroadenomas were operated. The most frequent co-morbidities were the alteration in the metabolism of carbohydrates and hypertension, and a frequent hormonal affectation was hypothyroidism; the rate of biochemical cure was 7 %. Discordant results with levels of growth hormone high and normal levels of IGF-1 were in 10 %. CONCLUSIONS: the present study confirms that the acromegaly is diagnosed late and it had been associated with co-morbidities and bigger tumor size, that they have influence on the surgical treatment results, since the rate of success were low (7 %).

[Usefulness of GH and IGF-1 to establish the dose and frequency of application of octreotide to treat acromegaly]. / IGF-1 y hormona de crecimiento. Marcadores para la aplicación de octreótida en acromegalia.

OBJECTIVE: to determine the dose and frequency of application of octreotide LAR to treat acromegaly by monitoring the levels of circulating growth hormone (GH) and insulin-like growth factor (IGF-1). MATERIAL AND METHODS: twelve patients (five men and seven women) with acromegaly, whose age was on average 48.9 years (range 35-67) participated. Eight had been surgically treated, yet non cured and 4 patients were treated de novo. The study lasted between 12-18 months. The initial octreotide dose was 20 mg/4 weeks intramuscular. Before administering the fourth dose, the levels of IGF-1 and GH were measured; then, the dose was adjusted and three more injections were applied. If the levels of GH and IGF-1 continued safe, the dose and frequency of application of octreotide LAR were individualized thus applying the minimum number of injections. RESULTS: the interval of octreotide LAR application to maintain the levels of GH and IGF-1 within safe range was prolonged to more than four weeks in nine patients (75%); in six patients (50%), the interval changed to eight weeks and to twelve weeks in three patients (25%). Three patients (25%) continued receiving injections in four-week intervals. The levels of GH and IGF-1 were lower during the treatment period when compared with the baseline measurements (p < 0.01). CONCLUSION: the adjustment of the dose of octreotide LAR keeps the levels of GH within safe range and reduces in 75% the frequency of injections to treat acromegaly.

[Follicular carcinoma of the thyroid and diffuse toxic goiter. Case report]. / Cancer folicular de tiroides y bocio tóxico difuso. Reporte de un caso.

BACKGROUND: Follicular thyroid cancer rarely manifests itself as a distant metastatic lesion. We report a case of a male with follicular thyroid cancer that presented as a distant metastatic lesion and diffuse toxic goiter. CASE REPORT: A 50-year-old man was evaluated because of a soft, painless, pulsating sternal mass of 6 x 6 cm. An incisional biopsy of the soft tissue showed metastatic thyroid follicular neoplasm. History and general examination revealed a weight loss of 10 kg, palpebral retraction and thyrotoxicosis, serum concentration of free thyroxine was elevated and TSH undetectable. A thyroid scan revealed uptake of (131)I in all thyroid areas of 36%. Clinical improvement was observed after methimazole (30 mg/day). Total thyroidectomy was performed: right lobe (5 x 4 x 2 cm), left lobe (4 x 3 x 1 cm), without nodules or lymphadenopathy. During the postoperative period, serum thyroglobulin level was 350 ng/ml, radioiodine treatment (100 mCi) was given, and there was a 75% reduction in the sternal mass. CT of the thorax showed bone destruction in the sternum and soft tissue. Clinical and radiological examination revealed no other metastases. Three months later, thyroid scan was negative and thyroglobulin was 17 ng/ml. CONCLUSIONS: We report this case of follicular thyroid cancer because of its uncommon initial sternal presentation and soft tissue metastasis with diffuse toxic goiter.

Radiologia en los feocromocitomas del organo de Zuckerkandl: informe de dos casos / Radiology in pheochromocytoma of the Zuckerkandl organ: report of 2 cases

La incidencia de feocromocitomas se estima en 0.5% de la población hipertensa, 90% de origen suprarrenal, 10% extraadrenal y 10% de comportamiento maligno. de 1983 a la fecha se han identificado en el Hospital de Especialidades No. 25 IMSS de Monterrey, N.L., 10 feocromocitomas, de los cuales 6 han sido unilaterales, 2 bilaterales y 2 extraadrenales, uno de estos últimos de presentación en postparto. Describimos las características clínicas y los hallazgos por arteriografia y tomografia axial computada (TAC) en los 2 pacientes con feocromocitomas extraadrenales retroperitoneales. Ambos casos demuestran la utilidad del TAC en la ubicación de feocromocitomas previamente identificados por clínica y laboratorio. Se describe la utilidad de la arteriografia al identificar el componente vascular preciso en estas lesiones